| Document Date: 2014-08-22 15:20:52
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Company Concentra Health Services Inc. / Concentra Operating Corporation / / Facility LABORATORY AND OTHER TEST FINDINGS Urinalysis / LABORATORY AND OTHER TEST FINDINGS Evaluation / / / MedicalCondition ataxia / glaucoma / deformities / paralysis / toe Spinal injury / disease / cataracts / Fainting / dyspnea / Eye disorders / enlarged heart / illnesses Seizures / emphysema / dizziness Sleep disorders / No Any illness / breath Lung disease / Chronic / macular degeneration / Ear disorders / Heart disease / muscle weakness / hernia / dialysis Liver disease Digestive problems Diabetes / tremor / chronic bronchitis Kidney disease / exophthalmos / loud snoring Stroke / psychiatric disorders / pulmonary / injury / heart attack / drug abuse / epilepsy / hypotonia / High blood pressure / low back pain / illness / hearing loss / paresthesia / average hearing loss / alcoholism / injuries / disorders / aphakia / asthma / / MedicalTreatment angioplasty / bypass / Heart surgery / Surgery / dialysis / / Person Appearance Marked / / / Position PULSE RATE Systolic Driver / DRIVER / Issue Driver / HEALTH HISTORY Driver / physician / General / Assistant Chiropractor / section Driver / optometrist / / ProgrammingLanguage C / / Technology dialysis / /
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Concentra Medical Centers (Ohio) Service Date: Patient Name: SSN: