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:

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

EAST RIVER MEDICAL IMAGING, PC Date: 06/05/2018 PATIENT INFORMATION RECORQ Patient Name: EPSTEIN, JEFFREY Address: 8100 RED HOOK QUARTERS City. SAINT THOMAS State: VI Data of Birth: 01/2W1963 Medical Record Number*: Seam SeCUrity t MOM

ATIENT INFORMATION RECORQ Patient Name: EPSTEIN, JEFFREY Address: 8100 RED HOOK QUARTERS City. SAINT THO

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

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

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: