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Page 2397 ce MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS SS 7-24-2019 Date i, JEFFREY EPSTEIN 7 76318-054 __, refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s): DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY: 4 ee ee ie ye el Pe eee EYE DOCTOR EVALUATION. The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. 2h RE a le ater mye ERS ST RP oo ¢ 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 accépt treatment: INABILITY TO DIAGNOSE CURRENT OPTHALMOLOGIC DISEASES. » { 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. FR seat RE Pa RRS oe a i pee ne ST es pe a Te NYM—NEW YORK MCC DOJ-OGR-00026073