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D Date: 07/09/2019 Qua= Details 66 y/() male 3 different stools Last Chest X-Ray Date: TB Treatment TB Follow-up Recommended: No Sickle Cell: Sickle Cell Trait/Disease: No Provider Optometrist Mid-Level Provider Physician 01 Nurse Induration: 0mm Results: Sx free for 30 days: Yes Generated 08/10/2019 O7:0O
ature of Wines Date re‘ ee.tes p /res:ice a is Sign NYM--NEW YORK MCC Date ; EFTA00049323 BP-A0618 A&O DENTAL EXAMINATION JUN 16 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: • 1 2 3 4 5 8 7 6 9 1011 --- 32 CC 31 30 28 28 27 2825 24 23 22 1213 14
/06/2019 One Time TB Clearance: Yes Last PPD Date: 07/09/2019 Last Chest X-Ray Date: TB Treatment TB Follow-up Recommended: No Sickle Cell: Sickle Cell Trait/Disease: No Dualism Retails 66 y/o male 3 different stools Induration: 0mm Results: Sx free for 30 days: Yes Generated 08/10/2019 07:00 by RN Bure
3 4 5 8 7 8 9 10 11 12 13 14 — 15 18 32 31 30 29 28 27 2825 21 23 22 21 20 19- 18 17 0 BP-A0618 A&O DENTAL EXAMINATION JUN 18 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair , 00, CPITN: 3 3 2- 9 Head & Nock / Soft Tissue
/06/2019 One Time TB Clearance: Yes Last PPD Date: 07/09/2019 Last Chest X-Ray Date: TB Treatment TB Follow-up Recommended: No Sickle Cell: Sickle Cell Trait/Disease: No Dualism Retails 66 y/o male 3 different stools Induration: 0mm Results: Sx free for 30 days: Yes Generated 08/10/2019 07:00 by Bureau o
by Date a** si .nature of Witne s Date a is Sign NYM -N EW YORK MCC Date EFTA00105056 BP-A0618 A&O DENTAL EXAMINATION JUN 18 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: 1 2 3 4 5 — 7 8 9 10 11 12 13 11 15 18 32 31 30 28 28 27 28 25 21 23 22 2
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