Bureau of Prisons Health Services Clinical Encounter Inmate Name: Reg #: | Date of Birth: Sex: WL Race: Facility: NYM Encounter Date: 08/16/2019 07:04 Provider: Unit: KO1 Injury Assessment - Non-work related encounter performed at Health Services. SUBJECTIVE: INJURY 1 Provider: Date of Injury: 08/16/2019 06:40 Date Reported for Treatment: 08/16/2019 07:05 Work Related: No Work Assignment: UNASSG Pain Location: Pain Scale: 0 Pain Qualities: Colicky Where Did Injury Happen (Be specific as to location): 11 North Cause of Injury (Inmate's Statement of how injury occurred): "| got caught with a weapon on me" Symptoms (as reported by inmate): "| have no injury” OBJECTIVE: Pulse: 08/16/2019 07:04 103 Via Machine Po Respirations: 08/16/2019 07:04 NYM 5 Blood Pressure: 08/16/2019 07:04 NYM 159/96 fF SaOQ2: Date Time Value(%) Air Provider 08/16/2019 07:04 NYM 96 Room Air FY Exam Comments General: AAOx3. NAD. Calm and noncombative. Neck: Supple Heart: S1, S2. RRR Lungs: CTAB Abd: Soft EXT: No edema Skin: No suspicious lesion or wound Neuro: Sensory & motor intact. Gait steady ASSESSMENT: Generated 08/16/2019 07:11 by Bureau of Prisons - NYM Page 1 of 2 EFTA00142554

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Inmate Name: Reg #: Date of Birth: Sex: | Race: m7 Facility: NYM Encounter Date: 08/16/2019 07:04 Provider: fF Unit: KO1 Encounter for general adult medical exam without abnormal findings, Z0000 - Current PLAN: Disposition: Follow-up at Sick Call as Needed Other: IM states he did not sustain any injury and claims no pain or any bodily complaints. He is about to be seen by Psychology soon for psych eval. Patient Education Topics: 08/16/2019 Counseling Access to Care FY Verbalizes Understanding Copay Required: No Cosign Required: Yes Telephone/Verbal Order: No Completed by II on 08/16/2019 07:11 Requested to be cosigned by fs MD. Cosign documentation will be displayed on the following page. Generated 08/16/2019 07:11 by Bureau of Prisons - NYM Page 2 of 2 EFTA00142555