Epstein Secrets

tville Read • Briarcliff Manor, N.Y. 10510 71.41 Cooper Avenue - Glendale, N.Y. 11305 160 Perk AVOTWO •

care in last 33 days 72 Yes No U Papitil in-pabent HeepiW ED/ outpatient U •losp COA C Other. specify: J J Nursing hone/long teem care Hospice rickey Decedent's residence DAM AND HOUR Of MAIM: 08/10/2019 7:36 AM Unk INJURY: Date Time: AM PM AT WORK J YES U NO TYPE OF PLACE:Irk

sRetying Road • Bdorcilff Manor, N.Y. 10510 7141 Cooper Avenue • Glendale, N.Y. 11385 168 Pork Avenue •

r: O Recent hospitalizations or travel: if yes, where and when: O Dentist name/address): O Tattoos or scars (e.g., old surgery), describe: 0 Any Hospice care in last 30 days? If so, where: High blood pressure Heart problems Diabetes Seizures Lung problems Tuberculosis Tobacco use Brain infecti

tvIlle Road - Briarcliff Manor, N.Y. 10510 71.41 Cooper Avenue • Glendale, MY. 11315 155 Park Avenue • Y

last 93 days Yes ijb• No u NO U. 0 Hospital In-patient Hospital ED/outpatient Hoop DOA Other specify: u U U Nursing harnMong term care Hospice facity Decedents resktence DATE AND HOUR OF DEATH: 08/10/2019 7:36 AM u Unk INJURY: Date Time: AM PM AT WORK U YES U NO TYPE OF PIACE