2019 Counseling Diagnosis Copay Required:No Cosign Required: No TelephoneNerbal Order: Completed by i07/12/2019 14:20 Provider !Dirtc_42me. Verbalizes Understanding Generaied 07/12/2019 14:20 by MD Bureau of Prisons - NYM Page 3 of 3 EFTA00110387 Bureau of Prisons Health Services See Amend

2019 Counseling Diagnosis Copay Required:No Cosign Required: No TelephoneNerbal Order: Completed by i07/12/2019 14:20 Provider !Dirtc_42me. Verbalizes Understanding Generaied 07/12/2019 14:20 by MD Bureau of Prisons - NYM Page 3 of 3 EFTA00140188 Bureau of Prisons Health Services See Amend

w-up at Sick Call as Needed Patient Education Topics: Date Initiated Format Handout/Topic ii. Outcome 07/24/2019 Counseling Access to Care . Verbalizes Understanding 07/24/2019 Counseling Preventive Health Verbalizes Understanding Copay Required:No Cosign Required: Yes Telephone/Verbal Order

Counseling Plan of Care Copay Required:No Cosign Required: No TelephoneNerbal Order: No Completed by on 07/30/2019 14:05 ry yiste:r I:10room Verbalizes Understanding Verbalizes Understanding Generated 07130/2019 14:05 by Bureau of Prisons • NYM Page 3 of 3 EFTA00105101

Due Date 08/01/2019 00:00 Due Date Priority Routine Priority 08/29/2019 Routine R 2-3 MINUTES 3 DAYS AGO. udg ii Provider 8eaudo caltOttle Verbalizes Understanding Verbalizes Understanding Generated 07/30/2019 14:05 by Bureau of Prisons • NYM Page 3 of 3 SONY _00001034 EFTA_00000243 EFTA00