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Page 2501 | BP-A0618 A&O DENTAL EXAMINATION JUN 16 (Initial Clinical Dental Findings) U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS _ aa | petite 12 3 465 67 8 § 1011 1213 14 15 16 30 29 28 27 2625 2423 22 2120 19:18 17 Classification: Dental Prostheses at Intake: met im AVANCE Type: (RSSjon ObServed. ge: Laer z Condition: Ons of” Croudia obsewved {ntra-oral Photos Taken: Radiographs Taken: (Decument findings on A&O encounter) Yes Yes Instructed how to obtain urgent and non-urgent dental care: ‘Yes: J No: Treatment Priorities: ” Non-urgent Urgent Referred to Sick Call: . non-urgent Radiographs authorized: . Prophylaxis authorized: Yes Jf No Sens (Approval valid 18 months from examination date) s: Panorex: Patient Name: — 0 SYN Det ee & Regist#r Number: Institution: 7b % |& OS4 MCC NEW YORK PDF Prescribed by P6400 ' Replaces BP-AQ618 of JUN 10 MCC New York DOJ-OGR-00026177