to Sick Cail: Radiographs PM: BWs Panore:c authorized: • Prophylaxis authortzed: Yes I No (Approval valid 10 months from examination date) Palient Narrar. , C,..-isti r skin , -3-cc-R--e_v £ D " nature: I>Ds ELI- -76 r Hanby: 3 I Se:- os-m Institution: / MCC NEW YORK Date: 7- 26 -1 9. Sign