Epstein Secrets

_____ _ _ -------- — --------- asserm: EXAMS TODAY Date / Time Exam Code Refemno Name Accession 06/05/2018 8:30 AM EDT MRCLAVL MOSKOWITZ, BRUCE W, M.D 7156124 PAYMENT IS DUE AT THE TIME OF SERVICE El Cash 0 Check 0 Mastercaro 0 visa almex 0 Discover HEREBY ACKNOWLEDGE THAT I AM FULLY R

TIME OF SERVICE El Cash 0 Check 0 Mastercaro 0 visa almex 0 Discover HEREBY ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: 2000/T0002 XV 03:11 STOZ/OC/SO EFTA00313962

e card(s) to the front desk receptionist.) EXAMS TODAY Pate / Time Exam Code Referring Name Accession 10/14/20157:30 AM EDT MRLSPNI MOSKOWITZ, BRUCE W, M.D 6784742 PAYMENT IS DUE AT THE TIME OF SERVICE K Cash K Check K Mastercard K Visa K Amex K Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY

IME OF SERVICE K Cash K Check K Mastercard K Visa K Amex K Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: £LLbh£LZLZ 643etal leoPaN Jame! 1823 Nd LL N L SLOZ1£L/LDO EFTA00282926 EAST RIVER MEDICAL IMAGING, PC OUTSIDE FILMS/CD FORM Da

to the front desk receptionist) atilt= EXAMS TODAY Pate / Time Exam Code Referring Name Accession 06/05/2018 8:30 AM EDT MRCLAVL MOSKOWITZ, BRUCE W, M.0 7156124 PAYMENT IS DUE AT THE TIME OF SERVICE 0 Cash 0 Check 0 Mastercard K Visa 0 Amex 0 Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY

ME OF SERVICE 0 Cash 0 Check 0 Mastercard K Visa 0 Amex 0 Discover I HEREBY ACKNOWLEDGE THAT I AM FULLY RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: goon/noon WI xv OZ:9 STOZ/OC/SO EFTA00299773 EAST RIVER MEDICAL IMAGING, PC OUTSIDE FILMS/CD FORM Oate: 5/30/18 Patient Name: