dness:No Abnormal Pigmentation: No Abnormal Lesions/Growths: No Comments: Lymphatics: Adenopathy: No Comments: Potential Items For Follow-up: Travel Outside US Other Infectious Disease History Rectum Not Done Male Genitalia Not Done PPD Administration Not Performed Comments: Patient has a history of

Abnormal Pigmentation: No Abnormal Les Ions/Growths: No Comments: Lymphatics: Adenopathy: No Comments: Potential Items For Follow-up: 10101 Travel Outside US Other Infectious Disease History Rectum Not Done Male Genitalia Not Done PPD Admintstradon Not Performed Comments: Patient has a history of

9 21 :43 NYM 72.0 Weight: Date Time Lbs 07/06/2019 21 :43 NYM 200.0 Prosthetic Devices/Equipment: Denied Potential Items For Follow-up: ~ Travel Outside US Other Infectious Disease History Comments: .cm Provider 182.9 .b)(6); (b)(7)(C) Kg Waist Circum. 90.7 I have reviewed O pages of intake p

Date Time Lbs Kg Waist Circum. Provider 07/06/2019 21 :43 NYM 200.0 Prosthetic Devices/Equipment: Denied Potential Items For Follow-up: ~ Travel Outside US Other Infectious Disease History Comments: 90.7 I have reviewed O pages of intake paperworks f ><6); (b)(7)(C) IPA-C Generated 07/06/2019 2