3
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3
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EFTA00306878
East Side Medical Radiology PLLC 170 East 77" Street - Lower Leval Mow York, NY 10075 Phone 212-369-9200 Date Patient Last Name Find Homo Address Apt 0 City Stat
EFTA00313924
Practice has eroady taken in reliance on this consent. RSORINUatI911 Jo Obtain or Release Medical Records from Medical Providers I hereby authorize East Side Medical Radiology PLLC to obtain any and all medical records spagreenfly rotated to my current condiboe from any physician, hospital, or other health care professiona
EFTA00313922
East Side Medical Radiology PLLC 170 East Tr3 Street - Lower Leval New York, MY 10075 Phone Date TA KI • Igc)-01 Ss? Patine Lust Name e P S it 1 Prat Tref-TRC->) Home

Eric Holder
PersonUnited States Attorney General from 2009 to 2015

Michael Wolff
PersonAmerican author, essayist, and journalist

Medicaid
OrganizationUnited States social health care program for families and individuals with limited resources
HIPAA
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Practice
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Secondary Insurance Company
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Release Medical Records
OrganizationOrganization referenced in documents