Samantha Bishop

 
 Discharge Information 
 Attestation 
 Attestation to: I personally interviewed the patient, I personally examined the patient, I certify that the services 
 provided were clinically indicated and medically necessary for the care of this patient. 
 Electronically signed by: GO MD, JENSEN L 
 On 28/12/15 20-04 
 Electronically Co-Signed By:GO MD, JENSEN L 
 On: 06/12/22 08:10 
 Patient name: 
 Samantha Bishop 
 MRN: 71826185 
 FIN#: 91810185 
 Printed On: 
 10/30/2023 05:11 EDT 
 Page 37 of 516 
 Report Request ID#: 321834188
