3
Shared Docs
3
Same-Page
3 / 3
Mentions
ility for respecting and following my expressed wishes and directions. 7-10-2019 Date Patie grtature Date NYM-NEW YORK MCC EFTA00050864 NYM--NEW YORK MCC 6P-5358.C60 MEDICAL TREATMENT REFUSAL C0E RM SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF FRISONS 7-24.2019 Date I, JEFFREY EPSTEIN
ensiv Metabolic Profile (CMP) Lab Tests-U-Urinalysis w/Reflex to Microscopic New Radiology Request Orders: Details Frequency Due Date angrily General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH COMPLAITN OF RIGH
Pap Travel: Direct Travel: No Travel Restrictions: None UNIVERSAL PRECAUTIONS OBSERVED WHEN TRANSPORTING ANY INMATE: Transfer From Institution: NEW YORK MCC Phone Number. 6468366300 Address 1: 150 PARK ROW Address 2: City/State/Zip: NEW YORK, New York 10007 Namerfltle of Person Completing Form:
x 7 day(s) Pill Line Only prescriber Order Take the tablet by mouth as directed x 6 day(s) Due Date Priority. Frequency, Due Date Priority. General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH COMPLAITN OF RIGH
Pap Travel: Direct Travel: No Travel Restrictions: None UNIVERSAL PRECAUTIONS OBSERVED WHEN TRANSPORTING ANY INMATE: Transfer From Institution: NEW YORK MCC Phone Number. 6468366300 Address 1: 150 PARK ROW Address 2: City/State/Zip: NEW YORK, New York 10007 Namerfitle of Person Completing Form:
x 7 day(s) Pill Line Only prescriber Order Take the tablet by mouth as directed x 6 day(s) Due Date Priority. Frequency, Due Date Priority. General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH COMPLAITN OF RIGH
Entities connected to both NEW YORK MCC and General Radiology-Spine

Jeffrey Epstein
PERSON
Metropolitan Correctional Center
ORGANIZATIONFederal Bureau of Prisons
ORGANIZATION
Ghislaine Maxwell
PERSONSpecial Housing Unit
ORGANIZATION
George W. Bush
PERSONHealth Services
ORGANIZATIONVascepa
ORGANIZATIONISNCE
ORGANIZATIONTOPROL
ORGANIZATIONPill Line
PERSON
Springfield
LOCATIONSmallpox Series Administration: History
ORGANIZATIONOrthopedic/Rheumatology
ORGANIZATIONRobert MD
PERSON
Achilles
PERSONRDW-CV
ORGANIZATIONVaricella Series Administration: History Unknown
ORGANIZATIONVesicular Breath Sounds Bilaterally
PERSONLow LI
PERSON