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between hereinafter called the. CBSDE STUDIENGEB57564HREN ACHELORPROGRAMME INTERNATIONAL USINESS INTERNATIONAL CULTURE AND MANAGE ENT INTERNATIONAL OURIS MANAGE ENT INTERNATIONAL MEDIA MANAGE ENT GENERAL MANAGE ENT BUSINESS PSYCHOLOGY WIRTSCHAFTSP 1 miles ____/____/____ NOTE: This form cannot be used to request ECT or psychological testing . Type of Service Requested:  Mental Health  Substance Abuse Patient Name: _____ Dry & Slept ____ Dry & Woke ____ Wet during night ___ Dry & Slept ____ Dry & Woke ____ Wet during night ___ Dry & Slept ____ Dry & Woke ____ Wet during night ___ Dry & Slept ____ Dry & Woke ____ W O 1 Nissen Fundoplication Name:__________________________ ____ __ Date:___________________________ ____ __ Dietitian:__________________________ ____ Telephone:_______________________ ____ __ Questions? _____Se"'uaZ. .____-Diyestive. _____Spinal. ____Oereb•.al. } ___Hyste"ia. ___HYPOchondria. ________Hay-Fever. _____AsthenOPia. .;___Sleeplessness. 1: .. _____ Chorea. ._____Nea•.-si(Jhtednes Copyright 2007 (909) 399-3104 www.pbguitarstudio.com POS II POS I POS III PENTATONIC LADDERS ____/____/____ Copyright 2007 Pebber Brown (909) 399-3104 www.pbguitarstudio.com PENTATONIC 1 /17 To day’s Date: ____/____/____ Group Name : ______________________________________ ________ _ _________________________ __________________________ Address: _______________________________ expCommeBNone ectations are postein the school ronment school rules are ed e and Best Practiehavioral Expeed are penvi No exteacce ratings requirevioral expectatioosted in the schoronment plicit sc ROVAROVAROVAROVAROVAROVATo Whom It May ConcernI request copies or summaries of the medical records forDate of Birth Phone NumberTo our of ceDr Paul LenkowskiRoanoke Valley ENT and Allergy2154 McVitty Authorizations and Financial Policy Authorization Referrals I understand that my insurance may require an authorization before services can be rendered I hereby agree to obtain any referrals and autho Dr . S. hane Ling. Ear Nose and Throat Surgery. 20 August 2022. Otology. Otitis Media. Otitis Externa. Rhinology. Nasal obstruction. Tonsils and adenoids. OSA. Tonsillitis. The Ear. Eustachian tube is shorter, horizontal and floppier. Common ENT emergencies. Basic management . How to refer. Cases you should not miss. On call team. 0875, 0709. For patients who need to be reviewed in ENT OPD within next few days; refer to RAC clinic.