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/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
Referred to Sick Call: Radiographs authorized: PAs• . Prophylaxis auUtortzect Yes I No (Approval var 18 months from examination date) EPNs: Panorox iPc t Nan= i 9 4t, n -376 1-rite_ E. Dentist Si nature: 1,3" it 7‘ lisznben 3 IS= OS-1/4\ Institution: MCC NEW YORK Date: 7- 06 -1 9. Si
/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
nt Retuned to Sick Call: Radiographs authorized: FAa- . Prophylaxis augtortzect Yes I No (Approval var 18 months from examination date) EPNs: Panorox iPc t Nemec i 9 Skin teS ti E Den' ! Nu isitsr _7‘ tsts.mben 3 I Sr- OSN Institution:/ / MCC NEW YORK Date: 7- 26 -1 9. Signature Block/St
/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 Duration Petah 66 y/o male 3 different stools Induration: 0mm Results: Sx free for 30 days: Yes Generated 08/1 0/2019 07:00 by RN Burea
nt Referred to Sick Colt Radiographs authorized: PM. . Prophylaxis authorizect Yes I No (Approval var 18 months from examination date) BW5: Panorox :ga t Narrar. , 9 SA.C.4 O -5;SV7 -42_ti 2- D ' I alur : 1)17-5 istur Number: i I \ Institution: / MCC NEW YORK Date: 7 .- 74 -19. /Stamp
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