TMENT OF RADIOLOGY AND IMAGING Check-in Date: 11/03/15 1514 Patient Name Location EPSTEIN,JEFFERY DIS Ordering Physician RAWLINS,BERNARD A Adm/Reg Physician Consulting Physician RAWLINS,BERNARD A Medical Record # Date of Birth Age 840411 01/20/53 62y Chk-in # Order Exam 4121712 0001 0533 MR

ck-in Date: 11/03/15 1514 Chk-in # Order Exam 4121712 0001 Patient Name Location EPSTEIN,JEFFERY DIS Ordering Physician RAWLINS,BERNARD A Adm/Reg Physician Consulting Physician RAWLINs,BERNARD A Medical Record # Date of Birth Age 840411 01/20/53 62y 0533 MRI LUMBAR SPINE Ord Diag: M48.06-SPINA