William Sharp

 
 2016 Feb 29 FROM- CWFMD 
 T-256 P0027/0111 F-240 
 3883 imaging 
 Josh 
 Scheduling Imaging Procedures 
 1246 N FM 3083 West Suits C 
 Fax Orders to: 936-417-1017 
 Conroe, TX 77304 
 Patient Name: William Sharp 
 birth date: 2002 Jun 28 
 Phone#: 
 Diagnosis : M25.561 
 ICD-10: 
 ORDERED ON: 2021 Mar 04 
 Physician: Jason Laninghamma Physician
 Brain/Head wo 
 Signature: Jersey 
 70450 
 Abdomen W 
 Brain/Head wwo 
 74160 
 70470 
 Abdomen wwo 
 Upper Extremity wo 
 73200 
 Orbits wo 
 74170 
 70480 
 Right/Left 
 Abdomen/Pelvis wo 
 indicate liff or Right 
 Abd Complete Flat/Upright 
 X-Ray (Walk ins Only 9am-5pm) 
 74020 
 Femur 
 indicate Left or Right 
 Abdomen (KUB) 
 73552 
 Pelvis 
 74000 
 Finger 
 72170 
 Name: William Sharp 
 DOB: 2002 Jun 28 
 Date:
