{
  "document_metadata": {
    "page_number": null,
    "document_number": "BP-S358.060",
    "date": "7-10-2019",
    "document_type": "Medical Treatment Refusal",
    "has_handwriting": true,
    "has_stamps": false
  },
  "full_text": "BP-S358.060 SEP 05 MEDICAL TREATMENT REFUSAL CDFRM U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS 7-10-2019 Date I, 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: 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUTINE CXR. The following treatment(s) was/were recommended: CHEST X-RAY 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: WORSENING THE CONDITION IF THERE IS ANY FINDINGS I 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. (b)(6), (b)(7)(C) X-RAY 7-10-2019 Date Counseled by Patient's Signature 7-10-2019 Date (b)(6), (b)(7)(C) 7-10-19 Signature of Witness Date NYM-NEW YORK MCC DOJ-OGR-00024181",
  "text_blocks": [
    {
      "type": "printed",
      "content": "BP-S358.060 SEP 05 MEDICAL TREATMENT REFUSAL CDFRM",
      "position": "header"
    },
    {
      "type": "printed",
      "content": "U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS",
      "position": "header"
    },
    {
      "type": "printed",
      "content": "7-10-2019 Date",
      "position": "header"
    },
    {
      "type": "printed",
      "content": "I, JEFFREY EPSTEIN 76318-054 , refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s):",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "DESCRIBE CONDITION IN LAYMAN'S TERMINOLOGY:",
      "position": "body"
    },
    {
      "type": "handwritten",
      "content": "66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUTINE CXR.",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "The following treatment(s) was/were recommended:",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "CHEST X-RAY",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "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:",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "WORSENING THE CONDITION IF THERE IS ANY FINDINGS",
      "position": "body"
    },
    {
      "type": "printed",
      "content": "I 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.",
      "position": "body"
    },
    {
      "type": "handwritten",
      "content": "(b)(6), (b)(7)(C)",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "X-RAY 7-10-2019 Date",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "Counseled by",
      "position": "footer"
    },
    {
      "type": "signature",
      "content": "",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "Patient's Signature",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "7-10-2019 Date",
      "position": "footer"
    },
    {
      "type": "handwritten",
      "content": "(b)(6), (b)(7)(C)",
      "position": "footer"
    },
    {
      "type": "handwritten",
      "content": "7-10-19",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "Signature of Witness Date",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "NYM-NEW YORK MCC",
      "position": "footer"
    },
    {
      "type": "printed",
      "content": "DOJ-OGR-00024181",
      "position": "footer"
    }
  ],
  "entities": {
    "people": [
      "JEFFREY EPSTEIN"
    ],
    "organizations": [
      "U.S. DEPARTMENT OF JUSTICE",
      "FEDERAL BUREAU OF PRISONS"
    ],
    "locations": [
      "NEW YORK MCC"
    ],
    "dates": [
      "7-10-2019",
      "7-10-19"
    ],
    "reference_numbers": [
      "BP-S358.060",
      "76318-054",
      "DOJ-OGR-00024181"
    ]
  },
  "additional_notes": "The document contains redactions of personal information, marked as '(b)(6), (b)(7)(C)'. The document is a medical treatment refusal form signed by Jeffrey Epstein."
}