Screening - Pass (2) Bradgh2o
Screening - Pass (2) Bradgh2o
Screening - Pass (2) Bradgh2o
*AI42365750C5*
AI42365750C5
This order must be completed by: • You are required to take a photo ID,
this ePassport, and all documents with
which it printed.
2/13/2021 10:59 PM (CT)
• If you are under 18, a parent or legal
Note: Completion time displayed does not mean that guardian may be required in order for
the service provider is open until the time shown. services to be performed. Verify with
the service provider before arriving.
Please proceed to the following location:
St. Vincent Evansville EU
100 St. Marys Epworth Xing
STE B
NEWBURGH, IN 47630
Phone: 812-853-9651 Fax: 812-853-9899
Note: Please visit the service provider's website or call
to confirm operational hours.
Additional Notes: During the COVID 19 pandemic, we recommend
wearing masks when visiting a clinic for services. If you have questions
regarding measures being taken at the facility, please call the clinic.
Participant ID:
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