. New 26 Cinton Sted, Concord, NH 03301 8 'PSHI FAX COVER SHEET PRIVILEGED AND CONFIDENTIAL ‘he information contalned this facsimile message ts privlege and confidential and intend ony forth eof ‘the indvidaa or entty named below. You are hereby noted that any dissemination, dsribulon, or copy of this ‘Sacsinie tart prohibited. Ifyou have received ths facsimile ln errr, please Immediately nif th sender by ‘telephone. If th fcsile contains a patent's proteced health information, you wil Be aked lo renum the cover sheet and il documents received to the sender et he adress above. are; 09/09/2019 ‘Torat Paces: rr ‘Acancr/ AGENCY bm / wus Denakinar, Social WorkcDept. FAX NUMBER Contact PRONE Buwnc SeNTTo: ‘Nuwaen: NICS Index Self-Submission Form foy Boos eee ea vassal {se acs Reson deni (Rn. ‘NEW HAMPSHIRE HOSPITAL FAX LOCATIONS AND NUMBERS. son se eg eee iar var ADMINISTRATION OFRIGE—————_— r BTS cA Per For ADMITTING OFFICE (eoaya7isra 'BRBENE LIBRARY (603) 271.5425 (603) 271-5420 “Campus Poues (603)271-5333 (603) 271-5555 Ewptoves Heauta Senvi "608 27i5401" (68) 271-8344” FINANCIAL SERVICES (603) 273-5045 (603) 271-5853 HEALTH INFORMATION (603) 271-8784 (608) 271-5520 _ REsounceS SWITCHBOARD ‘ANNA PHILBROOK CENTER AT APS. (603) 271-5506 i 20-cv-206(FBI)-308 ‘Yr remarraxcoven D0 avn a 202,NEW HAMPSHIRE HOSPITAL, PSE ner ne SSC be 13 per For ann ono Bie :3 per Far tare Hepa perma veal rh wing 38 Stcibe blow br be PET (Seong Cue" 8a aden cava a ee aa. Focban ot Fone a ‘on GLCURRENT ADMISSION FBT MICK NEB =WECS Tacha BISCLOSEN, Sco —_ To Prove Snter Fortaner _— Information To Disclose to the Above Person or Organization: Record Above! (Cech me, Dacharge Medea is Hains, Réning Pcie Kea") ‘chagrin of Gare verala Ye conunanon ef care |Dactarge Summary] Physical wm C}.admason Pay atsassment [3 Soul Seria Assen Paychaogeat Tening (] uborteryRepens C) Raplony pote Ciemurzaton Sates 1ePrvcate!TevngEsecaiont Maths (it. to [OR GOST RECENT ADMISSION ‘or Dates of Care From OBTAIN rene ROM. Prone Number. Fes Nobo - leformation Requested From the Above Parson or Organization: Summa, Cachage Masenton Ls. sey, Aang Pac Elton) nA a acre Sonny Creatine ‘Ci tamanon Pye aseronet (1 Saal ace Nw Fpeetiante terse pcan, Sims ‘cheasaionnttrgcatortaan (enw FHS aL Bot Sars mato ‘A Prolcopy oxo Ws autheznton shal be as vaca the og ‘aw tempeh Hosp it code a eat ma even ft ectne te sign hs auhozaton. ‘The dicted ntomaton mip be re-dlstlosed and would no longer be prolate lero at owe Under the Nt Olson of elt Hath roguaton, He- M311, (afar May 1082) KH Hosp ted to dclse any Intrmatsa hs psserdon wit» propery eneculed auorzan. i “The sshoraaton expres ene yu! om bs dao lute, EXCEPTION: isclow infomation totam Communty ‘MantleathsCortar shal be 3 long one thelr of ary probee commimen! (Cerdlons Dischoge) tacts cred corwrneaton. Intormeton cecloced my lace paysite, subslencoleensal use, HI infection or weatag fox HIV Medcelpeycialerloreoton maybe daconad via fax or secu elacvonic ranemision| Teuthonts scoaut of med! ecards Worted se protecte heath formation relating toa fring ol No Probable Cavan in accordaree wih HH REA 138-G. Any cout cociments oer me tobe confined al NKH must be obiained Kom a [Being cour a th Heap eno urna a alos tose lage! documents 9, | Cantareke tas auinraton 9 sny tne by a writ recuest 1 he Heals nvrmaton Deparment of Ni Hosp. The ‘revacolon does re pry i any irlomaten relented pro tote dat cf revocation, The revocabon vl ot wy omy Inewranee company when Baw pores ry neu wh height coast aim under ry pay a Pisa Tetceayee emai Sr x el rr ML Toeat woe od pa FRNA TRE PalonGuardian Declined to ig (NH sal it), tre of twa staf who personaly witnessed the phone cal seee exe ‘An emeraacy verbal authoreation requ WiressOni erezs ate “Raaeaton Tor Diaocur of B63 Per ror ‘Protect’ Mami maton bic -3 ber FRE wre 20-cv-206(FBI)-310