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I understand that this authorization is valid for one year from this date or until and may be revoked by me at any time except to the extent Mount Sinai has already taken action based on my authorization. SPECIFIC UNDERSTANDINGS I understand that this consent may include disclosure of Alcohol and Dru
ent is a minor or incompetent}. To request records or to revoke authorization send a written request to: Mount Sinai Hospital Medical Records One Gustave L. Levy Place - Box 1111 New York, NY 10029 Mount Sinai Hospital Queens Medical Records 25-10 30' Avenue Long Island City. NY 11102 For Mount Sinai Use Only
From: Jocelyn Palmer, Mount Sinai <[email protected] > Sent: Thursday, March 14, 2019 11:09 PM To: Jeffrey Epstein Subject: Waiting on your response, Jeffrey. <=21-- Set ba
y> =20 =OA =20 =0A=20 <http://giving.mountsinai.oresite/R?i=AmCFz-kp2g4wri83q=4BsOuFA> =20 =20 <=2Ftable> EFTA_R1_01858828 EFTA02634219 One Gustave L. Levy Place, Box 1049 New York, NY=2010029 Read our privacy policy. <http://giving.mountsinai.oresite/R?i=lBOq=689uYmIAvcq3dkUmbBw> Unsubscribe from M=6Funt S
tion. However, if you refuse to sign we will riot release your records. PATIENT UNDERSTANDING AND SIGNATURE By signing below, I am requesting that Mount Sinai provide me with access to health information in the manner described above. I understand that I will be contacted if any fees for a summary or expla
is/her own behalf).. Need By: Reason. Send completed form to the most appropriate area listed below: a Mount Sinai Hospital Medical Records One Gustave L. Levy Place — Box 1111 New York,... 10029 0 Mount Sinai Hospital Queens Medical Records 25.10 30" Avenue Long Island City, NY 11102 G Other 0 FPA Patient
tion. However, If you refuse to sign we.will not release your records. PATIENT UNDERSTANDING AND SIGNATURE By signing below,• I am requesting that Mount Sinai provide me with access to health information in the manner described above. I understand that I will be contacted if any fees for a summary or expla
ddress: Tel No. Need By: Reason: Send completed form to the most appropriate area listed below. K Mount Sinai Hospital Medical Records One Gustave L. Levy Place — Box 1111 New York, N.Y. 10028 O Mount Sinai Hospital Queens Medical Records 25-10 3e Avenue Long Island City, NY 11102 O Other: O FPA Patien
Entities connected to both Mount Sinai and Gustave L. Levy Place

Jeffrey Epstein
PERSON
Karyna Shuliak
PERSON
Glenn Dubin
PERSONEva Andersson-Dubin
PERSON
Eric Trump
PERSON
Mount Sinai Hospital
ORGANIZATIONThe Mount Sinai Hospital
ORGANIZATIONRobin
PERSON
Solomon
PERSON
Huntington
PERSON
Queens
LOCATIONPeitz
PERSONErica Peitz
PERSONRecords Department
ORGANIZATION
Robin Solomon
PERSONMAMMO
ORGANIZATION
New York City
LOCATIONPersonal Representative
ORGANIZATIONRishi
PERSONParikh
ORGANIZATION