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Correctional Managed Care
RAD|OLOGY REP'ORT

Date Transcribed: 03/28/2013 08: 45

Patient Name: JONES, TONY R TDCJ#:1312115 Date: 03/28/2013 08 45 Age: 49 year Race: W Sex:
male _
Patient's Facility: M|CHAEL (M|)

Department of Radiology
The University of Texas Medical Branch Hospitals
~ »Galveston, TX 77555 , l '
Phone:(409)747-7000
Fax:(409)747-2850
PATIENT: Jones, Tony
DATE OF BIRTH:
` DATE OF E)Q\M: 3/25/2013 9:46:00 AM
PATIENT #: 1312115 `
EXAM ID #: 6429482 - ' ’€5//
REFERRING PHYSICIAN: u¢%

GARY D. WRIGHT glow

MICHAEL UNIT
TENNESSEE COLONY, TX 75886'

OFFKIALCOPY ' 1

WRIST, MINIMUM OF 3 VIEWS- RIGHT SIDE g

HISTORY: ORIF 01/24/2011,LOOSE HARDWARE PAST 3 MOS

COMPARISON: None.

FINDINGS: `

An old fifth metacarpal fracture is noted. A cortical plate and multiple
anchoring screws affix the distal radius in satisfactory alignment without
evidence of hardware complications.

No acute fracture or dislocation is identified. Mild soft tissue swelling
of the wrist is noted.

PAVIT BAINS, MD

Personally interpreted by:

FERNANDO CESANI, MD /signed by/ FERNANDO cEsANI, MD

Department of Radiology

The University of Texas Medical Branch

Last edited On: 3/27/2013 3:45:00 PM

Finalized on: 3/27/2013 3:45:00 PM

'Elecuonically Signed by GAS"i"lAN SUZANNE 011 03/28/21)13.
Elcctronically Signed by \‘v R1Gl1'1", GARY G D O. 011 04 ’OS 0213.
##A11d No 0111¢:13##

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-WHEREFORE»,; APPLI;<:AN¢!= mass THATTHE connT »GmsrArgchANfr
t 'RELIEF rio wnr'c:-H“HE"MAYBE ENTIILED5.IN '1“1'11'§§$_`P'ROc;‘,jI:?;ll~;i§)'ING:s

vERIFICATIoN:_

This application must be venf' ed or it will bc dismissed for non-comphance For
verification purposes an applicant ls` a person 111ng the application on his or her own behalf A
petitioner is a person filing the applrcatlon on behalf of an appllcant for example `an apphcant sl-
attorney An inmate is a person Who rs in custody

 

by a hccnsed attorney the attorney may sign the “Oath Bcforc a Notary Pubhc” as pcnnoner and
then complete ‘Pet111onor s lnforrnatlon ” A non-lnmate applicant most sign the “Oa`th Bc`forc a
Notary P'nblic” before a notary public unlcs§ he7 rs represented _by. a hccnsed attorney in Which
case thc attorney may sign th"c verification as petitioner

1 _ A non~inmate non-attorney patiti_oncr must sign the “Oath Be`for'c a' Notaly Publ:c”
before a notary public and must also complete “Petmoncr s Information ’~’ An inmatc pct1t1or1er
must sign either the “Oath Bcf_ore a Notdry Pubhc” before _a` notary pub1ic or the “Inmatc-’ s
Declara_tion”_ W'ithout a notany pnblic and must also complete the approprtate “Pcntmner s
Inf`orrnanon

carn_:annonr A_.No'rany marra 1 ,_ y ._ ;. ~ 1 '; : _;;H _ .' :\ ` l
mrs @FTEXAS ` " ` '
rcoUN-TY( orr

z ,b_cing duly sworn under oath;- says “I arn
.:\thc` applicant `/ petitioner (circle onc) m this act1o`n and know the contents of the above

apphcatlon for a writ of habeas corpus and, accordmg to iny behcf the facts stated 111 th_c
_apphcatxon arc true .

 

 

 

_. sUBsCRIBED AND_ sWORN 10: BEFoRE 1113 rios DAY on 1 1 20

 

 

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1 1..~INMATE’s DECLARATI<:)N

1 7//V/€‘1'Y`g>"'5_§ l ,`ani the applicant / petinoner (cir_¢le one) and
being presently incarcerated in M Kl< [/J. MZ}/AZL l4hW declare under penalty of

rapenjery that~_,,-acc_ording to my~-belief,~ the facts staiedyi'nthe above application are'tr_ne and;eorrect;,:

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