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TRIANGLE OR1'HOPAE•DIC ASSOCIATES, 1 .A. 100 Perkins Drive, CHAPEL HILL NC 27514-1783 <br /> NICHOLAIS, THOMAS F (id #651948, dob: 10/21/1954) <br /> Ar ZW- A . <br /> 08/13/2014 <br /> From Provider To Provider <br /> ALDRIDGE MACK III,MD <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 /> Order <br /> Orders Included: 1 <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 WORK/SCHOOL <br /> Note to Provider: Light duty,no lifting pulling or pushing with Left hand <br /> Patient Information <br /> Patient Name NICHOLAIS,THOMAS F <br /> DOB 10/21/1954 <br /> Electronically Slgned by:ALDRIDGE MACK III,MD <br />