EFTA00110414¶
Bureau of Prisons¶
Health Services Modified Diet Request¶
Types of Diets:¶
___ Clear Liquid Exp Date: ___ Low Fat Exp Date: ___ Mechanical Soft Exp Date: ___ Low Cholesterol Exp Date: ___ Low Triglyceride Exp Date: ___ Renal Exp Date: ___ Full Liquid Exp Date: ___ Sodium Controlled Exp Date: ___ Snack Exp Date: ___ Diabetic Exp Date: ___ Calorie Controlled Exp Date:¶
X Other: FISH ALLERGIES. Exp Date: 07/30/2020¶
Comments:¶
| MD | ||
| Health Service Staff | ||
| EPSTEIN, JEFFREY EDWARD | 76318-054 | 07/30/2019 |
| Inmate Name | Reg# | Date |
Generated 07/30/2019 14:57 by¶
MD¶
Page 1 of 1¶
Bureau of Prisons - NYM¶