Epstein Secrets

EAST RIVE R MEDICAL IMAGING, PC Date: 10/14/2015 Patient Name: EPSTEIN, JEFFREY PATIENT INFORMATION RECORD Medical Record Number #: 0315192 Social Security it: 090.44-3348 Address: Apt/Unit/Suite: City. SAINT THOMA

EAST RIVE R MEDICAL IMAGING, PC Date: 10/14/2015 Patient Name: EPSTEIN, JEFFREY PATIENT INFORMATION RECORD Medical Record Number #: 0315192 Social Security it: 090.44-3348 Address: Apt/Unit/Suite: City. SAINT THOMAS State:

me 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 RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: £LLbh£LZLZ 643etal

EAST RIVER MEDICAL IMAGING. PC Date: 06/05/2018 Patient Name: EPSTEIN, JEFFREY PATIENT INFORMATION RECORQ Medical Record Number #: 0315192 Social Security Address: 6100 RED HOOK QUARTERS Apt/Unit/Suite: APT B3 C

EAST RIVER MEDICAL IMAGING. PC Date: 06/05/2018 Patient Name: EPSTEIN, JEFFREY PATIENT INFORMATION RECORQ Medical Record Number #: 0315192 Social Security Address: 6100 RED HOOK QUARTERS Apt/Unit/Suite: APT B3 City: SAIN

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 RESPONSIBLE FOR ANY UNPAID BALANCES. Signature of Patient or Guardian: goon/noon WI xv O

110431 1459 (toeing 127 (Executive) 20115 NOO!JE 20115 Ii90(31E 3/1920r, 4/14/2011 31 5 CO

7417 nvoice Date: 04/29/2011 Account 617185 Amount Due: $850.00 PAYABLE IN US FUNDS Pay by: K Check/Money Order K Discover o MasterCard 138 K Visa CI American Express Card Number Name on the card Expiration date Signature Please detach and return with payment rhit —rtittor EXIIITRE CONTRO