IPage 2668 BP-A0618 JUN 16 U.S. DEPARTMENT OF JUSTICE A&O DENTAL EXAMINATION (Initial Clinical Dental Findings) FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair CPITN: 2- 3 s 2- Head & Neck/ Soft Tissue: 2 3 • s e 1 e o 10 11 12 13 1.c 1s 1e In 31 30 29 28 27 26 25 2, 23 22 21 20 19 • 18 17 ~ 1-------....--::~-.::--~--------1 rl ~ 'O Classification: Dental Prostheses at Intake: Yes Type: Age: Condition: G Intra-oral Photos Taken: Yes Q Instructed how to obtain urgent and non-urgent dental care: Treatment Priorities: None: Radiographs authorized: PAs: _____ _ BWs: _ ____ _ Panorex: ____ _ n Institution: 7 6 3 I~ OS"~ MCC NEW YORK \j\ D:. ____ ~ M:._...._1--' CLT F: /Y Pain Scale: /10. Radiographs Taken: (Document findings on A&O encounter) Yes Non-urgent: non-urgent No: Urgent: Referred to Sick Call: Prophylaxis authorized: Yes ✓ No (Approval valid 18 months from examination date) Dentist Signature: (b)(6); (b)(7)(C) Date: 7-?4-/9. l>Ds Signature Block/Stamp: (b)(6); (b)(7)(C) Icer MCC New York PDF Prescribed by P6400 Replaces BP-A0618 of JUN 10 /

Page 2669 BP-S358.060 SEP05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Date I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. I understand the possible consequences and/or complications, 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. 0)(6): (b)(7)(C) b~6): (b)(7){C) MD 7-24-2019 Date ig~ Date bl(6); (b)(7)(C) Signature of Witne s NYM- NEW YORK MCC b}(6); 1b){7)(C) L-----------------' l'/r'~ i I

Page 2670 BP-S358.060 SEP05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 Date I, JEFFREY EPSTEIN 76318-054 1 refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. The following treatment(s) was/were recommended: CHEST X-RAY Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to acce~t treatment: WORSENING THE CONDITION IF THERE IS ANY FINDINGS I understand the possible consequences and/or complications, 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 expr~ssed wishes and directions. 7-10-2019 Counseled by ~ -RAY Date Date ~[ " " _; (b)(7-)(C) ~ - ----1--1----::--~' C ' { °r Signature of Witness Date NYM-NEW YORK MCC

Page 2671 Medical Records request for Inmate Jeffrey Epstein, Reg. No. 76318-054 07/01/19 - 07/24/19 From r )(6); (b)(7)(C) To r )(6l: (b)(7)(C) Date 2019/07/24 10:38 Subject: Medical Records request for Inmate Jeffrey Epstein, Reg. No. 7 6318- 054 07/01/19 - 07/24/19 Attachments: TEXT.htm, PrintChartGetReport.faces.pdf Please see attached. Thank You!! l(b)(5>: (b)(?)(c ) I Legal Assistant CLC New York Metropolitan Correctional Center 150 Park Row New York, NY 10007 (P) 646-836 (b)(5J (b)(l )(C) (F) 646-836-7665 Page 16115

Page 2672 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/23/2019 06:20 Bureau of Prisons Health Services Clinical Encounter Sex: M Race: WHITE Provider: ib)C5>; ib)t7)tC> MLP Injury Assessment - Non-work related encounter performed at Health Services. SUBJECTIVE: INJURY 1 Provider: t0ic5>; tbK7l<C> IMLP Reg#: 76318-054 Facility: NYM Unit: H01 Date of Injury: 07/23/2019 01 :27 Date Reported for Treatment: 07/23/2019 08:25 Work Related: No Work Assignment: UNASSG Pain Location: Pain Scale: o Pain Qualities: Where Did Injury Happen (Be specific as to location): Special Housing Unit 205-Cell 124 L Cause of In·ur Inmate's Statement of how in"ur occurred : 'bX7)(A} Symptoms (as reported by inmate): None OBJECTIVE: Temperature: Time Provider ~ 07/23/2019 06:30 NYM Fahrenheit 97.5 Celsius Location 36.4 Oral l(b)(6); (b)(7)(C) I MLP Pulse: ~ Time 07/23/2019 06:30 Respirations: Rate Per Minute 92 Location Via Machine Rhythm Regular .om.e. Time Rate Per Minute Provider 07/23/2019 06:30 NYM 16 (b)(6); (b)(7)(C) MLP Blood Pressure: Date Time Value Cuff Size Provider (b)(6); (b)(7)(C) Provider 07/23/2019 06:30 NYM 140/85 Location Right Arm Position Sitting Adult-regulailbH5>; <bl(7Kc > Sa02: ~ 07/23/2019 Exam: General Affect Time Value(%) Air 06:30 NYM 96 Room Air Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 Provider f b)(G); (b)(7)(C) IM LP MLP I MLP No: Appears Distressed, Lethargic, Dyspneic, Appears in Pain, Pallor, Cyanotic, Diaphoretic, Disheveled, Generated 07/23/2019 09:05 b .b)(G); ib)(7)CCi LP Bureau of Prisons - NYM Page 1 of 2

Page 2673 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/23/2019 06:20 Exam: Acutely Ill Pulmonary Auscultation Sex: M Race: WHITE Provider: l(b)t5,; (o)(7)tC) IMLP Yes: Clear to Auscultation, Vesicular Breath Sounds Bilaterally No: Crackles, Rhonchi, Wheezing Exam Comments (b)(7)(A) ASSESSMENT: Injury, unspecified, T1490 - Current - RIO self inflicted injuries. PLAN: Disposition: Follow-up at Sick Call as Needed Placed on Suicide Watch Follow-up in 2-4 Hours Other: For follow up with psychology service. Patient Education Topics: Date Initiated Format 07/23/2019 Counseling 07/23/2019 Counseling Copay Required: No Telephone/Verbal Order: No Handoutaopic Access to Care Plan of Care Cosign Required: Yes Completed byfb)C5); <o)(7)(C> I MLP on 07/23/2019 09:05 Requested to be cosigned by l(b)C5>;<o>(7J(c> I MD. Cosign documentation will be displayed on the following page. Generated 07/23/2019 09:05 b ~ (b)(6);(b)(7)(C) IMLP Bureau of Prisons - NYM Reg#: 76318-054 Facility: NYM Unit: H01 Pr vi r (t>l(6); (b)(7)(C) Outcome Verbalizes Understanding Verbalizes Understanding Page 2 of 2

Page 2674 Bureau of Prisons Health Services Cosign/Review Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01 /20/1953 Sex: M =,....,,..,.,=---, Encounter Date: 07/23/2019 06:20 Provider: tb;(6); Cb)a icci MLP Cosigned b ~ ~(bl_i6_i: (-b)C_7>c_c> ___ ~~ MD on 07/23/201915:44. Bureau of Prisons - NYM Reg#: Race: Facility: 76318-054 WHITE NYM

Page 2675 Inmate Name: EPSTEIN, JEFFREY EDWARD Bureau of Prisons Health Services Clinical Encounter Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/14/2019 17:36 Provider: bl(51;<b)C71(C/ MD Chronic Care - 14 Day Physician Eval encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:~r- )(S-);(-b)(7- )(-C)----I MD Chief Complaint: ENDO/LIPID Subjective: 66 YR OLD WHITE MALE WITH HX OF Reg#: 76318-054 Facility: NYM Unit: Z05 HYPERTRIGLYCERIDEMIA X 5 YEARS ON VASCEPA FOR 1 YEAR. STATES TRIGL WAS 800 , NOW 431 . STATES HE COULD NOT TOLERATE OTHER ANTI-TRIGLYCERIDE MEDS DUE TO THEIR GI SIDE EFFECTS. HX OF OBSTRUCTUVE SLEEP APNEA X 5 YEARS FOR WHICH HE USED A CPAP MACHINE. STATES HE HAD HIS CPAP MACHINE WITH HIM WHEN HE ARRESTED. STATES THE FBI LOKELY HAS L4 - L5 SEVERE STENOSIS CASUING NUMBNESS AND SHOOTING PAIN IN THE LOWER EXTREMITIES. SURGICAL HX: NONE MENTAL HEALTH HX: NONE Pain: Yes Pain Assessment Date: Location: Quality of Pain: Pain Scale: Intervention: Trauma Date/Year: Injury: Mechanism: Onset: Duration: 07/12/2019 13:25 Back-Middle Shooting 5 MEDROL DOSE PACK 5+ Years 5+ Years Exacerbating Factors: NO EXERCISE Relieving Factors: MEDROL DOSE PACK Reason Not Done: Comments: Seen for clinic(s): Orthopedic/Rheumatology, Pulmonary/Respiratory, Endocrine/Lipid Added to clinic(s): Orthopedic/Rheumatology, Pulmonary/Respiratory, Endocrine/lipid OBJECTIVE: Exam: General Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No: Appears Obese Generated 07/14/2019 18:1 1 by,.,., r b)=rs)....,, : (b..,..,, )(?,,.,. )(C,..,... ) ------,~ D Bureau of Prisons - NYM Page 1 of 3

Page 2676 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/14/2019 17:36 Provider: tb:(5); ib)(7)cc > D Exam: Eyes General Yes: PERRLA, Extraocular Movements Intact Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rate and Rhythm (RRR), Normal S1 and S2 No: M/R/G Abdomen Auscultation Yes: Normo-Active Bowel Sounds Palpation Yes: Within Normal Limits Musculoskeletal Tibia / Fibula No: Edema Back Yes: Tenderness Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam ASSESSMENT: Constipation, unspecified, K5900 - Current Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Rx# Medication Omega 3 ( Vascepa) 1 GM Capsule Indication: Hyperlipidemia, unspecified New Laboratory Requests: Order Date 07/14/2019 17:36 Reg#: 76318-054 Facility: NYM Unit: Z05 Prescriber Order TAKE 2 CAPS Orally - Two Times a Day x 180 day(s) -- TAKE WITH FOOD. Details Lab Tests-H-Hemoglobin A1C Lab Tests-L-Lipid Profile Frequency One Time Due Date 10/10/2019 00 :00 Priority Routine Additional Information: Generated 07/14/2019 18:11 b ~ib)(6); lb)(7)(C) Bureau of Prisons - NYM Page 2 of 3

Page 2677 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Provider: r bi(5): (b)(7)(C) ~ D Reg#: 76318-054 Facility: NYM Encounter Date: 07/14/2019 17:36 Unit: Z05 FASTING. Lab Tests-H-Hep B surface Ab Lab Tests-H-Hep B surface Ag Lab Tests-H-Hep C Ab Lab Tests-H-Hepatic Profile Schedule: Activity Clinical Encounter One Time 08/08/2019 00:00 Date Scheduled Scheduled Provider 07/24/2019 00:00 Optometrist 66 YR OLD MALE FOR ROUTINE SCREENING. Chronic Care Visit 01/07/2020 00:00 Mid-Level Provider 6 MONTH F/U. Chronic Care Visit Other: 07/01/2020 00:00 Physician 01 PENDING EKG AND FOBT. CXR WAS REFUSED. Patient Education Topics: Date Initiated Format 07/14/2019 Counseling Copay Required: No Telephone/Verbal Order: No Handout/Topic Diagnosis Cosign Required: No Completed b~~(b_>'5_>:<-bK-7>_<c_> ---~IMD on 07/14/2019 18:1 1 Generated 07/14/2019 18:11 b ~ (b)(6l; (b)(7)(C) Bureau of Prisons - NYM Provider r )(6); (b)(7)(C) Routine Outcome Verbalizes Understanding Page 3 of 3

Page 2678 Inmate Name: EPSTEIN, JEFFREY EDWARD Bureau of Prisons Health Services Clinical Encounter Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/12/2019 13:10 Provider: (b)(S); (b)C7)(C) MD Chronic Care - 14 Day Physician Eval encounter performed at Health Services. SUBJECTIVE: COMPLAINT 1 Provider:~l(bX-5l_;<b_l(7_xc_l ___ ~IMD Chief Complaint: ENDO/LIPID Reg#: 76318-054 Facility: NYM Unit: Z05 HYPER G CERIDEMIA X 5 YEARS ON VASCEPA FOR 1 YEAR. STATES TRIGL WAS Subjective: 66 YR- HITE MALE WITH HX OF 800 , . STATES HE COULD NOT TOLERATE OTHER ANTI-TRIGLYCERIDE MED EIR GI SIDE EFFECTS. HX OF UVE SLEEP APNEA X 5 YEARS FOR WHICH HE USED A CPAP MACHINE. HAD HIS CPAP MACHINE WITH HIM WHEN HE ARRESTED. STATES TH Y HAS L4 - LS SEVERE SIS CASUING NUMBNESS AND SHOOTING PAIN IN THE LOWER EXTREM S.~ SURGICAL HX: NONE MENTAL HEALTH HX: Pain: Yes ~ Pain Assessment Date: 07/12/2019 13:25 Location: Back-Middle ~ Quality of Pain: Shooting \. ~ Pain Scale: 5 ...-~ ;:~::::~/Year: MEDROL DOSE PACK % Injury: Mechanism: Onset: 5+ Years Duration: 5+ Years Exacerbating Factors: NO EXERCISE Relieving Factors: MEDROL DOSE PACK Reason Not Done: Comments: Seen for clinic(s): Endocrine/Lipid, Pulmonary/Respiratory, Orthopedic/Rheumatology Added to clinic(s): Endocrine/lipid, Pulmonary/Respiratory, Orthopedic/Rheumatology OBJECTIVE: Exam: General Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distressed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unkempt, Acutely Ill Nutrition No: Appears Obese Generated 07/12/2019 14:20 b{~.bl-(61-; (b-)(7-)(C-) -~I MD Bureau of Prisons - NYM Page 1 of 3

Page 2679 Re: 1/M Epstein #76318-054 From To Date Subject: 2019/07/24 07:36 Re: 1/M Epstein #76318-054 Attachments: TEXT.htm yes l (b)(6); (b)(7)(C) I '-· ____ ____, Psy.D. Chief Psychologist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York, New York 10007 Office: (646) 836 b)cs,: (b)(7)(c) Fax: (646) 836-7712 E-maifb)(5>: (b;(7)cc) pbop.gov > r s); (b){?)(C) v /23/2019 10:17 PM > > > The purpose of this email is to inquire as to whether or not inmate Epstein, Jeffrey #76318-054 is mentally capable of proceeding with the disciplinary process. Thanks in advance. Page 16416

Page 2680 Excuse the crude headline ... not mine! https:llwww.vice.com/en us/a rticl e/zmjvb4/jeffrey-epstei ns-death-i s-exposi ng-the-cl usterfuck-i nsi de- trumps-pri sons > > >l(b)(B); (b)(7)(c> KOPA)" l(b)(B>; <b){7)(c> ~ usdoj.gov> 8/14/2019 4:52 PM > > > Thanks - Hugh, can you send me the story? -----Original Message----- From: rb)(B); (b){?,(C) toDAG) l(b)(B); (b)(7)(C) @jmd.usdoj.gov> Sent: Wednesday, August 14, 2019 4:51 PM To: Hugh Hurwitz fb><5> (b)(7)cci @bop.gov> b)(6); b)(7)(C) Cc: Lofthus, Lee J (JMDjtb)(B> (bX7:cc> ~ jmd.usdoj.gov>;j<b)(5>:<b>(7)<C> l(OAG) i~\~iic> OPA) tbJ(B>; (b){7)cc> ~ jmd.usdoj.gov> ~-~ Subject: Re: Staffing in media C . (b)(6); (b)(7)(C) opyIng ~-~ (b)(6); (b)(7}(C) 202 532 (b)(6): - (b)(7)(C} (b)(6); (b)(7)(C) > On Aug 14, 2019, at 4:34 PM, Hugh Hurwitz bop.gov> wrote: ~--~ > > Lee, I saw a story today claiming that BOP lost 12% of our workforce since Trump Administration started which is double the drop in the prison pop. This is highly misleading. As you know (and AG Sessions and DAG Rosenstein were also acutely aware of), over the 5 years leading into this administration our prison population had dropped 40,000 inmates, but our staffing had gone up (and pop has continued to drop another almost 9,000 since the start of the Administration)! The drop in staffing that they are referring to also likely includes the 5156 unfunded vacant positions that were eliminated ... positions we never could fill in the first place. > > We do not need more staff, we just need to fill the vacancies we have. I continue to point out to anyone that will listen (and have reiterated this in several Hill briefings), the problem is not our authorized staffing levels or funding, rather it is finding good candidates to come work for us in hard to fill areas. I have dozens of examples where we post jobs, get 30 applicants and only 10 end up actually coming on board. At that rate it will take a long time just to fill the vacancies we have. We are working on several new initiatives to try and make BOP more attractive to applicants (unfortunately news like this does not help). > > Anyway, I know you know this, but also want you to know that we are working to change this narrative, but right now we are getting drowned out by the media hysteria. Thanks. > > Hugh Page 16520