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6318-054 Date of Bldh: 01/20/1953 Sex: M Race: WHITE Facility: NYM Encounter Date: 07/28/2019 06:51 Provider: SRN Unit: H01 Date Initiated Esimat Handout/Tonic Copay Required: No Cosign Required: Yes TelophoneNerbal Order: No Completed by RN on 07/28/2019 07:22 Requested to be cosigned b
ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis
h: 01/20/1953 Encounter Date: 07/28/2019 06:51 Sex: Provider: M Race: WHITE ME RN Reg #: 76318-054 Facility: NYM Unit: H01 Date Initiated Esimat Handout/Tonic Copay Required: No Cosign Required: Yes TelophoneNerbal Orden No Completed by RN on 07/28/2019 07:22 Requested to be cosigned by
ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis
: 76318-054 Date of Bldh: 01/20/1953 Sex: M Race: WHITE Facility: NYM Encounter Date: 07/28/2019 06:51 Provider: Unit: H01 Date Initiated Esimat Handout/Tonic Copay Required: No Cosign Required: Yes TelophoneNerbal Order: No Completed by on 07/2812019 07:22 Requested to be cosigned by
ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperlipldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis
76318-054 Date of Bit 01/20/1953 Sex: M Race: WHITE Facility: NYM Encounter Date: 07/28/2019 06:51 Provider: SRN Unit: H01 Date Initiated Esimat Handout/Tonic Copay Required: No Cosign Required: Yes TelephoneNerbal Order: No Completed by RN on 07/28/2019 07:22 Requested to be cosigned b
ential and must be appropriately safeguarded. Transfer To: Transfer Date: 08/10/2019 Health Problems Health Problem Hyperripldemia, unspecified HYPERTRIGLYCERIDEMIA Sleep apnea Essential (primary) hypertension BY HX. Constipation, unspecified Low back pain Neuralgia and neuritis, unspecified No Diagnosis
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