had any radiology study of the area being o Yes 4 When? examined now? What type (X-ray, ultrasound, CT, MRI, etc.)? Were prior exams at one of these Mount Sinai Health System sites? o Mount Sinai Hospital o Mount Sinai Beth Israel o Mount Sinai St. Luke's o Mount Sinai West (formerly Roosevelt) o Mount Sinai Brooklyn

any radiology study of the area being examined now? oNo o Yes 4 When? What type (X-ray, ultrasound, CT, MRI, etc.)? Were prior exams at one of these Mount Sinai Health System sites? K Mount Sinai Hospital o Mount Sinai St. Luke's o Mount Sinai Brooklyn (formerly Kings Highway/Beth Israel Brooklyn) a Another Mount Sina