Document NeVnaxbY6zoML8Vrx93nBpnOR
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a*- Dear Dr. Tauber:"
Date Dec. 13, 1974-
I recently participated in the vinyl chloride medical surveillance program as an employee of The Pantasote Company
of New York, Inc.
Please forward all test results to my personal physician.
Dr. Jamie Martinez > 11-05 Fair Lawn Ave. Fair Lawn. N. J. 07410
Sincerely,
Signature _ Print Name
oseph Memice
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UCCLEW0345
2.
NAME
TVSZPjJ
DATE
employment date
9/at/l>o
DEKIRTMENTZ!Z. iro A/0/?/i
Please answer the following questions to the best of yoilr
knowledge.
/
1. Do you drink alcoholic beverages?
Beer / Light Moderate Heavy
8 - fiT
Yes
Light
0
. aNo
Liquor (including wi Moderate Heavy
.2 Have you ever had hepatitis?
-Yes
O
(If Myes", give dates and details.)
m
JP--
3. What companies have you worked for before being employed by
Pantasote? (Give approximate dates, titles or positions held
'and name of company.)
OXo/VJTS
. -7"
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''
a. What chemicals or drugs were you exposed to with your previous employer? (Give names of chemicals or drugs and dates exposed.)
4. Do you smoke?
Yes D
(If "yes'1, the number of packs a day.
No .0
UCCLEW0346
I*
5. Have you ever been Hospitalized:'
Yes
O
(If "yes", when and for what illness?)
No
m..
3.
6. Have you ever received any blood transfusions?
(If "yes'1, give dates and details.) i
a
13
Yes
Q7. Are you presently taking any form of medication?
No
`I hereby authorize Idle doctor or his designated representative to give me a physical examination and to draw a blood specimen forlaboratory tests.
Signature:
+ At* a
<N / "4
UCCLEW0347
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--------
**-
---
MEHICE, JOSEPH
PATIENT SOC.-IEC. NO.
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11/19/74
DATE DRAWN- -W^
CR TAUBERS CO. PHYSICAL*
893 PARK AVE.
NEK YORK
N.Y.
DATE REC?0*;` .**F'
ACCT. MO.;
:..'. ^ -
5512
SPEC. NO*"
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J!?LV'*`*''!.>*-. `S&V ^ (Tp1* *''
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CHEM-SCREEN PRCFILE
CALCIUM
PHOSPHDRUS .
BUN `
CREATININE - *
-
BUN/CREAT RATIO
URIC ACID
GLUCOSE (CS)
TOTAL PROTEIN
ALBUMIN ALB/GLCE RATIO THYMOL TURBIDITY
TOTAL BILIRUBIN
DIRECT 3ILIRUBIN .
TRANSAMINASE.SGO
TRANS AM IN AS ES GP
ALK. PHOSPHATASE
LDH
CHOLESTEROL BETA LIPID
TOTAL LIPIDS
SODIUM C.
POTASSIUM
CPLOP IDE-
G-GLUTAMYL TRANSPEP. C3C WBC
RBC - HGB
HCT
MCV
MCH
MCHC PERIPHERAL SMEAR
PLATELET
SEROLOGY (ART)
i TRIGLYCERIDES
8.90 . MG/DL. -
2.60
MG/DL
16.00
MG/DL. .
1.10.,- MG/DL
14.55
5.70
MG/DL
100.00
MG/DL
6.60
GM/DL
4.50
GM./DL
2.14 .00
UMTS
.76 M.G/DL
.20 MG/DL
2d.00
I.U./L
12.00
I.U./L
22. 00
UNITS/L
123.00
UNITS
164.00
MG/DL
8.90
UNITS
.39'
GM./DL
139.00-
MEQ/L
' 4.20 .
MEQ/L
106.OtT' ' MEC/L '
7.00
UNITS/L
6.30
THOUSAND
4.'75 14.80
KILL!ON GM/DL
43.30
PERCENT
" 89.00
U3
31.10
UUG
34.70
PERCENT
NORM
NORM -W\ *
NON-REACTIVE
85.00-.
MG/DL
:
8.8-10.8 2.0-4.7 6--25 0.5--1.5
2.5-8.5 65-115 6 0TM '3.4-5.5
0-10 0.1-1.5 0-0.2
1-40 1-40 10-40 90-250 125-300 7-15 0.3-1.0 134-145 3.5--5.5 96-110 1 - 3C 4.8-10.8 4-6
62-99 26-32 31-36
50-200
5r=t^* >}:* **jps^*^*=p A ***X=5S
TEST RESULTS OUTSIDE ESTABLISHED REFERENCE RANGE
:*****:$:;*** normal- A.NGE
AMYLASE
*(01)
RU
(Cl) --.ESULT UNACCEPTABLE- ADDITIONAL SAMPLE IS REQUIRED IF CLINICALLY INlICATED.
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JOSEPH E. O'BRIEN. M.D. PAUL A. BROWN, M.D.
UCCLEW034E
UCCLEW0349
Date
Dear Dr. Tauber:
I recently participated in the vinyl chloride medical surveillance program as an employee of The Fantasote Company of. Hew York, Inc.
Please forward all test results to my personal physician.
Dr. 7"
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Sincerely,
Print Name
Scz PH Srf /^f/&
UCCLEW0350