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:

ed? If yes, when? Any surgery on your eyes, ears brain or heart? DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? Brain/Aneurysm Clips Pacemaker, Pacer Wires or Defibrillator if yes, make\ year Ear Implants or Hearing Aids Electrical Stimulators Implant/Prosthesis Infusion Pumps Coils. Catheters. Fitters or Wires in

EAST RIVER MEDICAL IMAGING. PC MAGNETIC RESONANCE IMAGING IMRI) Patient Name; EPSTEIN. JEFFREY MRN #: 0315192 Age: 65 Years Sex: M Height Feet Inches Weight Referring Physician: MOSKOVVITZ, BRUCE W. M.D. M.D. Exam Code: MRCL

RESONANCE IMAGING IMRI) Patient Name; EPSTEIN. JEFFREY MRN #: 0315192 Age: 65 Years Sex: M Height

scopy within the last 6 weeks? If yes. date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 Brain/Aneurysm Clips 0 Pacemaker, Pacer Wires or Defibrillator if yes. make% year O Any Metallic fragment or foreign body O Ear Implants or Hearing Aids O Electrical Stimulators O Implant/Prosthesis O

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

within the last 6 weeks? If yes, date of exam YES NO DO YOU HAVE ANY OF THE FOLLOWING IN YOUR BODY? 0 0 Brain/Aneurysm Clips 0 0 Pacemaker, Pacer Wires or Defibrillator if yes, make\ year 0 0 Any Metallic fragment or foreign body CI O Ear Implants or Hearing Aids 0 C7 Electrical Stimulators 0 0 Implant/Pr