DOJ-OGR-00026076.jpg

Page 2400 | 1 BP-A0618 A&O DENTAL EXAMINATION JUN 16 {Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS Occlusion: Oral Hygiene: « F123 4567 6 9 101 1213 4 15 16 O°32 31 30 29 28 27 26252623 22 21.20 19° 18 17 tab & Dental Prostheses at Intake: Comments: caddy ~ Type: (ROSSjon ObServed.- Age Loree onto Crrvdint opseved Condition: intra-oral Photos Taken: Radiographs Taken: (Document findings on A&O encounter) Yes Yes Instructed how to obtain urgent and non-urgent dental care: Yes: Y No: Treatment Priorities: Non-urgent: Urgent: Referred to Sick Call: non-urgent ; Radiographs authorized: ‘ Prophylaxis authorized: Yes’ Y No PAs: BWs: Panorex: (Approval valid 18 months from examination date) ————————— Patient Name: og etyn, JeFyrey & ReGistir Number. Institution: Date: 7b 31% OSY [McC NEW YorRK F-26149. PDF Prescribed by P6400 ’ Replaces BP-AQ618 of JUN 10 MCC New York DOJ-OGR-00026076