Nicole Thompson

 
 BETHESDA HEALTH 
 RELEASE FROM LIABILITY FOR PATIENT'S PERSONAL PROPERTY 
 The security of your personal property is important to us; however, Bethesda Health's goal is to 
 attend to your healthcare needs. Bethesda Health accepts no responsibility for any personal property that you 
 maintain in your possession or at your bedside.  
 As a patient, you have the right to keep your personal property with you while in the hospital. However, if you 
 choose to keep your personal property with you during your stay, you must sign the following disclaimer, 
 releasing the hospital from any and all liability for the loss or damage to your personal property. 

 September 29, 2015 09:02:03-0400 
 Patient of Legal Representative 
 Date 
 Signed by Retano. Lisa on January 26, 2021 09:02:03-040 
 September 29, 2015 
 Signature of Witness 
 Date 
 Pt Name: 
 Nicole Thompson
 MRN: 111786xx 
 Date of Birth: May 18, 1990T00:00:00 Pt ID: 2521037xxx 
 RELEASE FROM LIABILITY FOR 
 Sex: F 
 PATIENT PERSONAL PROPERTY 
 Admit Date: April 28, 2017T00:00:00 
 Admitting M.D.: Stephen Sanchez 
 Attending M.D.: Stephen Sanchez 
 GENNADIY 
 GENNADIY
