NYC 9/11 Public Portal Document
FROM:: Teresa % Andrew PHONE NO. : 718+456 5389
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a -SMASON TENDERS TRAINING FUND
15 Varick Street,'Suite 501
: New York, NY 10013-1917
APPLICANTS NAME:
HOME ADDRESS:
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DATE OF BIRTH: ;
SOCIAL SECURIT: , “oe
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BASED UPON THE MEDICAL WHICH INCLUDES:
1. PULMONARY FUNCTION TESTS (SPIROMETRY) OF FORCED VITAL CAPACITY (FVC), FORCED VITAL
CAPACITY {FVC), FORCED EXPIRATORY VOLUME AT ONE SECOND (FEVT) AND INTERPRETATION,
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2, A CHEST ROENTGENOGAAM, TWO (2) VIEW -
3, MEDICAL HISTORY ; os o
4, A PHYSICAL EXAMINATION DIRECTED TO THE PULMONARY AND GASTROINTESTINAL SYSTEMS
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INCLUDING BLT NOT LOVOTED TO HEIGHT. WEIGHT. a PULSE AND RESPIRATION.
(TS MY OPINION THAT THE ABOVE NAMED PATIENT SS ORIS NOT __. PHYSICALLY QUALIFIED TO"
WEAR A RESPIRATOR IN THE PERFORMANCE OF Hi: RER JOB:
HT. 44 WT. Jasth B?. “, 71, ¢?
DISPOSITION: QUALSIED 7. QUALIFIED WITH REFERRAL UNQUALIFIED
SPROMETER: _ Aan. cust aay: Yer
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WC, #194670-1 . Q7/0 /.
NAME GF PHYSICIAN DATE OF ATION
i. Lok Cs oe 88 Naasau Ave. Brooklyn, N.Y. 11222
SIGNATURE OF PHYSICIAN ADORESS OF PHYSICIAN
LSBON MD.
STATE LICENSE NUMBER
NYC-WTC_000094975
Aug. 13 2041 B1:45FM PB
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NYC-WTC_000094975Source: NYC Law Department, mirrored locally