g /!: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/10/2019 16:58 Provider. Lab Result Receive Facility: NYM CosIgnod bye MD on 07/14/2019 18:12. &IMAM of Prisons • NYM EFTA00132659 BP-S358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP CS U.S. DEPARTMENT OF JUSTIC

g /!: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/10/2019 16:58 Provider. Lab Result Receive Facility: NYM CosIgnod bye MD on 07/14/2019 18:12. &IMAM of Prisons • NYM EFTA00059496 BP-S358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP C6 U.S. DEPARTMENT OF JUSTIC

g /!: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/10/2019 16:58 Provider. Lab Result Receive Facility: NYM CosIgnod by on 07/14/2019 18:12. Bureau of Prisons • NYM EFTA00105055 BP-S358.060 MEDICAL TREATMENT REFUSAL CDFRM SEP CS U.S. DEPARTMENT OF JUSTICE