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ts: Family History - Sibling: Number of Siblings: 1 Significant Illnesses: Comments: Past Hospitalization: Reason Location Acute Appendicitis Mount Sinai Hospital Complications: None Comments: Head: Normal: Yes Comments: When 1990 Generated 07/0912019 13:03 by MLP Bureau of Prisons NYM Pale 7 of 13
. . .t::.:.o .•: , • II gilt • I NYM-NEW YORK MCC EFTA00050840 BP.A0618 JUN 18 U.S. DEPARTMENT OF JUSTICE MO DENTAL EXAMINATION (initial Clinical Dental Findings) FEDERAL. BUREAU 0 0 PRISONS endueIon: 5 t 2 3 4 5 8 7 8 9 10 11 12 13 14 15 18 0 - 31 31 30 28 28 27 2826 24 23 72 21 20 19 • 18 17 Oral
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
3 4 5 8 7 8 9 10 11 12 13 14 — 15 18 32 31 30 29 28 27 2825 21 23 22 21 20 19- 18 17 0 BP-A0618 A&O DENTAL EXAMINATION JUN 18 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Good Fair , 00, CPITN: 3 3 2- 9 Head & Nock / Soft Tissue
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
by Date a** si .nature of Witne s Date a is Sign NYM -N EW YORK MCC Date EFTA00105056 BP-A0618 A&O DENTAL EXAMINATION JUN 18 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: 1 2 3 4 5 — 7 8 9 10 11 12 13 11 15 18 32 31 30 28 28 27 28 25 21 23 22 2
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