EFTA00130239

# FEDERAL BUREAU OF PRISONS

## Part I - Patient Report

### Resident Present Record

| | | |
| :--- | :--- | :--- |
| 1. Treatment | MACC Name: Yvonne | 3. Hospital Number: 701916-04A |
| 2. Emission | Anthony | 4. Date of Incident: 01/22/2018 |
| 3. Ward of Incident | BRNO MA: No. 124 | 5. Appointment | 8. Date | 1:22 am |
| 4. Ward of Incident | BRNO MA: No. 124 | 6. Unsupervised | 7. ZA |
| 5. Ward of Incident | Split Administration | 7. Tissue ID: 127/744 | 8. Receipted AID Code NU 228 |

## 11. Conclusion of Incident Date: 07/23/2018

Time: 12:27 AM

Gift receipt number of resident:

On July 23, 2018 at 12:27 AM, a resident in the Special Hours Unit was admitted to the MACC for further medical care. The resident was admitted on July 23, 2018 at 12:27 AM. The resident was admitted on July 23, 2018 at 12:27 AM. The resident was admitted on July 23, 2018 at 12:27 AM.

The resident is now in the MACC for further medical care. The resident is now in the MACC for further medical care. The resident is now in the MACC for further medical care.