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WRISTS IV. SUBCUTANEOUS HEMORRHAGE OF LEFT DELTOID MUSCLE V. HYPERTENSIVE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE A. CARDIAC HYPERTROPHY (440 GM) B. LEFT VENTRICLE HYPERTROPHY (1.9 CM) C. RENAL ARTERIOLAR SCLEROSIS D. SLIGHT CORONARY ATHEROSCLEROSIS E. SLIGHT TO MODERATE AORTIC ATHEROS

care in last 33 days 72 Yes No U Papitil in-pabent HeepiW ED/ outpatient U •losp COA C Other. specify: J J Nursing hone/long teem care Hospice rickey Decedent's residence DAM AND HOUR Of MAIM: 08/10/2019 7:36 AM Unk INJURY: Date Time: AM PM AT WORK J YES U NO TYPE OF PLACE:Irk

WRISTS IV. SUBCUTANEOUS HEMORRHAGE OF LEFT DELTOID MUSCLE V. HYPERTENSIVE AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE A. CARDIAC HYPERTROPHY (440 GM) B. LEFT VENTRICLE HYPERTROPHY (1.9 CM) C. RENAL ARTERIOLAR SCLEROSIS D. SLIGHT CORONARY ATHEROSCLEROSIS E. SLIGHT TO MODERATE AORTIC ATHEROS

r: O Recent hospitalizations or travel: if yes, where and when: O Dentist name/address): O Tattoos or scars (e.g., old surgery), describe: 0 Any Hospice care in last 30 days? If so, where: High blood pressure Heart problems Diabetes Seizures Lung problems Tuberculosis Tobacco use Brain infecti

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a celebration of his fife on Sunday. June 28. 2009 at 12 PM at Ill S 911' Street. Lantana 547.0931 In IN of flovrem ptcylease make a donation to Hospice of t.••••••acmisalwamorotoo mei* Meet.. visit Pelnithrachlbst.comrobituaries JOHNNIE H. PETTIFORD Our Beloved Father Johnnie H Pettiford was Cel

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Optional Services Prescription drugs Dental services Rehabilitation and other therapies Prosthetic devices, eyeglasses, durable medical equipment Hospice services Inpatient psychiatric hospital services for individuals under age 21 e Other specialist medical or remedial care Note: Supplementary Sec