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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
rs Well, Alert and Oriented x 3 Skin General Yes: Within Normal Limits, Dry, Skin Intact Provider Head General Yes: Symmetry of Motor Function, Atraumatic/Norrnocephalic No: Facial Asymmetry, Battle's Sign, Raccoon Eyes, Deformity Eyes General Yes: PERRLA, Extraocular Movements Intact Face General Yes: Symmetri
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
d Oriented x 3 Skin General Yes: Within Normal Limits, Dry, Skin Intact Rhythm Provider Provider Head General Yes: Symmetry of Motor Function, Atraumatic/Norrnocephalic No: Facial Asymmetry, Battle's Sign, Raccoon Eyes, Deformity Eyes Genoral Yes: PERRLA, Extraocular Movements Intact Face General Yes: Symmetri
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
rs Well, Alert and Oriented x 3 Skin General Yes: Within Normal Limits, Dry, Skin Intact Provider Head General Yes: Symmetry of Motor Function, Atraumatic/Norrnocephalic No: Facial Asymmetry, Battle's Sign, Raccoon Eyes, Deformity Eyes General Yes: PERRLA, Extraocular Movements Intact Face General Yes: Symmetri
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
rs Well, Alert and Oriented x 3 Skin General Yes: Within Normal Limits, Dry, Skin Intact Provider Head General Yes: Symmetry of Motor Function, Atraumatic/Norrnocephalic No: Facial Asymmetry, Battle's Sign, Raccoon Eyes, Deformity Eyes General Yes: Extraocular Movements Intact RN Face General Yes: Symmetric
Entities connected to both the Buroau of Prisons and Its and Atraumatic/Norrnocephalic
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