EFTA00035180.pdf

Type: pdf
Source set: data-set-8
Extracted text

BP-S358.060 
SEP 05 
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. 
Counseled by 
7-24-2019 
Date 
NYM-NEW YORK MCC 
EFTA00035180


BP-S358C80 
MEDICAL TREATMENT REFUSAL 
CDFRM 
SEP 05 
U.S. DEPARTMENT OF JUSTICE 
FEDERAL BUREAU OF PRISONS 
7-10-2019 
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: 
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 accept 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 …
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