CONSULTATION SHEET - CARANCI, JOHN C.

(b)(3) (b)(6) Standard Form 513 Rev. August 1954 Promulgated By Bureau of the Budget Circular A-32 CLINICAL RECORD .I CONSULTATION SHEET .5cue/4 i5 off" 1% EYe EYE CLINIC 39223 DATJ N, 2 Q 196 PLACE OF CONSULTATION ^DEDSIDE DON CALL. l~ Nan/e 2PHTHALM0 LO APPROVED FOR RELEASE^DATE: 1 O-Nov-2008 SIGNATURE AND TITLE A7 PATIENT'S IDENTIFICATION (For typed or written entries give: Name-last, first, middle; grade; date; hospital or medical facility) C'.I1,?I7 J6 1 ?