Text extracted via OCR from the original document. May contain errors from the scanning process.
BP-S358 .060
SEP 05
CDFRM
7-24-2019
Date
76318-054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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.
7-24-2019
Date
s Sign
Date
CONFIDENTIAL
3
1
SDNY 00009374
EFTA00139318
BP-S358.C60
SEP 05
COMM
7-10-2019
Date
76318-054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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.
7-10-2019
Date
Signature of Witness
Paten
Signature
Date
[VICTIM NAME REDACTED] 00009375
EFTA00139319
BP-S358 060
[VICTIM NAME REDACTED]
C0FRkl
SEP 05
U.S. [VICTIM NAME REDACTED]
7-24-2019
Date
76318-054 refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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
as Sign
Date
i •
I
CONFIDENTIAL
SDNY_00009376
EFTA00139320
BP-A0618
JUN 16
(Initial Clinical Dental Findings)
POF
(Approval valid 18 months from examination date)
Ptescdbod by P6400
re
en
icer
MCC New York
Replaces BP.A0618 of JUN 10
CONFIDENTIAL
SDNY_00009377
EFTA00139321
BP-A0618
JUN 16
(Initial Clinical Dental Findings)
PM:
BWs:
Panorex:
(Approval valid 18 months from examination date)
PeentName:
gi p &kin
eSirity
r
Institution: /
MCC NEW YORK
Number:
I
7‘31(C-os-I
Den'
•
Date:
PDF
Piesalbed by P6400
Signature Block/Stamp:
Replaces BP-A0616 c4JUN 10
CONFIDENTIAL
SDNY_00009378
EFTA00139322
BP-5358 060
CDFRM
SEP 05
7-24.2019
Date
76318.054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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
Dale
Pa as Sign
Date
CONFIDENTIAL
SDNY_00009379
EFTA00139323
Federal
Bureau of
Prisons
U.S. Medical Center for Federal Prisons
••• Sensitive But Unclassified •••
Name EPSTEIN, JEFFREY
Reg # 76318-054
DOB [DOB REDACTED]
Sex
M
Facility MCC New York
Order Unit E06-547U
Provider
Collected 07/09/2019 13:34
Received 07/10/2019 10:44
Reported 07/10/2019 14:46
LIS ID
188191004
HIV
FLAG LEGEND
L=Low L!=Low Critical H=High H!=High Critical A=Abnorrnal A! =Abnormal Critical
Page 3 of 3
CONFIDENTIAL
SDNY_00009380
EFTA00139324
Bureau of Prisons
Health Services
Cosign/Review
Inmate Name:
Reg #:
76318-054
Date of Birth [DOB REDACTED]
Sex:
M
Race:
WHITE
Encounter Date: 07/10/2019 16:58
Provider:
Lab Result Receive
Facility:
NYM
Cosigned byl
on 07/14/2019 18:12.
Bureau of Prisons - NYM
CONFIDENTIAL
SDNY_00009381
EFTA00139325
BP-S358 C50
CDFRM
SEP 05
7-24-2019
Date
76318.054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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.
7-24-2019
Counseled by
Date
CONFIDENTIAL
SDNY_00009382
EFTA00139326
BP-A0618
JUN 18
(initial Clinical Dental Findings)
•
Instructed how to obtain urgent and non-urgent dental care:
Yes: i
No:
Treatment Priorities:
None:
Non-urgent
non-urgent
Urgent Referred to Sick Call:
Radiographs authorized:
PM:
.
Prophylaxis authorized:
Yes I
No
(Approval valid 18 months from examination date)
8Ws:
Panorex:
Patient Name:
s --c4
.
n 1
--)C_M -Q t1 E
Den'
ins
FA
c
T4Number.
I
-7G 3 1 Sf- D.S-\
Institution: /
MCC NEW YORK
Date:
7- zo -1 Q.
PDF
Prescribed by P64C0
Replaces BP.A0618 ofJON 10
CONFIDENTIAL
SDNY_00009383
EFTA00139327
Ell:14358.0W
SEP 05
CDFRM
7-24-2019
Date
76318-054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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
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
CONFIDENTIAL
SDNY_00009384
EFTA00139328
BP-S358.C60
CDFRM
SEP 05
7-10-2019
Date
76318-054 , refuse treatment recommended by the Federal
Bureau of Prisons Medical staff for the following condition(s):
DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:
The following treatment(s) was/were recommended:
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:
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
7-10-2019
Date
Patien
Signature
Signature of Witness
Date
Date
CONFIDENTIAL
SDNY_00009385
EFTA00139329
BP-A0618
JUN 16
1
7-2-6 -19.
r Number:
76 3 RP- US-1/4i
(Initial Clinical Dental Findings)
3-c.c.city £
Institution: /
MCC NEW YORK
POE
non-urgent
Prophylaxis authorized:
No
(Approval valid 18 months from examination date)
Date:
Prescribed by P8400
Replaces 8P-A0618 of JUN 10
/
CONFIDENTIAL
SDNY_00009386
EFTA00139330
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg
76318-054
Date of Birth [DOB REDACTED]
Sex:
Facility: NYM
Encounter Date: 08/10/2019 07:25
Provider:
Unit:
Z04
Emergency Code - Resuscitation Event encounter performed at Special Housing Unit.
SUBJECTIVE:
Emergency Note Provider:
Team Members:
Provider
Bak
Team/Code Leader
Code Events:
Tvoe
Value
Data
CPR
Compressions
08/10/2019 06:35
EKG/Monitor
Lifepak
08/10/2019 06:39
No shock advised
CPR
Compressions
08/10/2019 06:40
Oxygen
15 L
08/10/2019 06:47
IV Access
Peripheral IV
08/10/2019 06:48
18 g Left AC
Airway
Endotracheal Tube
ET Tube 7.5 24CM to L Lip line Placed by Paramedics
08/10/2019 07:08
Medications
Epinephrine 1mg IV
08/10/2019 07:10
Epinephrine 3 doses and Sodium bicarb 2 doses administered by paramedics
CPR
Compressions
08/10/2019 07:11
Medications
Sodium Bicarbonate 1 mEa/kg IV
08/10/2019 07:11
IV Fluids
Normal Saline 0.9% 1000 ml
08/10/2019 07:12
Medications
Epinephrine 1mg IV
08/10/2019 07:13
CPR
Compressions
08/10/2019 07:14
Medications
Sodium Bicarbonate 1 mEa/kg IV
08/10/2019 07:14
Medications
Epinephrine 1mg IV
08/10/2019 07:16
CPR
Compressions
08/10/2019 07:17
Comments:
Responded to a body alarm at 0635 for medical emergency on 9S, Upon arrival Inmate was received on the floor of his
cell unresponsive with CPR in progress by correctional officers, Inmate was Cold, with circumferential Bruising around the
neck and posterior mottling, Pupils Fixed and dilated, No Palpable pulses, Call place for EMS, CPR Continued, AED
Placed No shock advised, CPR Continued, inmate transported to HSU treatment room with CPR in progress, 18g hep lock
to L AC, O2 15 Lt ViA BVM, Pulse Check NO SHOCK advised. EMS and Paramedics arrived 0656, Placed on cardiac
monitor asystole Resumed CPR, Inmate was intubated by Medics, 3 Rounds of Epinephrine administered, Pulse Check
asystole, Inmate was transported to Local ER with CPR in progress.
OBJECTIVE:
Exam:
General
Appearance
Yes: Unconscious
Generated 08/1012019 08:10 by
Bureau of Prisons - NYM
Page 1 of 2
CONFIDENTIAL
SDNY_00009387
EFTA00139331
Inmate Name: EPSTEIN. JEFFREY EDWARD
Date of Birth [DOB REDACTED]
Sex:
Encounter Date: 08/10/2019 07:25
Provider:
M
Rare: WHITF
Reg #:
76318.054
Facility: NYM
Unit:
Z04
Exam:
ASSESSMENT:
Cardiac Arrest
PLAN:
New Consultation Requests:
Consultation/Procedure
Target Date Scheduled Target Date Priority
Translator
Language
Emergency Room
08/10/2019
08/10/2019
Emergent
No
Subtype:
AMBULANCE
Reason for Request:
Cardiac arrest with CPR in progress
Copay Required:No
TelephoneNerbal Order: No
Completed b
Requested to be cosigned by
Cosign documentation will be displayed on the following page.
Cosign Required: Yes
n 08/10/2019 08:10
Generated 0811012019 08:10 by
Bureau of Prisons • NYM
Page 2 of 2
CONFIDENTIAL
SDNY_00009388
EFTA00139332
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg #:
76318-054
Date of Birth [DOB REDACTED]
Sex:
•
Facility: NYM
Encounter Date: 07/30/2019 15:58
Provider:
Unit:
201
Chronic Care - Chronic Care Clinic encounter performed at Health Services.
SUBJECTIVE:
COMPLAINT 1
Provider:
CONFIDENTIAL
SDNY_00009389
EFTA00139333
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth [DOB REDACTED]
Sex:
Encounter Date: 07/30/2019 15:58
Provider:
Generated 07/30/2019 16:12 by
Bureau of Prisons • NYM
Page 2 of 2
M
Race: WHITE
Reg #:
76318-054
Facility: NYM
Unit:
201
CONFIDENTIAL
SDNY_00009390
EFTA00139334
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name: EPSTEIN, JEFFREY EDWARD
Reg ft 76318-054
Date of Birth [DOB REDACTED]
Sex:
M
Race: WHITE
Facility: NYM
Encounter Date: 07/30/2019 11:12
Provider:
Unit:
201
Generated 07/302019 14A5 by
Bureau of Prisons NYM
Page 7 of 3
CONFIDENTIAL
SDNY_00009391
EFTA00139335
Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth [DOB REDACTED]
Encounter Date: 07/30/2019 11:12
Sex:
Provider:
M
Race: WHITE
Reg #:
76318-054
NYM
Unit:
201
CONFIDENTIAL
SDNY_00009392
EFTA00139336
Inmate Name:
Date of Birth [DOB REDACTED]
Encounter Date: 07/30/2019 11:12
Generated 07/30/2019 14:05 by
Bureau of Prisons • NYM
Page 3 of 3
Sex:
Provider
M
Race: WHITE
Reg #:
76318-054
Facility: NYM
Unit:
201
CONFIDENTIAL
SDNY_00009393
EFTA00139337
Bureau of Prisons
Health Services
Clinical Encounter
Inmate Name:
Date of Birth [DOB REDACTED]
Encounter Date: 07/30/2019 11:12
Sex:
M
Race: WHITE
Provider:
Reg #:
76318-054
Facility: NYM
Unit:
Z01
CONFIDENTIAL
SDNY_00009394
EFTA00139338
Inmate Name:
Date of Birth [DOB REDACTED]
Encounter Date: 07/30/2019 11:12
Sex:
M
Race: WHITE
Provider:
Reg #:
76318-054
Facility: NYM
Unit:
ZO1
CONFIDENTIAL
SDNY 00009395
EFTA00139339
Inmate Name: EPSTEIN. JEFFREY EDWARD
Date of Birth [DOB REDACTED]
Sex:
Encounter Date: 07/30/2019 11:12
Provider:
Generated 07/30/2019 14.05 by
M
Race: WHITE
Reg 8:
76318-054
Facility: NYM
Unit:
201
Bureau of Prisons • NYM
Page 3 of 3
CONFIDENTIAL
SDNY_00009396
EFTA00139340
Bureau of Prisons
Health Services
See Amendment
Inmate Name:
Reg #:
76318-054
Date of Birth [DOB REDACTED]
Sex:
M
Race:
WHITE
Encounter Date: 07/30/2019 15:58
Facility:
NYM
Amendment made to this note by
on 07/30/2019 16:12.
Bureau of Prisons - NYM
CONFIDENTIAL
SDNY_00009397
EFTA00139341