Epstein Secrets

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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

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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

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

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