EFTA00139326¶
BP-A0618¶
JUN 18¶
U.S. DEPARTMENT OF JUSTICE¶
A&O DENTAL EXAMINATION (Initial Clinical Dental Findings)¶
FEDERAL BUREAU OF PRISONS¶
Instructed how to obtain urgent and non-urgent dental care: Yes: ✓ No:¶
Treatment Priorities: None: Non-urgent: non-urgent Urgent: Referred to Sick Call:¶
Radiographs authorized: PAs: ___ BWs: ___ Panorex: ___¶
Prophylaxis authorized: Yes ✓ No (Approval valid 18 months from examination date)¶
Patient Name: Epstein, Jeffrey E¶
Register Number: 76318-054¶
Institution: MCC NEW YORK¶
Date: Signature Block/Stamp:¶
Prescribed by P6400¶
Replaces BP-A0618 of JUN 10¶
CONFIDENTIAL¶
SDNY_00009383¶