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Page 2500 te a MEDICAL TREATMENT REFUSAL CDFRM 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: EYE DOCTOR EVALUATION. Oe ee nn Re ee eee RR EST OE PS pte rns ee pn rege ee ge ae The following treatment(s) was/were recommended: EYE DOCTOR EVALUATION. Sante ae Te A Le ea AE ES 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. ! 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. rey TO) nee gs eS Cea ey MD 7-24-2019 Date So Ran se eR ee NYM--NEW YORK MCC (OMG) (bMT OC) afm acne ERO Ne eae 2 DOJ-OGR-00026176