MECKLENBURG COUNTY HEALTH DEPARTMENT
VISION \ HEARING \ DENTAL \ HEALTH WORKSHEET
SCHOOL: RN:
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
7/14/2007 PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS 7/12/2007
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID
PATIENT INFORMATION REASON PATIENT CONTACT / DATE COMMENTS SECURE HEALTH
GRADE
CARE CARD
NAME 1. TC LS
TEACHER ADDR ZIP: 2. TC LS
PARENT 3. TC LS
DATE PHONE Vision Hearing Dental Medical 4. TC LS INSURANCE
ENCOUNTER
COMPLETED
PHONE GL Yes No PMD VSP MEDICAID