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mily History - Sibling: Number of Siblings: I Significant Illnesses: Comments: Past Hospitalization: Reason Location When Acute Appendicitis Mount Sinai Hospital 1990 Complications: None Comments: Head: Normal: Yes Comments: Generated 07/0912019 13:03 by Bureau of Prisons • NYM Page 7 of 13 EFTA00048
88.1 MD Lbs Kg Waist Circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed, Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic, Disheveled, Unk cutely III Nutrition No: Appears O Pulmonary
of Siblings: 1 Significant Illnesses: Comments: Past Hospitalization: on Speaking/Listening English None Reason Location Acute Appendicitis Mount Sinai Hospital Complications: None Comments: Head: Normal: Yes Comments: When 1990 Ger-waled 07/C9/2019 13.03 by MLP Bureau of Prisons • NYM Page 7 of 13
88.1 MD Lla Kg Waist circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed. Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic. Disheveled, Unke Acutely III Nutrition No: Appears O Pulmonar
of Siblings: 1 Significant Illnesses: Comments: Past Hospitalization: on Speaking/Listening English None Reason Location Acute Appendicitis Mount Sinai Hospital Complications: None Comments: Head: Normal: Yes Comments: When 1990 Ger-waled 07/C9/2019 13.03 by Bureau of Prisons • NYM Page 7 of 13 EFT
.2 88.1 Lla Kg Waist circum Provider Exam: General Affect Yes: Cooperative Appearance Yes: Appears Well, Alert and Oriented x 3 No: Appears Distre ed. Dyspneic, Appears in Pain, Writhing in Pain, Pale, Pallor, Cyanotic, Diaphoretic. Disheveled, Unke Acutely III Nutrition No: Appears O Pulmonar
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