Epstein Secrets

Eg. Waist Circunt, Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic. Disheveled, Unkejii• '•fi cutely III Nutrition No: Appears On Pulmonary

equipment ,other. Exp. Date: AYTPREirgEffirelartlitrriTittailiiiTtiziailiiiiciliiitiU ; • Equipment Start Date End Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL tt: P113121313B1ED. WO 110 • Wir .r. s'ziff : :Xie<; . :fr ; • Cleared for Food Service: Yes X No Restrict

bs Kg Waist Circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unk cutely III Nutrition No: Appears O Pulmonary Auscultati

ketball _handball _stationary equipment other: Equipment May have the following equipment In his / her possession: Start Date C-Pap 07/30/249 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. .%i% SERIAL #: P11312813B1ED. Work Restriction I Cleared for Food Service: Yes X No Restrictions Comments: N/A Beaudou

IM Kg Waist Circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distr ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unk cutely III Nutrition No: Appears O Pulmonary Auscultati

ap. Date: Exp. Date: May have the following equipment in his / her possession: Equipment Start C ite End Date Return Date C-Pap 07 ni 19 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. Page 082 of 148 Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions

1 Exam: General Affect Waist Circum Provider MD Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unke cutely III Nutrition No: Appears Ott Pulmonary Ausculta

: _football _basketball _handball stationary equipment • falergiffinagra urS areigiga niiiiig •';' Equipment Start Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. O W m tali Cleared for Food Service: Yes X No Restrictions Comments: N/A 1rtatts:Iriart He

.K.9 Waist Circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unke cutely III Nutrition No: Appears Ott Pulmonary Ausculta

_basketball _handball stationary equipment • falergiffinagra urS areigiga nieig (Mif; •';' Equipment Start Date End Date Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. Cleared for Food Service: Yes X No Restrictions Comments: N/A Health Services Staff • Exp. D

.K.9 Waist Circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unke cutely III Nutrition No: Appears O Pulmonary Auscultati

ther: _football _basketball _handball stationary equipment • faletanagra urS areigiga niiiiig •';' Equipment Start Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. W m tali Cleared for Food Service: Yes X No Restrictions Comments: N/A ttiatts:niart Health