Epstein Secrets

Provider. IMIll ekILP Unit: F01 Immunization Date: Provider: IMIE. MLP Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/201912:51 EST Immunization Date: Provider: NEB MLP Location: Drug Mfg: Lot Number: Dosage: Route:

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

b)(6); (b)(7)(C) IMLP Immunization Date: Provider: b)(G); <b>(7 lCC> LP Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/2019 12:51 EST Immunization Date: Provider (b)(G): (b)(7)CC> MLP Location: Drug Mfg: Lot Number: Dos

ITE Provider: r b)(6); (b){?)(C) I Dental Asst Reg#: Facility: Unit: 76318-054 NYM 205 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 b~""(b.,.,, >(5,.,... >: .,,.., (b>""' (7,..,.,)(c,.,...)--

b)(6); (b){7){C) MLP Immunization Date: Provider: (bl<5>; <bJ(7J<c ) MLP Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/2019 12:51 EST Immunization Date: (b)(6); (b)(7)(C) Provider .__ ___ ..... MLP Location: Drug Mfg: L

WHITE Provider: r b)(G); (b)(7)(C) p ental Asst Reg#: Facility: Unit: 76318-054 NYM Z05 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 b~~bl_r5_u _b)C-7J_cc_> --~ !Dental Asst on 07/19/2019 13:4

. Unit: Immunization Date: Provider: ~ )(6); IMLP -~- VZ~V-C-' _ _._ Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/2019 12:51 EST Immunization Date: Provider: V,X6), b\Q\IC\ IMLP Location: Drug Mfg: Lot Number: Dos

WHITE Provider: rb)(6); (b)(7)(C) I Dental Asst Reg#: Facility: Unit: 76318-054 NYM Z05 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~~b~)(6~);=(b~)(7=)(~C)-~IDental Asst on 07/19/2019 13:49

Provider. IMIll ekILP Unit: F01 Immunization Date: Provider: IMIE. MLP Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/201912:51 EST Immunization Date: Provider: NEB MLP Location: Drug Mfg: Lot Number: Dosage: Route:

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 HITS Facility: NYM Unit: F01 Immunization Date: Provider: Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/201912:51 EST Immunization Date: Provider: Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt:

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

TS Reg #: Facility: NYM Unit: 01 18-054 Immunization Date: Provider: Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt: Comments: Varicella Series Administration: History Unknown, Not Administered Documented Date: 07/09/201912:51 EST Immunization Date: Provider: Location: Drug Mfg: Lot Number: Dosage: Route: Exp Dt:

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