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h: No Decayed teeth: No Loose teeth: No Wear dentures: No None: No Comments: Generated 07128/2019 07:59 by DDS Eturuau of Prison, • NYM Pan 2 of 3 EFTA00059489 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Facility: NYM Encount
ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. MD 7-24-2019 Counseled by Date Signature
h: No Decayed teeth: No Loose teeth: No Wear dentures: No None: No Comments: Generated 07128/2019 07:59 by DDS Eturuau of Prison, • NYM Pan 2 of 3 EFTA00132652 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Facility: NYM Encount
ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO 'Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. 7-24-2019 Counseled by Dale e a is Sign
No Decayed teeth: No Loose teeth: No Wear dentures: No None: No Comments: Gertousad 07262019 07.59 by NM EIMM Eturuau of Prison, • NYM Pan 2 of 3 EFTA00105048 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Facility: NYM Encount
ations, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental CO Won, and release the Buroau of Prisons and Its employees from any and all liability for respecting and f• owing my expressed wishes and directions. 7-24-2019 Counseled by Date a** si .nature
Entities connected to both Pan 2 and the Buroau of Prisons and Its

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