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Page 2401 — | oO 1 BP-A0618 A&O DENTAL EXAMINATION JUN 16 (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS “ 2.3 46567 6 9 1011 1213 14 15 167 32 31 30 29 26 27 2625 2423 22 2120 19° 18 17 4] RIGHT .. 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: Jf No: Treatment Priorities: Non-urgent | Urgent: Referred to Sick Call: non-urgent . Radiographs authorized: , Prophylaxis authorized: Yes’ / No PAs: BWs: Panorex: (Approval valid 18 months from examination date) Patient Name: —~ 9 Stn Delt Fe = ReQgisttir Number. Institution: 7, 31% OSY [McC NEW YoRK PDF Prescribed by P6400 * Replaces BP-A0618 of JUN 10 Dentist Signature: Lb }G); (DIF NC) DDS Signature Block/Stamp: Date: “J- 26 MCC New York DOJ-OGR-00026077