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FROM : ST. JOE GAS & BAIT FAX NO. 12185687272 Jun. 04 2006 08:04PM P5 <br /> 1: <br /> SURGICAL SERVICES DISCHARGE <br /> rr given, and reviewed with patient. <br /> Instruction/Discharge sheet for 1' �-' I <br /> to become drowsy or have slow reflexes for <br /> [ "`(ou have received medication that causes some people <br /> several hours. <br /> DO NOT drive or operate any equipment for 24 hours. <br /> DO NOT drink alcohol. <br /> DO NOT engage in other jobs or activities that require you to be alert. <br /> I <br /> [] Prescriptions: V s� <br /> Prescription: 0 Civen to family <br /> ❑ Called to: <br /> p Destroyed <br /> ❑ You have a clinic appointment with: physi cian/Clinic Location <br /> ' at Time <br /> On Day Date <br /> Other Comments or Instructions: <br /> �t. raF. .. _ ' <br /> t <br /> 6610 . <br /> * Meds given prior to discharge Time <br /> I have reviewed and understand the above instructions. <br /> paueM/Responsiole Person Signaturs Date <br /> i ` t <br /> 1•��•' ,/ ,,.. S \ 1. Time <br /> urses Signature <br /> ViS22133 WATT,B0WHIEE JBAR <br /> CUYWAIZEaONAL white-Medical Records ' AD1', DATE.. 61/11105 STATUS:tSDC M069042 <br /> (��A T T SDc Age 38 DDB WDI Eye Yellow-Patient COPY Dr: (,9MI>`uR,TIMDTNY P�g Mol'16 PFtCtJR: 218-'S8b-6B 11 <br /> CROSBY,MINNESOTA 56441 IIIIIIP IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br />