Documents tagged "Patient Name"

Found 9 documents with this tag

EFTA00005569-p-6.jpg

The image shows a printed document with multiple sections of text and fields filled out. The top section appears to be titled "Photo Lab Print Release," followed by a date that is partially obscured (starting with "07/30/96"). There are two blacked-out names in the first field labeled "Patient Name." Each subsequent section has similar fields such as "Photographer," "Print Number," "Medical Record," and others that are also filled out with either blacked-out information or actual data like dates and initials. The document is secured by a binder clip on the left side, indicating it's meant to be part of an organized collection or file.

Photo Lab Print Release Patient Name Print Number Medical Record Lab Print Release Patient Name Photographer Number Medical Record form id Photo Lab Print Release,07/30/96 Patient Name.Photographer,Print Number,

DOJ-OGR-00006583.jpg

The image shows a printed document with text on it. The top part of the text is partially obscured, but what can be seen includes phrases such as "Request for" and "Laboratory Services" along with a file date in blue text that reads "08-26-97." Below this header, there are lines where information should be filled out, including sections titled "Patient Name," "Address," and "Phone Number." The document appears to be related to medical or healthcare services due to the context of its purpose. The style of the image is a simple photograph capturing the printed page without any additional embellishments or decorations.

Laboratory Services Patient Name Phone Number Request Laboratory Services Below Patient Name Address Phone Number

DOJ-OGR-00026318.jpg

The image is of a document with printed text, which appears to be an official form or letter from a medical institution. At the top, there's a section with handwritten notes and marks, suggesting annotations or corrections have been made. The visible portions of the text include phrases such as "Patient Name," "Address," and "Phone," indicating fields for personal information about the patient. There is also some reference to medical terms like "Health Care Provider," "Appointment Date," and "Time," which suggest that this form is related to scheduling or keeping track of appointments within a health care context.

Patient Name Health Care Provider Appointment Date Patient Name Address Phone Health Care Provider Appointment Date Time

DOJ-OGR-00026287.jpg

The image shows a printed form with various fields and headings. At the top of the form is the title "Prisoners Health Services" followed by what appears to be an identification number in pink ink. There are sections titled "Patient Name," which is currently blank, "Medical Number," again left empty, and other areas such as "Date of Birth," "Address," and "Phone Number." Each section seems to be intended for specific personal information about the individual receiving healthcare services. The form has a structured layout with lines dividing different fields, suggesting it's designed to collect essential demographic and contact details.

Prisoners Health Services Patient Name Medical Number Phone Number Prisoners Health Services Patient Name Medical Number Date Birth Address Phone

DOJ-OGR-00026274.jpg

The image is a blurry photograph of a printed document. The text on the document is partially obscured and not fully legible due to the focus and resolution of the photo. However, it appears to be an informational sheet with various sections such as "Patient Name," "Medications," and possibly additional details like dates or notes. There are some visible words and numbers that suggest a medical context, but their specific meanings are not clear in this image. The overall quality of the photograph makes it difficult to provide detailed information about the document's content.

Patient Name However Patient Name Medications

DOJ-OGR-00026244.jpg

The image shows a printed document with various columns of information. At the top left corner, there's a header that includes numbers and possibly reference codes. There are several entries under different categories such as "Date," "Time," "Location," "Patient Name," and "Medical Problem." Some of these fields have data entered into them, while others appear to be blank or marked with an "N/A." The document appears to be a medical record sheet used for tracking patient information during hospital visits or treatments.

Patient Name Medical Problem Date Time Location Patient Name Medical Problem

DOJ-OGR-00026217.jpg

The image is a scanned document titled "Bureau of Prisons Clinical Encounter Administrative Note" with the date stamp reading April 2017. The document appears to be a form intended for medical-related interactions within the Bureau of Prisons, possibly in the United States. There are sections labeled "Patient Name," "Visit Date," and other fields that would likely contain information about the patient's visit, although the specific details are redacted or not filled out on this particular form. A signature is visible at the bottom right corner of the document, but the name associated with it is not legible in this image. The style of the document suggests a standard administrative format typically used by governmental agencies for tracking medical encounters within their jurisdiction.

Prisons Clinical Encounter Administrative United States Patient Name Visit Date Bureau Prisons Clinical Encounter Administrative Note April United States Patient Name Visit Date

DOJ-OGR-00026085.jpg

The image shows a document with various sections of text and numbers, including a form filled out by hand. There is also an x-ray film placed on top of the document, which appears to be a dental panoramic radiograph showing teeth and jaw structures. The focus of the image seems to be related to medical records or patient information, specifically for dental care. The text includes words such as "Patient Name", "Date of Birth", "Address", and numbers possibly representing identification numbers, ages, or dates.

Patient Name Patient Name Date Birth Address

DOJ-OGR-00025627.jpg

The image shows a printed document with a pink header at the top that contains various sections of information. The text is small and includes words such as "SERVICE", "Psychopharmacology Observation Summary", and "Patient Name". Below this header, there are several boxes with lines for filling in details like patient's name, date, time, and possibly additional notes or observations that are associated with a psychiatric observation summary. The body of the document is mostly blank, suggesting it may be used to record specific data related to the psychiatric care of patients. There is no visible text indicating people's names, locations, or significant objects other than those already mentioned.

Psychopharmacology Observation Summary Patient Name Psychopharmacology Observation Summary Patient Name Below