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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
tory Unknown MLP History Unknown • MU' History Unknown MLP History Unknown MLP History Unknown MLP Txp Date Generated 08/10/201911:02 by RN/IOP/IDC Bureau of Prisons - NYM Page 1 of 1 EFTA00059483 Bureau of Prisons Health Services Medical Duty Status Reg #: 76318-054 Inmate Name: EPS
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
tory Unknown MLP History Unknown • MU' History Unknown MLP History Unknown MLP History Unknown MLP Txp Date Generated 08/10/201911:02 by RN/IOP/IDC Bureau of Prisons - NYM Page 1 of 1 EFTA00132646 Bureau of Prisons Health Services Medical Duty Status Reg #: 76318-054 Inmate Name: EPS
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
ries Total: 5 Orig Entered: 07/09/2019 12:51 EST History Unknown History Unknown History Unknown History Unknown Generated 08/10/201911:02 by RN/IOP/IDC Bureau of Prisons -NYM sotic0000cgr 1 °I l EFTA_000001 87 EFTA00134722 Bureau of Prisons Health Services Medical Duty Status Reg #: 76318-
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