Epstein Secrets

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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

nic Care Clinics-Diabetic-Hemoglobin A1C Lab Tests-H-HIV 1/2 Lab Tests-R-RPR Chronic Care Clinics-Diabetic-Comerehensive Metabolic Profile (CMP) New Radiology Request Orders: Details Frequency End aatft Due Pate General Radiology-Chest-2 Views One Time 07/25/2019 Specific reason(s) for request (Comp

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

nic Care Clinics-Diabetic-Hemoglobin A1C Lab Tests-H-HIV 1/2 Lab Tests-R-RPR Chronic Care Clinics-Diabetic-Comerehensive Metabolic Profile (CMP) New Radiology Request Orders: Details Frequency End aatft Due Pate General Radiology-Chest-2 Views One Time 07/25/2019 Specific reason(s) for request (Comp

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

onic Care Clinics-Diabetic-Hemoglobin Ai Lab Tests-H-HIV 1/2 Lab Tests-R-RPR Chronic Care Clinics-Diabetic-Comprehensive Metabolic Profile (CMP) New Radiology Request Orders: Details Frequency End aan Due Pate General Radiology-Chest-2 Views One Time 07/25/2019 Specific reason(s) for request (Compla

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

nic Care Clinics-Diabetic-Hemoglobin A1C Lab Tests-H-HIV 1/2 Lab Tests-R-RPR Chronic Care Clinics-Diabetic-Comprehensive Metabolic Profile (CMP) New Radiology Request Orders: Details Frequency End aak Due Pate Edo* General Radiology-Chest-2 Views One Time 07/25/2019 Ftouline Specific reason(s) for

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