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IED — This information is confidential and must be appropriately safeguard Transfer To: Health Problems Healtbfatiem Hypertipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis
llowing my expressed wishes and directions. ESGUERRA, S. X-RAY 7-10-2019 Counseled by Date cir bicSit.:- -7- to - Signature of Witness Date Patien Sign Lure Date NYM-NEW YORK MCC EFTA00049332 BP-A0818 JUN 18 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION plait Clinigal Dental Findin
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
es from any and all liability for respecting and following my expressed wishes and directions. Counseled by Signature of Witness 7-10-2019 Date Patien Date NYM-NEW YORK MCC EFTA00105080 BP.S358.060 MEDICAL TREATMENT REFUSAL SEP 05 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF RISONS 7-24-20
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
ts employees from any and all liability for respecting and following my expressed wishes and directions. RAY 7-10-2019 r\ t Counseled by Date Patien Signature Date Signature of Witness Date NYM—NEW YORK MCC ONY_00001026 EFTA_00000235 EFTA00134770 •• ••. •••••••• •••mm. BP-A0618 A&O D
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