3
Shared Docs
3
Same-Page
3 / 3
Mentions
e provide date of implant: O Magnetic Dental Implants O Transdermal Patches 0 IUD O Tissue expander for future implants O Bone Stimulators. Insulin Pumps. or Mechanical Valves O Programmable Shunts WARNING: fore entering the MR room, you must remove all metallic objects including HEARING AIDS, DEN
fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O Infusion Pumps 0 Coils. Catheters. Filters or Wires in blood O Artifical Limbs or Joint Replacement O Tattooed Eyeliner O Artificial Heart Valves O Stents If yes, please provide date of implant
s If yes, please provide date of implant Magnetic Dental Implants Transdermal Patches IUD Tissue expander for future implants Bone Stimulators. Insulin Pumps, or Mechanical Valves Programmable Shunts WARNING: Before entering the MR room, you must remove all metallic objects Including HEARING AIDS, DENTU
res or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters, Filters or Wires in blood • Artifical Limbs or Joint Replacement Tattooed Eyeliner Artificial Heart Valves Stents If yes, please provide date of implant: Magnet
implant: 0 Q Magnetic Dental Implants I= D Transdermal Patches CI D IUD 0 0 Tissue expander for future implants 0 0 Bone Stimulators. Insulin Pumps, or Mechanical Valves 0 D Programmable Shunts WARNING: Before entering the MR room, you must remove all metallic objects including HEARING AIDS,
n body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Prosthesis CI 0 Infusion Pumps 0 0 Coils. Catheters. Filters or Wires in blood 0 0 Artifical Limbs or Joint Replacement CI 0 Tattooed Eyeliner 0 O Artificial Heart Valves 0 0 Stents If yes, please provide d
Entities connected to both Insulin Pumps and Filters or Wires
Pacer Wires or Defibrillator
ORGANIZATION
George W. Bush
PERSON
Jeffrey Epstein
PERSONK Visa
ORGANIZATIONTHE TIME OF SERVICE
ORGANIZATIONSignature of Patient
ORGANIZATIONEast River Medical
ORGANIZATIONBRUCE W. M.D. M.D.
PERSONMechanical Valves
ORGANIZATIONK Return
ORGANIZATION
Bruce Moskowitz
PERSON
BRUCE W
PERSON