{ "document_metadata": { "page_number": "2565", "document_number": "76318-054", "date": "07/14/2019", "document_type": "Medical Examination Report", "has_handwriting": false, "has_stamps": false }, "full_text": "Page 2565 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Reg #: 76318-054 Encounter Date: 07/14/2019 17:36 Provider: (b)(6); (b)(7)(C) MD Facility: NYM Unit: Z05 Exam: Eyes General Yes: PERRLA, Extraocular Movements Intact Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rate and Rhythm (RRR), Normal S1 and S2 No: M/R/G Abdomen Auscultation Yes: Normo-Active Bowel Sounds Palpation Yes: Within Normal Limits Musculoskeletal Tibia / Fibula No: Edema Back Yes: Tenderness Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam ASSESSMENT: Constipation, unspecified, K5900 - Current Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Sleep apnea, G4730 - Current PLAN: New Medication Orders: Rx# Medication Order Date Prescriber Order Omega 3 (Vascepa) 1 GM Capsule 07/14/2019 17:36 TAKE 2 CAPS Orally - Two Times a Day x 180 day(s) -- TAKE WITH FOOD. Indication: Hyperlipidemia, unspecified New Laboratory Requests: Details Frequency Due Date Priority Lab Tests-H-Hemoglobin A1C One Time 10/10/2019 00:00 Routine Lab Tests-L-Lipid Profile Additional Information: Generated 07/14/2019 18:11 by (b)(6); (b)(7)(C) MD Bureau of Prisons - NYM Page 2 of 3 DOJ-OGR-00026225", "text_blocks": [ { "type": "printed", "content": "Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Race: WHITE Reg #: 76318-054 Encounter Date: 07/14/2019 17:36 Provider: (b)(6); (b)(7)(C) MD Facility: NYM Unit: Z05", "position": "header" }, { "type": "printed", "content": "Exam: Eyes General Yes: PERRLA, Extraocular Movements Intact Pulmonary Auscultation Yes: Clear to Auscultation Cardiovascular Auscultation Yes: Regular Rate and Rhythm (RRR), Normal S1 and S2 No: M/R/G Abdomen Auscultation Yes: Normo-Active Bowel Sounds Palpation Yes: Within Normal Limits Musculoskeletal Tibia / Fibula No: Edema Back Yes: Tenderness Neurologic Cranial Nerves (CN) Yes: Within Normal Limits Motor System-General Yes: Normal Exam", "position": "middle" }, { "type": "printed", "content": "ASSESSMENT: Constipation, unspecified, K5900 - Current Hyperlipidemia, unspecified, E785 - Current Low back pain, M545 - Current Neuralgia and neuritis, unspecified, M792 - Current Sleep apnea, G4730 - Current", "position": "middle" }, { "type": "printed", "content": "PLAN: New Medication Orders: Rx# Medication Order Date Prescriber Order Omega 3 (Vascepa) 1 GM Capsule 07/14/2019 17:36 TAKE 2 CAPS Orally - Two Times a Day x 180 day(s) -- TAKE WITH FOOD. Indication: Hyperlipidemia, unspecified New Laboratory Requests: Details Frequency Due Date Priority Lab Tests-H-Hemoglobin A1C One Time 10/10/2019 00:00 Routine Lab Tests-L-Lipid Profile", "position": "middle" }, { "type": "printed", "content": "Additional Information: Generated 07/14/2019 18:11 by (b)(6); (b)(7)(C) MD Bureau of Prisons - NYM Page 2 of 3 DOJ-OGR-00026225", "position": "footer" } ], "entities": { "people": [ "JEFFREY EDWARD EPSTEIN" ], "organizations": [ "Bureau of Prisons" ], "locations": [ "NYM" ], "dates": [ "01/20/1953", "07/14/2019", "10/10/2019" ], "reference_numbers": [ "76318-054", "DOJ-OGR-00026225" ] }, "additional_notes": "The document appears to be a medical examination report for Jeffrey Epstein, an inmate at the Bureau of Prisons - NYM facility. The report includes various medical assessments and treatment plans. Some personal identifiable information has been redacted." }