Epstein Files Search

EFTA00313618Dataset 9

2016-12-141p216w

…New York, NY 10O21 (City) (State) (Zip Code) (Street) Please request/check all that apply: I authorize Mount Sinai to disclose medical information about my tZ Manhattan C Queens O Huntington _Emergency Room visit on Date(s) _OPD Clinic visit. specify clinic: Date(s) _FPA Practice/Provider Name of Provider Date(s) Hospitalization front to Admission Date(s) Discharge Date(s) Ambulatory Surgery Date _Specify (i.e. Lab tests. Operative Reports) NA RI's Date 12/14/2016 Records to…

https://www.justice.gov/epstein/files/DataSet%209/EFTA00313618.pdf

EFTA00313615Dataset 9

2016-12-141p212w

…New York. NY 10021 (State) (Zip Code) (Street) (DIY) Please request/check all that apply: I authorize Mount Sinai to disclose medical information about my. 0 Manhattan O Queens O Huntington Emergency Room visit on. Date(s) OPD Clinic visit. specify clinic: Date(s) FPA Practice/Provider Name of Provider Date(s) Hospitalization from: to Admission Date(s) Discharge Date(s) Ambulatory Surgery Date Specify (i.e. Lab tests. Operative Reports) MR I'S Date 12/14/2016 Records to…

https://www.justice.gov/epstein/files/DataSet%209/EFTA00313615.pdf

EFTA00306876Dataset 9

2p584w

…Number: Birth: Tel. No.: / MontIVDay/Year Address: (Street) (City) (State) (Zip Code) Please request/check all that apply: I authorize Mount Sinai to disclose medical information about my: ❑ Manhattan ❑ Queens ❑ Huntington _Emergency Room visit on: Date(s) _OPD Clinic visit. specify clinic: Date(s) FPA Practice/Provider Name of Provider Date(s) Hospitalization from: to Admission Date(s) Discharge Date(s) Ambulatory Surgery: Date: _Specify (i.e. Lab tests, Operative Reports) Date Records to be disclosed do…

https://www.justice.gov/epstein/files/DataSet%209/EFTA00306876.pdf

EFTA00283622Dataset 9

2014-10-052p463w

…RAY O Psychiatry ❑ O Radiation Oncology BONE DENSITY ❑ O Specialty MAMMO ❑ Outpatient Clinic Queens lj COO CI ❑ O Family Health Associates CD ❑ O Senior Health Center ❑ REPORT o Industrial Health Center ❑ PICK UP ❑ FPA Practice/Provider: ❑ MAIL TO HOME ❑ X-ray Films/Reports MAIL TO OTHER ❑ ❑ Pathology Slides/Reports ❑ i ❑ Other ❑ MR-WO (Rev 1113) EFTA00283622 10/05/2014 22:09 2122419987 RADIOLOGY ACC IATES …

https://www.justice.gov/epstein/files/DataSet%209/EFTA00283622.pdf

EFTA00283624Dataset 9

2013-01-152p439w

…s) ❑ CI ED Visit(s) El ❑ Ambulatory Surgery O Outpatient Clinic— Manhattan b AHC ❑ Dialysis o COOO1:1O1:3OOO1:3O 0 IMA ❑❑ CTA/CT SCAN a Jack Martin MRI - MRA NRC ❑ OBIGYN ❑ ULTRA-SOUND O Pediatrics PET SCAN 0 Psychiatry 0 Radiation Oncology O X-RAY 0 Specialty BONE DENSITY O Outpatient Clinic QUeens e Family Health Associates ❑ MAMMO = Senior Health Center O CD 0 Industrial Health Center ID FPA Practice/Provider…

https://www.justice.gov/epstein/files/DataSet%209/EFTA00283624.pdf

EFTA00316328Dataset 9

2017-02-203p398w

…/ 61; Y (Street) (City) (State) (Zip Code) Please request/check all that apply: ACCESS REQUESTED O record copy 5.75/page Records Date(s) of Service Document(s) El/Entire Designated Record Set O O Inpatient Visit(s) O O ED Visit(s) O ❑ Ambulatory Surgery O O Outpatient Clinic — Manhattan 0 0 Orthopaedics O O O O O FPA Practice/Provider. O O X-ray Films/Reports O O Pathology Slides/Reports O O Other ❑ Please complete…

https://www.justice.gov/epstein/files/DataSet%209/EFTA00316328.pdf