THE MEDICAL CITY CLARK Executive Check Up Itinerary . PATIENT NAME sex | DATE cuvueay woracio saver ‘nce: 80 z Male AN. 8, 2020 BIRTHDATE: SEPTEMBER 26, 1939 _.____|__[ room vee outpatient | "ACCOUNT TYPE: PERSONAL ACCOUNT J PACKAGE TYPE: Platinum Senior Male Evahiation 2 (@0 yrs. old & above) DATE "ACTIVITY PERSONNEL W- | PREPARATION aMINOER ‘TM cuARGE 00 AM] Regintaton: araction EqUStat” | Plate proceed to infomation dak. Show the vending ony ofthe sqnedHinrar and tetter of schedules and tests Authotuaton fom HMofeompany (theres ann Tam | toad Gamer Tedial Regus 10-1 hours eating Take your at fod exe Technologist | and water not ener than B2OPM and not ter rH than 30:300M on JAN.7, as Serum crea Up Pra Do nt eat or drink unless ntraces bythe Ure Aas eof SoPr/aLT Hbcke 5a ROAM] Unrarcand of reread, Tati sting Take water oly Wotan fa pancreas, Kidneys, urinary ‘adder before te procedure adder fadoter Prostate Techologst 4A. cest x= ay A View) None BREAK Complimentary meal inuded Teo AN [52D ehecrdogram Gardevaselr | None Sut TROOWN | Physal Assesment Goordinaine | one Phyatdon BETWEEN | 7. ENT Coneaaton ENT center | None 1eM~ | Pure Tone Audometry 0M Within te | 3 OphthoinogyConautaton | Ophaimologat | Rone a Within the | 30" Ditton Dison Wome ay Within the | i, Raine Fecal with ocak ‘ELUStaR | voided ment and vain Citak for 24 hours day | hood rior tothe ealecton ofthe specmens 12. Routine Ushi ‘GENERAL NSTRUCTIONS = * Your Promptness i highly appreciated ' Allcome of your test result may be avaliable fr release within 5-7 working days after your ECU. The date of your Results Discusion walbe scheduled once ALL results are ready The date willbe bazed on ‘YOUR/and your Doctor's aval. ‘Please send us back » copy ofthis kineray v/s email with your signature for your confirmation. 1 Time may be subject to some adjustments during the actual executive check-up schedule. ‘WAIVER | hereby acknowledge thatthe Executive Check Up t was property explained to me and thatthe package cost remains the same even if decided not to do any ore ofthe procedures that comprises the package. All addtional procedures and Specialist referrals requested by me and/or by ing Doctor which are not cvered by the Lette of Authorization 209 Gawker Cab Gan Login ly Intl sate 5 ‘sept Ze Pines “(4m Le S/O