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BP-A620.060 PATIENT PROBLEM LIST CDFRM AUG 96 U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS PROBLEM LIST DATE NOTED SIGNIFICANT DIAGNOSIS SIGNIFICANT OPERATIONS/ INVASIVE PROCEDURES DATE ADVERSE / ALLERGIC DRUG REACTIONS (If none, record “No Known Drug Allergies) Patient Identification (This form may be replicated via WP) (Name, Reg #, DOB)

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Page 1: Form BP-S620.060, Patient Problem List

BP-A620.060 PATIENT PROBLEM LIST CDFRMAUG 96

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

PROBLEM LIST

DATENOTED SIGNIFICANT DIAGNOSIS

SIGNIFICANT OPERATIONS/INVASIVE PROCEDURES DATE

ADVERSE / ALLERGIC

DRUG REACTIONS

(If none, record “No Known Drug Allergies)

Patient Identification (This form may be replicated via WP)(Name, Reg #, DOB)

Page 2: Form BP-S620.060, Patient Problem List

PROBLEM LIST (Continued)

DATENOTED SIGNIFICANT DIAGNOSES

SIGNIFICANT OPERATIONS/INVASIVE PROCEDURES DATE

Patient Identification(Name, Reg #, DOB)


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