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/2 Lab Tests-R-RPR Chronic Care Clinics-Diabetic-Comprehensive Metabolic Profile (CMP) New Radiology Request Orders: Dela Frequency endlUate General Radiology-Chest-2 Views One Time Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. Copay Required: No Co

her: Exp. Date: ------ May have the following equipment in his / her possession: Equipment Start D.:\te End Date Return Date C-Pap 07/30i2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL#: P1 1312813B1 ED. Work Restriction / Limitation: Cleared for Food Service: Yes --- x No Restrictions Comments: N

New Radiology Request Orders: Frequency One Time Details Frequency End Date Due Date 08/05/2019 00:00 Due Date 07/25/2019 00:00 Due Date General Radiology-Chest-2 Views One Time 07/25/2019 Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. Copay Requ

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#: P11312813B1ED. Work Restriction / Limitation: Cleared for Food Service: Yes --- x No Restrictions Comments: N/A

rders: Frequency One Time Details Frequency End Date Reg#: Facility: Unit: Due Date 08/05/2019 00:00 Due Date 07/25/2019 00:00 Due Date General Radiology-Chest-2 Views One Time 07/25/2019 Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH NO PMHX , REFERRED FOR ROUITNE CXR. Copay Requ

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PR Chronic Care Clinics-Diabetic-Comprehensive Metabolic Profile (CMP) New Radiology Request Orders: Details Frequency End aak Due Pate Edo* General Radiology-Chest-2 Views One Time 07/25/2019 Ftouline Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH NO PMHX REFERRED FOR ROUITNE CXR. Co