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Cosign Note - Intake Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider: MED CL:1 NO CCC APPT. Discontinued Laboratory Requests: Detail% Frequency Lab Tests-H-Hemoglobin Al C One Time Lab Tests-C-C8C w/diff Lab Tests-L-Lipld Profile Lab Tests-C-Comprehensive Me
tions, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental con Dion, and release the Buroau of Prisons and Its employees from any and all liability for respecting and following my . . .t::.:.o .•: , • II gilt • I NYM-NEW YORK MCC EFTA00050840 BP.A061
Cosign Note - Intake Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider. MED CL:1 NO CCC APPT. Discontinued Laboratory Requests: Details Frequency Lab Tests-H-Hemoglobin AlC One Time Lab Tests-C-CBC w/diff Lab Tests-L-Lipld Profile Lab Tests-C-Comprehensive Met
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
Cosign Note - Intake Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider. MED CL:1 NO CCC APPT. Discontinued Laboratory Requests: Details Frequency Lab Tests-H-Hemoglobin AlC One Time Lab Tests-C-CBC w/diff Lab Tests-L-Lipld Profile Lab Tests-C-Comprehensive Met
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
n Note - Intake Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider. =MM. MED CL:1 NO CCC APPT. Discontinued Laboratory Requests: Details Frequency Lab Tests-H-Hemoglobin AlC One Time Lab Testsi-CBC w/diff Lab Tests-L-Lipld Profile Lab Tests,Comprehensive Metabo
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
Cosign Note - Intake Cosign encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider. MED CL:1 NO CCC APPT. Discontinued Laboratory Requests: Details Frequency Due Date Lab Tests-H-Hemoglobin A1C One Time 08/05/2019 00:00 R• no Lab Tests-C-CBC w/diff Lab Tests-L-Llpld Pro
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
Entities connected to both Discontinued Laboratory and the Buroau of Prisons and Its

Jeffrey Epstein
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PERSONVascepa
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ORGANIZATIONCERIDEMIA X
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PERSONHYPERT
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