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    Physician's Statement - Salman, Jennifer

    Uploaded by

    Jennifer Chan
    The document is an encounter summary from a medical clinic. It provides information about a post offer physical exam conducted on a patient, including the provider and visit details. Lab tests were completed and a drug screen was collected as part of the exam.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Physician's Statement - Salman, Jennifer

    Uploaded by

    Jennifer Chan
    17 views3 pages
    The document is an encounter summary from a medical clinic. It provides information about a post offer physical exam conducted on a patient, including the provider and visit details. Lab tests were completed and a drug screen was collected as part of the exam.

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    Physician's Statement_ Salman, Jennifer (1)

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    © © All Rights Reserved

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    The document is an encounter summary from a medical clinic. It provides information about a post offer physical exam conducted on a patient, including the provider and visit details. Lab tests were completed and a drug screen was collected as part of the exam.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    17 views3 pages

    Physician's Statement - Salman, Jennifer

    Uploaded by

    Jennifer Chan
    The document is an encounter summary from a medical clinic. It provides information about a post offer physical exam conducted on a patient, including the provider and visit details. Lab tests were completed and a drug screen was collected as part of the exam.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Date 04/01/24 Sunrise Medical Group Page 1

    5475 E La Palma Ave Suite


    100 Anaheim, CA 92807-
    2001
    (714) 970 0911, Fax: (714) 970-0604
    Encounter Summary
    Company: e5CREEN Acct. # 129202-404
    P.0 80x 25902 Employee: Ibrahim Salman DOB: 6/07/85
    Overland Park, KS 662ZS 3443 Bordeaux Place
    Pleasanton, CA
    94566
    Attention: Accounts Payable
    Telephone: (913) 327-1185
    Fax: (913) 234-4507 Ident: xxx-xx-4647
    Department:
    Job Title:
    Email'
    Provider: Le, Trl PA/ Sunil Mapara, MD Phone:(714) 660-8382
    Visit Date: 4/01/24 Time In: 8:25AM Out: 9:26AM Purpose: OH Emp - Post Offer Physical

    Description of Services

    ESNonCoIIeDS Sunrise OH - Escreen NonDOT DS Collect


    EScreenForm2 Sunrise OH - Escreen NonDOT Physical Form

    Comments

    NON-DOT PHYSICAL. COMPLETED


    NON-OOT DRUG SCREEN: COLLECTED
    Escreen Account B133313-1
    Client Account Name: ProLjnk Healthcare Confirmation #: AIB056:3717GZ

    Employer Name: ProLink Healthcare Medical Examination Report


    Clinic: Sunrise Medical Group - Anaheim
    Non-DOT Fitness Determination
    Appli t¥ Name fLast, First,
    Midde} Salman. Jennifer Z72-76—0736 47 F
    Address Phone Driver's License 8
    3443 Bordeaux Place B i1S455Z
    E.veniug.
    Applicant czimpletes this sultan, bu•t medical wammw (s encouraged to diWss patient. Yes N a
    Yes No
    1 Any Blness or injury in the last 5 years 13 ' Liver disease

    8/11/2023
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