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Page 2551 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Encounter Date: 07/28/2019 06:51 Sex: M Race: WHITE Reg #: 76318-054 Provider: [b)(6); (b)(7)(C) RN Facility: NYM Unit: H01 Date Initiated Format Handout/Topic Provider Outcome Copay Required:No Cosign Required: Yes Telephone/Verbal Order: No Completed by [b)(6); (b)(7)(C) RN on 07/28/2019 07:22 Requested to be cosigned by [b)(6); (b)(7)(C) MD. Cosign documentation will be displayed on the following page. Generated 07/28/2019 07:22 by [b)(6); (b)(7)(C) RN Bureau of Prisons - NYM Page 3 of 3 DOJ-OGR-00026211