DOJ-OGR-00024179.jpg

BP-A0618 A&O DENTAL EXAMINATION JUN 16 (initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: Gocd | Head & Neck / Saft 1s 3.45 6 7 B OO 101f 1213 f4 15 1 30 29 26 27 2625 2423 22 2120 19-18 1 Classification: Dental Prostheses at Intake: Type: Age: Condition: intra-oral Photos Taken: Petes Observed. Later orlera” Crudint obseved Radiographs Taken: (Document findings on A&O encounter) Yes Yes (e, Instructed how to obtain urgent and non-urgent aan care: Yes: v Treatment Priorities: Non-urgent: Urgent: Referred to Sick Call: . non-urgent Radiographs authorized: Prophylaxis authorized: Yes Jf No PAs: (Approval valid 18 months from examination date) BYVs: Pancrex: Patient Name: Dentist Sianature: 0 Stun del t}re AeGistir Number. Institution: i Sie aia 7b 31% OS4_ |Mcc NEW YoRK 26-19. 5 MCC New York PDF Prescribed by P6400 ’ Replaces BP-A0618 of JUN 10 DOJ-OGR-00024179