pat\ 11:U Langone MEDICAL CENTER Heis.pm Wyss Department of Plastic Surgery 305 East 33rd Street New York, NY 1001 Patient Name: 5 —eFficel GPs-reiNI Date of Bette --cz Cl -19 SS Consent for Diagnostic & Treatment Ph

owitzMD < > wrote: Ok got it. It was faxed to Dr. Rodriguez. His information is as follows: Eduardo D. Rodriguez, M.D., D.D.S. Chairman, Hansj6rg Wyss Department of Plastic Surgery Director, Hansj6rg Wyss Department of Plastic Surgery Helen L. Kimmel Professor of Reconstructive Plastic Surgery NYU Plastic Surgery 305 E 33rd

still needs to review your MM results. Eduardo D. Rodriguez, M.D., D.D.S. Chairman, HansjOrg Wyss Department of Plastic Surgery Director, HansjOrg Wyss Department of Plastic Surgery Helen L. Kimmel Professor of Reconstructive Plastic Surgery NYU Plastic Surgery 305 E 33rd St New York, New York 10016 Phone: Fax: EFTA_R1_01031