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Page 2399 St gee MEDICAL TREATMENT REFUSAL CDFRM t U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS | 7-24-2019 Date |, 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: f 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. thorny tte cope te | 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. MD 7-24-2019 NYM--NEW YORK MCC (biG); (BMT HC} DOJ-OGR-00026075