f NW Langone Health's Notice of Privacy Practices. Patient Name: Ten= kem Signature: Date: Personal Representative's Name (if applicable): Personal Representative's Authority (e.g., parent, guardian, health care prosy): Effective as of 11101 +'2017. EFTA00313918

d a copy of NYU Langone Health's Notice of Privacy Practices. Patient Name: Signature: Date: Personal Representative's Name (if applicable): Personal Representative's Authority (e.g., parent, guardian, health care pt-ox Effective as of 11/01/2017. EFTA00308061 BENEFITS OF MYCHART • View your test and lab results • Acce