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of your insurance card for laboratory purposes only. I request that payment of authorized Medicare benefits be made either to me or on my behalf to Mitchell Kline. M.D. for semices furnished to me by the provider. I authorize any holder of medical information about me to release to CMS and its agents any info
Date: T A rj • I 1)a-IDI CI MITCHELL A KLINE E PATIENT REGISTRATION NAME: J e SOCIAL SECURITY: -53 DATE OF BIRTH1- 2O GENDER 1.\-4 PREFERRED LANGUAGE: I; ICI ‘L1SH Marital Status:eM
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Y via Jet Blue#544 at 11:04am, arrive Newark 1:49pm (booked w/Jet Blue Confirm#MQU$BA) TBD Depart PB TBD Arrive NY TBD Hardeep 3:00pm Appt w/Dr. Mitchell Kline 4:30pm Haircut w/Patrick at salon EFTA00311357 From Subject: Dr. Mitchell Kline-Dermatologist Date: December 313, 2014 at 12:20 PM To: Jeffrey
Amt. No. Exp. Date Security Code Amount Signature EPSTEIN. JEFFREY ACCOUNT NO. 0000008048 Statement Date: 01/28/2015 payable to: MITCHELL A KLINE, MD PC EFTA00311355 Statement of Account ERD PC JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Date Procedure Description Date I
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apsule Written,. 01/1 5/2 01 9 Qty3Q Capsule Refills: 0 Days Supply: DAW: 1 Substitution Not Allowed by Prescriber. Qd Notes from Prescriber: Mitchell Kline MD 700 Park Avenue New York, NY 10021 NPI: 1932138231 DEANumber: BK0650831 Electronically Signed By (SP0: 6755230500004 Diagnosis Code: Eloctr
0 • "1 - ai - Current ken 1 oi1 ea Cyder Number A3132179 . Fa 00 Nerd 884kflow Stec" enspill tr . (I) I 7114. . 17 JEFFREY EPSTEIN MITCHELL A KLINE Written IF 7l: ABSORICA 20 MG CAPSULE Plan UNITE1) HEALTHCARE - 358 Dispensed irer ABSORICA 20 MG C 7O0 PARKAVE Code UHCIN EL BRILLO WAY N
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To: Dr. Mitchell Kline From: Sent Mon 1/14/2019 6:11:02 PM Subject Re: Dr. Kline's Office On Jan 14, 2019, at 11:34 AM, Jennifer Rodriguez ote: Thank you. Jennifer
ery 700 Park Avenue I New York, NY 10021 EFTA_R1_01083661 EFTA02272195 WWW.DrKlineDerma toloqy.com <PatientH is too,- NEW- Jan20 1 8.pdf><DR KLINE REGISTRATION NEW 20 1 3 .pdf> <EPSTEIN.pdf> EFTA_R1_01083662 EFTA02272196
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