or. please call 800-631-5250 Page 5 of 6 02004-13 Laboratory Corporation of America ® Holdings All Rights Reserved DOCI Ver. 1.49 EFTA00304968 LabCorp Raritan 69 First Avenue Raritan. NJ 08869-1800 Phone. 877-C47-6817 NimemNanse EPSTEIN, JEFFREY 263-480-2797-0 31143092 ii, ('M 0 Mmther CNT3114309

sidnmeCoUftW 10/:8/16 17:56 I I DmeNeaW 10/16/16 I I DeeaSTimeRaipmed 10/24/16 20:06ET Physician Name LIGHVANI , S NM :407879885 AysicuoW LabCorp Raritan 69 First Avenue TeanekdalW CBC/Diff Ambiguous Default; Pneumococca: Ab (23 Serotype); Immmnoglobulins A/G/M On, Ser; Tetanus/Diphtheria Ab; Compl