epstein-index / content-documents /ds9 /25 /EFTA00058501.md
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title: DOJ Epstein Files, Data Set 9 (EFTA00058501)
source: DOJ Epstein Files, Data Set 9
sourceUrl: https://huggingface.co/datasets/ishumilin/epstein-files-ocr-complete
date: '2026-01-01'
category: DOJ Data Set
eftaNumber: EFTA00058501
ocrPages: 0
ocrChars: 3468
ocrElapsed: 0
parseTier: external
engine: ishumilin OCR pipeline (engine undisclosed; CC0 mirror)
externalSource: ishumilin-ocr-complete
externalLicense: CC0-1.0
externalCredit: ishumilin/epstein-files-ocr-complete (Hugging Face)
externalUrl: https://huggingface.co/datasets/ishumilin/epstein-files-ocr-complete

Bureau of Prisons Health Services Clinical Encounter

Inmate Name: EPSTEIN, JEFFREY EDWARD Sex: M Race: WHITE Reg #: 76318-054
Date of Birth: 01/20/1953 Facility: NYM
Encounter Date: 07/23/2019 06:20 Unit: H01

Injury Assessment - Non-work related encounter performed at Health Services.

SUBJECTIVE:

INJURY 1 Provider:

Date of Injury: 07/23/2019 01:27 Date Reported for Treatment: 07/23/2019 08:25

Work Related: No Work Assignment: UNASSG

Pain Location:

Pain Scale: 0

Pain Qualities:

Where Did Injury Happen (Be specific as to location):

Special Housing Unit Z05-Cell 124 L

Cause of Injury (Inmate's Statement of how injury occurred):

"I do not know. Just went to drink a little water and wake up snorting".

Symptoms (as reported by inmate):

None


COPY

7-23-19

OBJECTIVE:

```markdown

SaO2:


<table><thead><tr><th>Date</th><th>Time</th><th>Value(%)</th><th>Air</th><th>Provider</th></tr></thead><tbody><tr><td>07/23/2019</td><td>06:30 NYM</td><td>96</td><td>Room Air</td><td></td></tr></tbody></table>

## Exam:

## General

Affect

Yes: Cooperative

<table><tr><td>Appearance</td></tr><tr><td>Yes: Appears Well, Alert and Oriented x 3</td></tr><tr><td>No: Appears Distressed, Lethargic, Dyspneic, Appears in Pain, Pallor, Cyanotic, Diaphoretic, Disheveled,</td></tr></table>

Generated 07/23/2019 09:05 by

Page 1 of 2

Bureau of Prisons - NYM

EFTA00058501

EFTA00058502

Inmate Name: EPSTEIN, JEFFREY EDWARD
Date of Birth: 01/20/1953
Encounter Date: 07/23/2019 06:20
Sex: M Race: WHITE
Facility: NYM
Unit: H01

Exam:
Acutely Ill
Pulmonary
Auscultation
Yes: Clear to Auscultation, Vesicular Breath Sounds Bilaterally
No: Crackles, Rhonchi, Wheezing

Exam Comments
Inmate for injury report as requested by Operational Lt.
He is ambulatory, oriented x 3. In not apparent distress, smiling during this clinical encounter. Alleges, that he does not know what happened. Can not explain the marks on his neck. Responded: "I don't know".
He does not want to talk of the events leading to the marks on his neck.
He does not look in any distress or pain.
Has an circular line of erythema at the base of the neck. Reaching 2/3 of the neck circumference, 2 inches wide, sparing the back of the neck. Has one section of this erythema in the front with marks of friction.
No inflammation, no deformities, no hematomas, no lacerations, no tenderness. Patient moving his neck without any restriction. Denies having any pain or discomfort. Denies any respiratory problem.
Has another small erythema on left knee about 2cm in diameter(mild).
As per information from custody staff inmate Epstein was found in his cell with a rope around his neck and sitting on the floor.
Inmate is currently placed on suicide watch.

ASSESSMENT:
Injury, unspecified, T1490 - Current - R/O self inflicted injuries.

PLAN:

Disposition:
Follow-up at Sick Call as Needed
Placed on Suicide Watch
Follow-up in 2-4 Hours

Other:
For follow up with psychology service.

Patient Education Topics:

Date Initiated Format Handout/Topic Provider Outcome
07/23/2019 Counseling Access to Care Verbalizes Understandin
07/23/2019 Counseling Plan of Care Verbalizes Understandin

Copay Required: No Cosign Required: Yes

Telephone/Verbal Order: No
Completed by on 07/23/2019 09:05
Requested to be cosigned by
Cosign documentation will be displayed on the following page.

```markdown

COPY

| EFTA00058503 | | :--- | :---