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Bureau of Prisons Health Services Clinical Encounter - Administrative Note Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: = 01/20/1953 Sex: M Race:WHITE Facility: © NYM Note Date: 07/24/2019 15:10 Provider: MD Unit: HO01 Admin Note - General Administrative Note encounter performed at Health Services. Administrative Notes: ADMINISTRATIVE NOTE 1 Provider: OPC MD PATIENT WAS OFFERED TO HAVE AN OPTOMETRIST EVALUATION. HE REFUSED. REFUSAL FORM SIGNED. Copay Required: No Cosign Required: No Telephone/Verbal Order: No Completed by PX@) GNC) MD on 07/24/2019 15:17 Generated 07/24/2019 15:17 a reY° Bureau of Prisons - NYM Page 1 of 1 DOJ-OGR-00024111