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Cortland County Department of Social Services 60 Central Avenue Cortland, NY 13045-2746 (607) 753-5347 FAX (607) 753-5121 HEALTH CARE APPOINTMENT GRID FOR DATE AREA TYPE PROVIDER DIAGNOSIS OUTCOME Examples: 7/10/2008 Dental Initial Dr. White One Cavity Filled and cleaned 7/11/2008 Mental Health Treatment Dr. Black Depression Refill on Zoloft 7/12/2008 Physical / Medical Emergency ER Broken Arm Casted, Codeine 7/13/2008 Drug / Alcohol Follow-up Dr. Green Cannabis Addiction in Remission Discharge from Program 7/12/2008 Developmental Initial Dr. Pink No Delays Nothing Further Needed 7/13/2008 Physical / Medical Illness ER Sinus Infection RX – Antibiotic – Amoxicillin 7/13/2008 Physical / Medical Well Child Dr. Brown None None ---PAGE BREAK--- DATE AREA TYPE PROVIDER DIAGNOSIS OUTCOME