Epstein Secrets

other: Exp. Date: May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P1131281381ED. Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions Comments: N/A

er: Dental Ant Unit: ZOS Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Generated 07/19120191

other: Exp. Date: May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P1131281381ED. Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions Comments: N/A

er: Dental Ant Unit: ZOS Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Generated 07/19120191

Exp. Dale: Exp. Date: Exp. Date: Exp.. Date: Exp. Date: nrilartiletriailiTtheiii3Oataiiiiiii:Ilii ,77:; .- • Start Date End Date 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. !fla;:a-)ciaetaitat7 - Cleared for Food Service: Yes • No Restrictions Comments: N/A MD 07/3

er: Dental Asst Unit: 205 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs far his Dental A & O screening but has not been escorted to dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Conereloci 07119/2019 13

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

r: Dental Asst Unit: Z05 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Generated 07/19/2019

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

YM Dental Asst Unit: Z05 Screening encounter at Dental Clinic. Reason Not Done: Unavailable Comments: Patient has had several call outs for his Dental A & O screening but has not been escorted to the dental clinic. Cosign Required: No Completed by Dental Asst on 07/19/2019 13:49. Page 090 of 148 With