Devin Chavez
 
 
 MN 
 I 
 Neurological, Orthopedic & Spine Center 
 PREOP REQUEST 
 PATIENT NAME: Luces, David Jose Gregoric 
 D.O.B.: 
 15/02/04 
 D.O.A: 
 23/14/05 
 PHONE: 786-253-8738 
 ADDRESS: 801 Brickell Key Blvd Apt 3304 
 Miami 
 FL 
 33131 
 SURGERY TYPE: Lumbar discectomy 
 LABS REQUIRED: CBC ,CMP, PTT, PT/INR, U/A, EKG, CHEST XRAY 
 ATTORNEY: Edersy Suarez 
 ATTORNEY CONTACT: 786-420-2893 
 DATE OF PROCEDURE: 29/15/08 
 SURGEON: Robert Jacobson MD, Miami I 
 Requested By: Gretchen 
 Comments: Please schedule STAT 
 Send Results to: 
 Surgerydept1@omniorthoandspine.com 
 Fax to 954-440-3115 
 817 S. University Drive #109 Plantation, FL 33324 T.954-279-2170 F.954-440-3115 
 5040 NW 7th Street #530 Miami, Fl 33126 T.305-461-3116 F. 954-765-3206 
 13526 Village Park Drive Orlando Fl 32837 T. 407-794-1465 F. 954-440-3115
