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ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis

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

ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis

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

ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis

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

ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperripldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis

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 a is Sign NYM