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TRIANGLE ORTHOPAEDIC ASSOCIATES, P.A. - 100 Perkins Drive, CHAPEL HILL NC 275141783 <br /> NICHOLAIS, THOMAS (id #651948, dob: 10/21/1954) <br /> 08/06/2014 <br /> From PrqVI 1,0,er To Provider <br /> DYER SAM,PA-C <br /> TRIANGLE ORTHOPAEDIC ASSOCIATES,P.A. <br /> 100 Perkins Drive <br /> CHAPEL HILL,NC 27514-1783 <br /> Phone:(919)942-3171 <br /> Fax: (919)969-9131 <br /> Order Information <br /> 10rdO <br /> Orders included: I <br /> Laceration of hand <br /> ICD-9:882.0:Open wound of hand except finger(s)alone,without mention of complication <br /> • NOTE TO RETURN TO WORKISCHOOL <br /> Note to Provider:NO USE OF LEFT HAND.MUST KEEP LEFT HAND CLEAN. <br /> Patient Information <br /> Patient Name NICHOLAIS,THOMAS <br /> DOB <br /> Electronically Signed by:DYER SAM,PA-C,PASUP <br />