LJ EAST RIVER ACKNOWLEDGEMENT OF RECEIPT MEDICAL IMAGING, PC OF NOTICE OF PRIVACY PRACTICES |, EPSTEIN, JEFFREY , have received the Notice of Privacy Practices from East River Medical Imaging, PC. PATIENT SIGNATURE: ( \ ee 5/30/18 in lieu of patient signature, |, , 4 Staff member of East River Medical Imaging, PC state that the patient named above has been given our current Notice of Privacy Practices, STAFF SIGNATURE: —— CATE: PATICNT NAMC;, FPSTFIN, IFFFREV 0316192 $000/¢0008 Xvd KY 02:8 STOZ/OC/S0 EFTA00313966