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7/09/2019 12:35 Provider M R : WHITE Reg #: 76318-054 Facility: NYM Unit: H01 Reflexes: Right ken Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
90 day(s) SLIDING SCALE Subcutaneously - Two Times a Day x 7 day(s) Pill Line Only 008 of 148 Withheld e emption Details Frequency Due Date General Radiology-Spine / Cervical- One Ti(ix)(6); (b)( )(C) 08/29/2019 General Specific reason(s) for request (ttfififtSiffigraei6 InfRnalje 66 YR OLD MALE WITH COMPL
M Race: WHITE Facility: Encounter Date: 07/09/2019 12:35 Provider. a MLP Unit: Reflexes: flight ken Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
x 7 day(s) Pill Line Only prescriber Order Take the tablet by mouth as directed x 6 day(s) Due Date Priority. Frequency, Due Date Priority. General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH COMPLAITN OF RIGH
3 Sex: M Race: WHITE Facility: Encounter Date: 07/09/2019 12:35 Provider. Unit: Reflexes: flight ken Biceps: Patellar: Brachioradialis: Achilles: Sensation: Vibratory: Yes Light Touch: Yes Pin Prick: Yes Comments: GU: Chaperoned By: Rectum: Not Done Comments: Refused. Male Genitalia:
x 7 day(s) Pill Line Only prescriber Order Take the tablet by mouth as directed x 6 day(s) Due Date Priority. Frequency, Due Date Priority. General Radiology-Spine / Cervical- One Time 08/29/2019 Routine General Specific reason(s) for request (Complaints and findings): 66 YR OLD MALE WITH COMPLAITN OF RIGH
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