Case File
efta-efta00033843DOJ Data Set 8CorrespondenceEFTA00033843
Date
Unknown
Source
DOJ Data Set 8
Reference
efta-efta00033843
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0
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0
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Text extracted via OCR from the original document. May contain errors from the scanning process.
Bureau of Prisons
Health Services
Vision Screens
Reg #: 76318-054
Inmate Name: EPSTEIN, JEFFREY EDWARD
Vision Screen on 07/09/2019 12:52
Blindness:
Distance Vision: OD: 20/100
OS: 20/70
OU:
Near Vision:
OD:
OS:
OU:
With Corrective
Distance Vision: OD:
OS:
OU:
Near Vision:
OD:
OS:
OU:
Present Glasses - Distance
Refraction - Distance
Sphere
Cylinder
Axis
Add
Sphere
Cylinder
Axis
Add
R:
R:
L:
L:
Color Test:
Tonometry:
R:
L:
Comments: Needs evaluation with optometrist.
Orig Entered: 07/09/2019 12:54 EST
MLP
Generated 08110/2019 11:02 by
Bureau of Prisons - NVM
Page 1 of 1
CONFIDENTIAL
SDNY_00009458
EFTA00033843
Bureau of Prisons
Health Services
Immunizations
Begin Date: 07/07/2019
End Date:
08/10/2019
Reg #:
76318-054
Inmate Name: EPSTEIN, JEFFREY EDWARD
immunization
immunization Date
Administered
JLocation
Dosaae Drug Mfg
Lai
Axp Date
Hepatitis A and B (TwinRx)
History Unknown
Orig Entered: 07/09/2019 12:51 EST MM.
MLP
Measles/Mumps/Rubeila Series
History Unknown
Orig Entered: 07/09/2019 12:51 EST
. MLP
Smallpox Series
History Unknown
Orig Entered: 07/09/2019 12:51 EST
MLP
Tetanus
History Unknown
Orig Entered: 07/09/2019 12:51 EST
MLP
Varicella Series
History Unknown
Orig Entered: 07/09/2019 12:51 EST
MLP
Total: 5
Generated 09/10/201911:02 by
RN/1OPADC
Bureau of Prisons NYM
Page loll
CONFIDENTIAL
SDNY_00009459
EFTA00033844
Bureau of Prisons
Health Services
Medical Duty Status
Reg #: 76318-054
Inmate Name: EPSTEIN. JEFFREY EDWARD
Housing Status
confined to the living quarters except
meals
pill line
_treatments
Exp. Date:
on complete bed rest:
_bathroom privileges only
Exp. Date:
X cell:
cell on first floor _single cell X lower bunk
airborne infection isolation
Exp. Date:
10/09/2019
other:
Exp. Date:
Physical Limitation/Restriction
all sports
Exp. Date:
weightlifting:
_upper body
lower body
Exp. Date:
cardiovascular exercise:
running _jogging
walking
softball
Exp. Date:
_football _basketball _handball
stationary equipment
other:
Exp. Date:
May have the following equipment in his / her possession:
Equipment
Start Date
End Date
Return Dale
C-Pap
07/30/2019
PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE.
SERIAL ti: P1131281381ED.
Work Restriction / Limitation:
Cleared for Food Service: Yes
X No Restrictions
Comments: N/A
07/30/2019
Health Services Staff
Date
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg 4:
76318.054
Quarters:
Z04
ALL EXPIRATION DATES ARE AT 24:00
Generated 08/10/2019 11 02 by
Bureau of Prisons • NYM
Page 1 of
CONFIDENTIAL
SDNY 00009460
EFTA00033845
Bureau of Prisons
Health Services
Medical Duty Status
Reg #: 76318-054
Inmate Name: EPSTEIN, JEFFREY EDWARD
Housing Status
confined to the living quarters except _meals
_pill line
_treatments
Exp. Date:
_
___
_
on complete bed rest:
bathroom privileges only
Exp. Date:
X cell:
cell on first floor _single cell X lower bunk
airborne infection isolation
Exp. Date:
10/09/2019
other:
Exp. Date:
Physical Limitation/Restriction
all sports
Exp. Date:
weightlifting:
upper body
lower body
Exp. Date:
cardiovascular exercise:
running _jogging
walking
softball
Exp. Date:
football
basketball
handball
stationary equipment
other:
May have the following equipment in his / her possession:
Work Restriction / Limitation:
Cleared for Food Service: Yes
X No Restrictions
Comments: N/A
Exp. Date:
MLP
07/09/2019
Health Services Staff
Date
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg #:
76318-054
Quarters:
Z04
ALL EXPIRATION DATES ARE AT 24:00
Generated 08/10/2019 11:02 by
bureau of Prisons - NYM
Page 1 of 1
CONFIDENTIAL
SONY 00009461
EFTA00033846
Bureau of Prisons
Health Services
Medication Summary
Historical
Complex: NYM--NEW YORK MCC
Inmate:
EPSTEIN. JEFFREY EDWARD
Begin Date: 07/07/2019
End Date: 08/10/2019
Reg #:
76318-054
Quarter:
Z04-206LAD
Medications listed reflect prescribed medications from the begin date to end date on this report.
Allergies:
Denied
Active Prescriptions
Bisacodyl E.C. 5 MG TAB
Take one tablet (5 MG) by mouth at bedtime AS NEEDED for 10 days
Rx#: 121757-NYM
Doctor:
MLP
Start: 07/09/19
Exp: 07/19/19
D/C: 07/12/19
Pharmacy Dispensings: 10 TAB in 32 days
Docusate Sodium 100 MG Cap
Take one capsule (100 MG) by mouth twice daily for 30 days
Rx#: 121823-NYM
Doctor:
Start: 07/12/19
Exp: 08/11/19
Pharmacy Dispensings: 60 CAP in 29 days
Docusate Sodium 100 MG Cap
Take one capsule (100 MG) twice daily by mouth with plenty of water
Rx#: 122084-NYM
Doctor:
Start: 07/26/19
Exp: 01/22/20
Pharmacy DIspensIngs: 30 CAP in 15 days
Milk of Magnesia Susp (OTC) (473ML) 400MG/5ML
shake well take 2 tablespoonful twice daily by mouth
Rx#: 121835-NYM
Doctor:
Start: 07/12/19
Exp: 07/14/19
Milk of Magnesia Susp (OTC) (473ML) 400MG/5ML
shake well take 10mi by mouth twice daily AS NEEDED
Rx#: 122150-NYM
Doctor:
Start: 07/30/19
Exp: 10/28/19
methylPREDNISolone 4 MG Tab ( 21 count Pack)
Take the tablet by mouth as directed
Rx#: 121836-NYM
Doctor:
Start: 07/12/19
Exp: 07/18/19
methylPREDNISolone 4 MG Tab ( 21 count Pack)
Take the tablet by mouth as directed
Rx#: 122149-NYM
Doctor:
Start: 07/30/19
Exp: 08/05/19
Generated 08/10/2019 11:02 by
Pharmacy Dispensings: 473 ML in 29 days
Pharmacy Dispensings: 473 ML in 11 days
Pharmacy Dispensings: 21 tab in 29 days
Pharmacy Dispensings: 21 tab in 11 days
Bureau of Prisons - NYM
Page 1 of 2
CONFIDENTIAL
SDNY_00009462
EFTA00033847
Complex: NYM—NEW YORK MCC
Inmate:
EPSTEIN, JEFFREY EDWARD
Begin Date: 07/07/2019
End Date: 08/10/2019
Reg #:
76318-054
Quarter:
204-206LAD
Active Prescriptions
Omega 3 (Vascepa) 1 GM Capsule
Take two capsules (2 GM) twice daily by mouth with food
Rx#: 121885-NYM
Doctor:
Start: 07/17/19
Exp: 01/13/20
Pharmacy Dispensings: 180 Cap in 24 days
Insulin Reg (10 ML) 100 UNITS/ML Inj
Inject regular insulin subcutaneously per sliding scale: twice daily '"pill linen' for 7 days "'pill linen'
Rx#: 122148-NYM
Doctor:
Start: 07/30/19
Exp: 08/06/19
D/C: 07/31/19
Pharmacy Dispensings: 0 ML in 11 days
Insulin Reg (10 ML) 100 UNITS/ML lnj
Inject regular insulin subcutaneously per sliding scale: each morning for 7 days "'pill linen' "'pill linen'
Rx#: 122160-NYM
Doctor:
Start: 07/31/19
Exp: 08/07/19
Pharmacy Dispensings: 0 ML in 10 days
Generated 08/10/2019 11:02 by
Bureau of Prisons - NYM
Page 2 of 2
CONFIDENTIAL
SDNY_00009463
EFTA00033848
Bureau of Prisons
Health Services
Dental Health History Screen
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg #:
76318-054
Date of Birth:
01/20/1953
Sex:
M
Race.
WHITE
Facility: NYM
Encounter Date: 07/26/2019 07:54
Provider:
DDS
Unit:
H01
ASSESSMENTS:
Health Problems as of Dental Health History Encounter date: 07/26/2019 07:54
Health Problems
hen
Status
Hyperlipidemia, unspecified
Current
HYPERTRIGLYCERIDEMIA
Sleep apnea
Current
Constipation, unspecified
Current
Low back pain
Current
Neuralgia and neuritis, unspecified
Current
No Diagnosis
Current
Injury, unspecified
Current
R/O self inflicted injuries.
Medical History as of Dental Health History Encounter date
Medical History:
Allergies:
Denied
Seizures:
Denied
Diabetes:
Denied
Cardiovascular:
Denied
CVA:
Denied
Hypertension:
Denied
Respiratory:
Denied
Sickle Cell Anemia:
Denied
Carcinoma/Lymphoma:
Denied
HIV History:
When Tested:
2019
Test Result:
Negative
When Diagnosed AIDS:
Last CD4:
Comments:
Hepatitis:
Denied
Generated 07/26/2019 07:59 by
07/26/2019 07:54
DOS
Bureau of Prisons - NYM
Page 1 of 3
CONFIDENTIAL
SDNY_00009464
EFTA00033849
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg #:
76318-054
Date of Birth:
01/20/1953
Sex:
M Race:
WHITE
Facility: NYM
Encounter Date: 07/26/2019 07:54
Provider:
DDS
Unit:
H01
Other Infectious Diseases:
Syphilis:
No
Syphilis Last Treatment:
N/A
Genital Wads:
No
Chlamydia:
Yes
Gonorrhea:
No
Herpes:
No
Chicken Pox:
Yes
Other:
No
Comments: Chlamydia in 2015, treated
Chicken pox in childhood
Other Health Issues:
Other Medical Conditions And Treatment: sleep apnea
Current Medical Conditions:
Other Current Treatments:
Pregnant: N/A
Dental Observations as of Dental Health History Encounter date: 07/26/2019 07:54
History:
Alcohol:
No
Methamphetamine:
No
Tobacco products:
No
Other drugs:
No
Sensitive teeth:
No
Bleeding gums:
Yes
Food impaction:
Yes
Pain around ear:
No
Toothache:
No
Wear partial dentures:
No
Unusual sounds while eating:
No
Snoring:
Yes
Blisters on lips or mouth:
No
Clenching or grinding:
Yes
Swelling or lumps in mouth/throat:
No
Burning tongue:
No
Bad breath:
No
Decayed teeth:
No
Loose teeth:
No
Wear dentures:
No
None:
No
Comments:
Generated 0712612019 07.59 by
DOS
Bureau of Prisons - NYM
Page 2 of 3
CONFIDENTIAL
SDNY_00009465
EFTA00033850
Inmate Name:
EPSTEIN. JEFFREY EDWARD
Reg #:
76318-054
Date of Birth:
01/20/1953
Sex:
M
Race:
WHITE
Facility: NYM
Encounter Date: 07/26/2019 07:54
Provider:
DDS
Unit:
H01
Cardiac Condition Requiring Prophylaxis: No
Prosthetic joint(s):
No
Radiation history of head or neck:
No
Excessive bleeding:
No
Bisphosphonates:
No
Comments:
Medications as of Dental Health History Encounter date:
07/26/2019 07:54
Medications:
Docusate Sodium 100 MG Cap Exp: 08/11/2019 SIG: Take one capsule (100 MG) by mouth twice daily for 30 days
Omega 3 (Vascepa) 1 GM Capsule Exp: 01/13/2020 SIG: Take two capsules (2 GM) twice daily by mouth with food
OTCs: Listing of all known OTCs this inmate is currently taking.
Instructed inmate how to obtain medical, dental, and mental health care.
Copay Required:No
Cosign Required: No
TelephoneNerbal Order: No
Completed by
DDS on 07/26/2019 07:59
Generated 07/26/2019 07:59 by
DOS
Bureau of Prisons - NYM
Page 3 or 3
CONFIDENTIAL
SDNY_00009466
EFTA00033851
Bureau of Prisons
Health Services
Dental A&O Exam
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Date of Birth:
01/20/1953
Sex: M
Race: WHITE
Encounter Date: 07/26/2019 07:47
Provider:
Reg #:
76318-054
Facility:
NYM
DDS
Unit:
H01
Reviewed Health Status:
Yes
Occlusion:
Class I
Oral Hygiene: Fair
CPITN:
3
2
3
3
1
2
1
3
Hard and soft tissue examination performed and documented on BP618 form: Yes
Head & Neck/Soft Tissue within normal limits?
No
Comments:
moderate to advanced upper posterior gingival recession
Decayed:
Missing:
Filled:
0
1
14
Comments:
Lower anterior crowding
Approved for hygiene appointment and radiographs:
Yes
Instructed inmate how to obtain routine and emergency dental care. Oral hygiene Instructions given: Yes
Dental A&O Screening Exam findings entered on EPSTEIN. JEFFREY EDWARD by
DDS on
07/26/2019 07:47.
Generated 07/26/2019 08:00 by
DOS
Bureau of Prisons - NYM
Page 1 of 1
CONFIDENTIAL
SDNY_00009467
EFTA00033852
Bureau of Prisons
Health Services
Dental Soap/Admin Encounter
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg #:
76318-054
Date of Birth:
01/20/1953
Sex:
M
Race: WHITE
Facility:
NYM
Encounter Date: 07/18/2019 13:48
Provider:
Dental Asst
Unit:
205
Screening encounter at Dental Clinic.
Reason Not Done: Unavailable
Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic.
Cosign Required: No
Completed by
Dental Asst on 07/19/2019 13:49.
Consumed 07/19/2019 13:49 by
Denial
Bureau of Prisons • NYM
Page 1 of 1
CONFIDENTIAL
SDNY_00009468
EFTA00033853
Federal
Bureau of
Prisons
U.S. Medical Center for Federal Prisons
1900 W. Sunshine Street
Springfield, MO 65807
417-874-1621
"' Sensitive But Unclassified 1"
Name EPSTEIN, JEFFREY
Reg # 76318-054
DOB 01/20/1953
Sex
M
Facility
MCC New York
Order Unit E06-547U
Provider
Collected 07/09/2019 13:34
Received 07/10/2019 10:44
MD
Reported 07/10/2019 14:46
LIS ID
188191004
CHEMISTRY
Sodium
Potassium
Chloride
CO2
BUN
Creatinine
eGFR (IDMS)
137
4.7
99
27
17
1.05
>60
137-148
3.5-5.0
99-114
22-30
7-22
0.66-1.25
mmol/L
mmoUL
mmol/L
mmoUL
mg/dL
mg/dL
GFR units measured as mUmin/1.73 mA2. If African American multiply by 1.210.
A calculated GFR <60 suggests chronic kidney disease if found over a 3 month period.
Calcium
9.8
8.5-10.9
mg/dL
Glucose
102
70-110
mg/dL
AST
H
57
11-55
U/L
ALT
62
11-66
U/L
Alkaline Phosphatase
64
41-133
U/L
Bilirubin, Total
1.1
0.2-1.3
mg/dL
Total Protein
7.3
6.0-8.2
g/dL
Albumin
4.4
3.6-5.1
g/dL
Globulin
2.9
2.0-3.7
g/dL
Alb/Glob Ratio
1.50
1.00-2.30
Anion Gap
10.2
9.0-19.0
BUN/Creat Ratio
16.1
5.0-30.0
Cholesterol
H
216
<200
mg/dL
Trighicerides
H
413
10-150
mg/dL
Calculation of LOL is not appropriate for samples with a triglyceride greater than 400 mg/dL. Therefore the LDL Is not calculated.
HDL Cholesterol
L
31
40-60
mg/dL
Chol/HDL Ratio
H
6.9
0.0-4.0
HEMATOLOGY
WBC
7.6
4.3-11.1
K/uL
NRBC%
0.0
RBC
5.42
4.46-5.78
M/ut.
Hemoglobin
15.6
13.6-17.6
g/dL
Hematocsit
47.8
40.2-51.4
MCV
88.2
82.5-96.5
iL
MCH
28.8
27.1-34.9
P9
MCHC
L
32.6
33.0-37.0
g/dL
RDW-CV
12.8
12.0-14.0
Platelet
338
130-374
K/uL
FLAG LEGEND
L=Low L!=Low Critical H=High HI=High Critical A=Abnormal Al =Abnormal Critical
Page 1 of 3
CONFIDENTIAL
SDNY_00009469
EFTA00033854
Federal
Bureau of
Prisons
U.S. Medical Center for Federal Prisons
1900 W. Sunshine Street
Springfield, MO 65807
417-874-1621
••• Sensitive But Unclassified •••
Name EPSTEIN, JEFFREY
Reg # 76318-054
DOB 01/20/1953
Sex
M
Facility MCC New York
Order Unit E06-547U
Provider
Collected 07/09/2019 13:34
Received 07/10/2019 10:44
MD
Reported 07/10/2019 14:46
LIS ID
188191004
HEMATOLOGY
MPV
10.4
6.9-10.5
fL
Neutrophils %
58.7
Therapeutic decision making should be based on absolute values, rather than percentages
Lymphocytes %
25.0
Monocytes %
11.1
ok
Eosinophils %
4.1
Basophils %
0.8
Immature Granulocytes %
0.3
0.0-5.0
Neutrophils #
4.4
1.9-6.7
K/uL
Lymphocytes #
1.9
1.3-3.7
K/uL
Monocytes #
0.8
0.3-1.1
K/uL
Eosinophils #
0.3
0.0-0.5
K/uL
Basophils #
0.1
0.0-0.1
K/uL
Immature Granulocytes #
0.02
0.00-0.50
10^3/uL
HEMOGLOBIN A1C
Hemoglobin A1C
H
6.3
<5.7
5.7 - 6.4 Increased Risk
6.4 Diabetes
SEROLOGY
RPR
Non-Reactive
Results may be affected in patients with severely advanced immunosuppression.
Non-Reactive
FLAG LEGEND
L=Low L!=Low Critical H=High Fil=High Critical A=Abnormal A! =Abnormal Critical
Page 2 of 3
CONFIDENTIAL
SDNY_00009470
EFTA00033855
it
apE)Federal
Bureau of
Prisons
U.S. Medical Center for Federal Prisons
1900 W. Sunshine Street
Springfield, MO 65807
417.874-1621
••• Sensitive But Unclassified '•'
Name EPSTEIN, JEFFREY
Reg # 76318-054
DOB 01/20/1953
Sex
M
Facility MCC New York
Order Unit E06-547U
Provider
MD
Collected 07/09/2019 13:34
Received 07/10/2019 10:44
Reported 07/10/2019 14:46
LIS ID
188191004
HIV
HIV 1/2
Negative
Screening lest - See confirmatory testing for Reactive results
Negative
FLAG LEGEND
L=Low LI=Low Critical H=High H!=High Critical A=Abnonnal A! =Abnormal Critical
Page 3 of 3
CONFIDENTIAL
SCINY_00009471
EFTA00033856
Bureau of Prisons
Health Services
Cosign/Review
Inmate Name:
EPSTEIN, JEFFREY EDWARD
Reg #:
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
Cosigned by
on 07/141201918:12.
Bureau of Prisons NYM
CONFIDENTIAL
SDNY_00009472
EFTA00033857
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
ions.
7-24-2019
Counseled by
Date
Signature
of VVitne s
Date
NYM--NEW YORK MCC
Date
I
CONFIDENTIAL
SDNY_00009473
1
EFTA00033858
BP-A0618
A&O DENTAL EXAMINATION
JUN 16
(Initial Clinical Dental Findings)
U.S. DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF PRISONS
Occlusion:
• MN
x 1 2
3
4
5 0
7
8
0 1011 12 13 14 15 18 WI
-
32 31
30 2D 28 27 28 25 24 23 22 21 20 ID
18
17
7
054
Oral Hygiene:
Good
E
Fair
00r
CP:TN:
3
3
3
2-
3
Head & Neck / Soft Tissue:
cAk, p
Classification:
CL -7—
Pain Scale:
/10
Dental Prostheses at Intake:
Yes
No
Type:
Age:
Condition:
Comrant
.1O :44
0.*
75 / V41
r ie. 02 SS/ on 017 Serum
Lat-ste--r C+N. AC1 or
catsliAc
0.10w
Intra-oral Photos Taken:
Yes
0
Radiographs Taken: (Document findings on ASO encounter)
Yes
9
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)
BWs:
Panorer
Patient Name:
s—terni
.
- ) C-C1PW-v E
-
-
•
-1 9.
DS
Fiegsti: Number
,
76 3 ISE; ock-\
Institution: /
MCC NEW YORK
a e:
--7- z6
gnature Block/Stamp:
IDS.
PDF
Mescal:it'd by PeAci0
ief DentalOfficer
MCC New York
Replaces BP-A0618 of JUN 10
CONFIDENTIAL
SDNY_00009474
EFTA00033859
Technical Artifacts (6)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Flight #
AC1Phone
12612019Phone
417-874-1621Phone
417.874-1621Phone
8191004Wire Ref
RefractionRelated Documents (6)
DOJ Data Set 10OtherUnknown
EFTA01682184
186p
DOJ Data Set 10OtherUnknown
EFTA01370863
1p
Dept. of JusticeOtherUnknown
Medical Record/Clinical Encounter: DOJ-OGR-00026334
This clinical encounter document from the Bureau of Prisons details a medical evaluation of Jeffrey Epstein on July 12, 2019. It covers his medical history, current complaints, and treatment, including discussions around his triglyceride levels, sleep apnea, and back pain. The document was generated by the treating physician at the Metropolitan Correctional Center in New York.
1p
DOJ Data Set 8CorrespondenceUnknown
EFTA00014087
0p
DOJ Data Set 11OtherUnknown
EFTA02367961
1p
DOJ Data Set 10OtherUnknown
EFTA01977826
2p
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