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‘Rectal and genital examination SEP 05 BP-S358.060 MEDICAL TREATMENT R FUSAL ; . GOFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-9-2019 Date 1, JEFFREY EPSTEIN 76318-054 _, refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): fa DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: The following treatment(s) was/were recommended: Rectal and genital examination 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: Undetected and untreated medical condition. | understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. | 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. ; -9-2019 x Date Patient's Signa ANG Date BCC NY NYM—NEW YORK MCC Signature of Witness DOJ-OGR-00024177