Mr. Kyle Grant

 
 Mr. Kyle Grant 
 MRN: 5512513 
 Preferred Pharmacy (continued) 
 Referral (continued) 
 Order 
 MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] 
 electronically signed by: Dennis S Frerichs, PA-C on 2020-06-13 0519 
 Status: Completed 
 This order may be acted on in another encounter. 
 Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 
 Authorized by: Dennis S Frerichs, PA-C 
 Ordered during: Office Visit on 2019-11-12
 Screening Form 
 General Information 
 patient name: Mr. Kyle Grant
 MRN: 5512513 
 DOB: 1997-03-16
 Mobile: 551-951-4519 
 Sex Assigned at Birth: Male 
 MC ROCKWOOD MAIN CLINIC Mr. Kyle Grant
 - SPOKANE 
 MRN: 5602313, DOB: 1997-03-16, Sex: M 
 400 East 5th Ave 
 visiting date: 2016-11-02
 Spokane WA 99202-1334 
 Page 89 
 Printed by 414221 at 7/17/23 9:40 AM