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/09/2019 12:35 Provider: Joaquin, Y. MLP Reg 76318.054 Facility: NYM Unit: H01 Reflexes: Right L2ft Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
tions, listed above, and still refuse recommended treatment I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. BEAUDOUIN, ROBERT MD 7-24-2019 Coun
rs /re NYM-NEW YORK MCC 1 EFTA00049727 BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS ;04 2 1 2 3 4 5 6 7 6 0 10 11 1213 t4 15 18; E-2 32 31 30 20 28 27 2625 2423 22 21 20 10 18 ccifil 4f1"111. Occlusion: OralHygiene: Goo
TEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: Encounter Date: 07/09/2019 12:35 Provider: Reflexes: Biceps: Patellar: Brachioradlalis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
isted above, and stlll refuse i. recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and ( release the Bureau of Prisons and Its employees from any and all liability for respecting and following my expressed wishes and directions. ,b){6); (b)(7}(C) 7-24-2019 Counsel
TEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: Encounter Date: 07/09/2019 12:35 Provider: Reflexes: Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
s, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and { release the Bureau of Prisons and Its employees from any and all liability for respecting and following my expressed wishes and directions . . b)(6); (b)(7)(C) r )(6); (b)(7)(C
Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/09/2019 12:35 Reflexes: Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
ns, listed above1 and still_ refuse recommended treatment. I" hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and 'an llablllty for respecting and following my expressed wishes and directions. I · b)(6); (b)(7XC) /'] I -----
3 Sex: M Race: WHITE Facility: Encounter Date: 07/09/2019 12:35 Provider. Unit: Reflexes: flight ken Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
tions, listed above, and still refuse recommended treatment l hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expresso• • -rectlons. Counseled by 7-24-2019 Date Siffiature of W
Sex: M Race: WHITE Facility: Encounter Date: 07/09/2019 12:35 Provider. Unit: 1 Reflexes: Bight knit Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
tions, listed above, and still refuse recommended treatment l hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions. 7-24-2019 Counseled by Date is Sig
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