EFTA00139060

| **76318-054** | EPSTEIN, JEFFREY |

| :--- | :--- |

Medication Administration Record

AUGUST 2019

<table><thead><tr><th colspan="2">Medication Orders</th><th>Time</th><th>1</th><th>2</th><th>3</th><th>4</th><th>5</th><th>6</th><th>7</th><th>8</th><th>9</th><th>10</th><th>11</th><th>12</th><th>13</th><th>14</th><th>15</th><th>16</th><th>17</th><th>18</th><th>19</th><th>20</th><th>21</th><th>22</th><th>23</th><th>24</th><th>25</th><th>26</th><th>27</th><th>28</th><th>29</th><th>30</th><th>31</th></tr></thead><tbody><tr><td>Ord. Date</td><td rowspan="4">MD</td><td>PRN</td><td>MI YJ</td><td>MI YJ</td><td></td><td>

<table border="1"><tr><td colspan="3">Providers: YJ =</td></tr><tr><td colspan="3">Documentation Codes: ORD = Order | NI = Dose Not Indicated</td></tr><tr><td>Registration #: 76318-054</td><td>Pt. Name: EPSTEIN, JEFFREY</td><td>DOB: 01/20/53Report information is current as of the date and time of printing: 05/11/2020 09:57ESTSDNY_00017424</td></tr></table>