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Case 18-2868, Document 283, 08/09/2019, 2628241, Page577 of 883 a .... onpens ra NewYork-PREsBYTERIAN Hosprrat New York Weili Comell Medical Center CARO DIAGNOSTIC PROCEDURE ORDER FORM- Indeaip faaiie) to b6 ; ate. ex Sie is aoe eines Fer this form to eppropriate tact ante} and-complota the follaviing: Dato Frexadt Time Cheri indote ating Gre and provi cenota) ancl Umea test(e) weit De cone, Wiite the Dake and Thine, ms provided by txt eri, enio this berm. Folow pyran procedure for posting ore: cw unit ane! pace torn etiege? Do rch tet fon. Phoris-aea 10 reuse! cham, Give yetow copy to povcdooles WOITTEY COMBENT le Premier CLINICAL DATA CConeert Obtained Gi Roopiratory Precautions © 0 Wound/Siin Precautions . for Petals Cardiology tax to 88373 0 Pre-dp Date af Surgery 5 91-06-2015 21:17:22 GIUFFRE003288 CONFIDENTIAL