J6)-4,t_CA.-4.44t-t-- Dr)-5' Date: -7- z6 -/ 9 Signature Block/Stamp: C. Ancrum DDS. Chief Dental Officer MCC New York PDF Prescnxe by P6400 Replargs 11P-A0618 of JUN 10 EFTA00049632 BP-5350.060 SEP 05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-24-2019 Da