Epstein Secrets

te) BWs: Perron= frit Name: Skin i i -O—e_Fici--e_ty S Den' Signature Block/Stamp: DOS. ..km f- Number. --7(, 3 lc= Us-Li institution: / MCC NEW YORK Date: 7- 26 -/ 9. PDF Presaibed by P6400 let uentatofficer MCC New York Replaces BP-A0618 of JUN 10 EFTA00110340 I 1 2 3 4 5 0 7 8 0 10

rgent Referred to Sick Can: Radiographs authorized: PM: - Prophybcds 811 (Approval vaad 18 i No date) k Yes months from examination BWs: Panorer Patient Name: ,,-- $4Q n i -3 -e_c Thy E Dent; • -1 9. sir . ft , r Number 76 3 iSC OS-LI Institution: / MCC NEW YORK Date: 7— 24, Signa

Pa • nt Name: Pa' --) CV- -P•reti E Dentist Signature: (1 L) ,_44.x.m..a,.."... tzT25- istf s --Cfn i Number: 76 3 I (C..- OSN Institution: / MCC NEW YORK Uate: —.7 - 2 6 1 -19. Signature Btoa/Stamp: C. Ancrum DDS. PCF Prescribed by PCA07 fer tJental icer MCC New York Replaces UP-A6618o1JUN ID

nt Referred to Sick Call: Radiographs authorized: PM: Prophylaxis authorized: Yes I No (Approve; valid 18 months from examination date) EtWs: Panorer ;Pa ' nt Name: 7 s ---C4 . n i i e_ciVi*e_i f S Denfist Signature: 11 > DS gistli :rfitumber. 76 3 i e- Us-1/4i Institution: / MCC NEW YOR

Ws: Panorer. Pagan Name:, S -1-C4 -3 —Cc-PR.-ti E n Dentist Signature: 0 - L1-44014LAA.4— >DS st r Number. f -7(, 31Se- USN Institution: / MCC NEW YORK Date: 7- z6. ---/ 9. Signature Block/Stamp: C. Ancrum DDS. PDF Prescribed by P6400 let L)ental Umcer MCC New York Replaces BP-A0618 of JUN 10

ent Referred to Sick Call: Radiographs authorized: PM: Prophylaxis authorized: Yes 1 No (Approval valid 18 months from examination date) BWs: Panorer. Pagan Name:, S -1-C4 -3 —Cc-PR.-ti E n Dentist Signature: 0 - L1-44014LAA.4— >DS st r Number. f -7(, 31Se- USN Institution: / MCC NEW YORK

Ws: Panorer. Pagan Name:, S -1-C4 -3 —Cc-PR.-ti E n Dentist Signature: 0 - L1-44014LAA.4— >DS st r Number. f -7(, 31Se- USN Institution: / MCC NEW YORK Date: 7- z6. ---/ 9. Signature Block/Stamp: C. Ancrum DDS. PDF Prescribed by P6400 let L)ental Umcer MCC New York Replaces BP-A0618 of JUN 10

ent Referred to Sick Call: Radiographs authorized: PM: Prophylaxis authorized: Yes 1 No (Approval valid 18 months from examination date) BWs: Panorer. Pagan Name:, S -1-C4 -3 —Cc-PR.-ti E n Dentist Signature: 0 - L1-44014LAA.4— >DS st r Number. f -7(, 31Se- USN Institution: / MCC NEW YORK