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HomeMy WebLinkAbout2679 . .aT6. 1%~0~ _4'74634 _ - ~ ~ ~ . ~ r~~°~.:~•~ . i~EVr YORK sTa~ • ~ o°M"~'ar ~ 4 DEPARTMENT OF HEALTH . t . ~ ~ ~~~~;~ERTI~IC~ITE OF DEATFI . to 6I1 Oi<T=OIOfATN iDK01M ~ .TatsnwolstacF - - ~ Nuac~a - m a M / ~ j~ 1 rye- , 7:00 REC. ~ s. ; . • WG T 1 (I / A. TL :raj T _ T1Py111.• •11KOEIITQi1Y •OSCN[MT6W111 T11lTtItAMOFY.iM11liFO1lGpr R~3. /,i\. 4 ~ ; - • i KOIIM IrMR/a MOMM d?7 11EM MO Q ~1NM0110ATp 4:~ ' i • 1 1 1 r r l - 1 ' AOII~itaK o~TE A .Y. ~chester Ps~ychtatriC~; °OE,IeIOEKC?~oon 'ro'"» rw1 cv Ko - - - - 1 1 °YTM,TBIi .Q? 1 74 a c~ ~ 1 Center 1 6MrUlEKT - fJ . • 6rl ~ T /lt, N rnFi QIrE I~IIDSI/ IU111f~ s ~ »MOT, _ . _ b. Q~uullweo ~1r11oa1rE6 - ~ y ietrt Jersey USel - °0""0"~O Anna. Prayer 1 ow ~ - ,s EOUa?Talewolu?al«al~earQluloEa°Ir?fTe° C - ~`.6e~ti a EunE~Twll+ron.eooKO+rIF ooueo~ 1 - 104 10 4~ - - Jcecutive ;anuPactu~^e ~ 4 u - /MpATS ITMa011NTr 11EC~OOI11lT1?ICKECKO11iANOtMCiVI 1 TMI~MKOTY~MIiIlOll11MTET 1 1 ~C/H1al 1 / 1 •-n~~ _ Penfield. 1pMt~BNCE 'E•r. ~!or'-~ ; :'on2`oe ~ E]valxuQrr ~ O OC.NO.s~an?TOwu ~ ~oe~ iNEQ _ i. - per,; ~=1~1 - 7~ C'!T'Jerle~• Ply ce ,KOOI,! - , .'~woE» FM16T MOO.E 4nsT IMY! OF~ _ I FA1ME1! :;ilfrec~ _~:3nc'~EE 1 ~ ~;,-~~,fe L~=-^.vens . - TTAKAMlaF ~ ,1TtYARJIgA0a11Ei16KClNGEL?a00II7 . me t-:?22^,hee- .76 C~rtjcy~ c ;r pla CF ~ cn'_.`i cl ~ ~ v~ E T.A 0111611E p1EtlIlT10M 11EYOYK YpKIK OA7 rfMl /NFSACSOFSl11a1.0Ad11?TIOKapIiYDrK f.CWGTg11K11YOATOWILiTATq G ~ ~ ~ ~ 2 12? ? ':l-''1i v~ ~ ayen =.-cr.. p:,~ *T.r.,.. „ - v - TM - FiMlE1Mt KOYE N ~ v c. _ ~^t~l~Zl ~~~':~Y"~~ ~it:?nel TYIC. ~ i~~ ~ r` flE ~lV~= ~'`_~c~ rvrl nor^R aa?w11/Eas 6rlECTae 1 stolll?TIIRE /socltEnt.Tnwno/rKO. Banton L. r'lntron 1 ~ LC~3? ~ _ - :u? Tu11EOF - st0 I/oKIK owr ran N? °wnaar • wwE6 IIOKi71 OAr .Poll L °+?TE ca sash 1 6r t j ~ - TO BE N 6Y TO BE COMPLE?EO BY _ ffi i:ER71FYING PHYSICIAN ONLY ER•OR MEDICAL ExAlWNER ONLY ~ = wT° THE 6EST aF w KN°RE06E. 6EATK OOp1p0E°wT w OK TKE OAlfS OF EXAYINATIDK /1u61aw 61VE371611T101<w w - tME n~ F1IACEAMOO1R10TME Ow/11oKOEATKOOaW1EDATTT+ETaIE.wTTcworlACEIIKo - _ I tlolOK OMtt cult OYETOTItEG11sESOTATW. ~ l1611EO. ~ LLO I ~ - M011Ea TUTS . aTl1E ~wTTEnoE°TItE awT6EEKwura aFeoKO1w~E6DE11D tKODU n °wTfsls+KfO._ - ~ onr ruw 6Mr gull I/oMIK Ollf ran 110MM owr rtwl IwwrK 61?r run ' ~ ¦ ~ ~ i (T 1a . QZ i 7? ~ ~g i 77 °M ~ ~ - AT r. ~ ` - i - ' a KAYE OFATTtdW610 FIIr61CU11t. w OTttE11Tt1AK s;EwTtnEw - E KAYE of aanOKEas wlrsleult. w 011iEn T?UK CENiIAEA F: ; ~ ~ - sa KA110 wwo w60nEi3 of CEwtIREw pKtratCelw. aawoltfl~ tlF.DIG1t EIU1111pE11.a0110KEATt FrlrstCwl'lIE6tC/1~ DInECTOi1t - ~ - ~ Zoltan Meinbe er M.D. 1600-South Ave. Rochester N.Y. 1 0 - _ ZS OEATM wAf ClullE° Or - ENTE11 pwtr OKE i:AI/6E FEn LIRE Fan (AL (S? A/M lCI _ O)OltATE R/TENYK - SEfNEEM ONSET E pEATM r/1AT L IIq/EOIATE CAUSE 16 Days w G ro-intestinal bleeding _ 6l1Yf I~ TO ouE Ta on A. w ooKSEauEtlcE oF: t., Pe is ulcer - -Years i wu~mn~s c~usl T~ > ~ ~ - _ _ ~ ~ MItT M. OTHEK t/T f/)KOlT10N5' CONatTtOnS CON::b6UTiN0 TA , - 1.A AYTOoSr7 t 1.61E IIE4 MrtRE ii/01Ya°.OUNSlOEfL'D W OEATM~NEtATEDTOCAYSEGNEi/wVA9TfNU rE! KO OE.'EWIIKw07tucCALL3Et7FOEw7K7 0 ZI i rESQ nop ?7A arkatY iF Aw.li?EM.KOwG6E. 1i/0 OJ?TE Of wJU:ir 1J~^~t~ GT 1=7D CESCWBE tKY:/+NJ13Kr OOW7MED. t111dG~ EnrrNEO. ?EKOIIIO I ItOKIM DAr rEwn ~ I - - 7 I 1 1 t 1 1 r ~ ~ T ~ ~AtT~irEO~caws~~ET~ ;1m t.ccwTwK d* a Ko.. crtr oa vwuoE. Taa.+. cawn. sr~TEi d C] ~ / / ~ - - - _ - a~ FEe , ~ ~ ~ as - 4'74634 - - FIlEO ~1NG~~~~ - ST.UJC G.ERK C ~t~/~ - a RECORg yERlFtF4_.--_5~~~~--~'- boos ~4 P~2~- _ -