Megan Burton

 
 03-08-2023  FROM- CWFMD 
 936-703-5455 
 IMPORTANT: PLEASE PRESENT THIS SLIP AT YOUR APPOINTMENT 
 Women's Imaging Center 
 CONROE REGIONAL MEDICAL CENTER 
 Patient: 
 Erica Pirie 
 D.O.B.: 07-06-2001 
 & SCREENING BILATERAL MAMMOGRAM (Asymptomatic Patient with or without implants) 
 Diagnostic Bilateral Mammogram (Symptomatic, Olinical Findings with or without Implants) 
 Spot Compression 
 Stateotacitio Core Bx 
 *Galactogram 
 Ultrasound of the Breast(a) 
 Patient Diagnosis: 
 CHANGE 
 maxine 
 and Discretion 
 design 
 CONROE 
 13057 
 QUEST 
 Signature 
 REGIONAL MEDICAL CENTER 
 May 100 
 Yesya 
 GIN 
 ST 
 508 Medical Ctr Slvd. (2nd 1001 behind elevators) 
 Conton, Texas 77304 
 TOTAL 
 It 17318 
 (336) 589-7522 to schadule an appointment 
 1-882-MED-CNTR 1-382-693-2847METRO # 21-564-7000 ext 7100 (030) 530-7100. Fax (938) 839-7622 
 us May 
 BCDG-12 NEV. 08/07) 
 This term must be dated and will be valid for six (6) months. 
 June family no 
 from HI 
 Physician Signatura: 
 Date: 09-18-2017 
 condide 
 ACCOUNT INFOICAL CENTER 
 Love 
 promit 
 0102-11-90 
 LOOS BEL 
 JASON LANINGHAM, M.D. 
 804 West Montgomery 
 Name: Megan Burton 
 DOB: 07-06-2001 
