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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
Unit: 76318-054 NYM Z05 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & 0 screening but has not been escorted to Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. e dental clinic. Generated 07/19/201913
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
nita Dental Asst Unit Z05 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & 0 screening but has not been escorted to dental clinic. Cosign Required: No Completed by DeBruce, Juanita Dental Asst on 07/19/2019 13:49. Generate
: 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
Unit: 76318-054 NYM Z05 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & 0 screening but has not been escorted to Cosign Required: No Completed by n 07/19/2019 13:49. e dental clinic. Generated 07/19/201913:49 by Burea
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
Unit: 76318-054 NYM ZO5 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & 0 screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Generated 07/19/20191
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