@ }) Quest Dragnestics” Patient Information EPSTEIN, JEFFREY MRO47987L. Client Report Status: Final EPSTEIN, JEFFREY ~S6W5265 0006029 MOSKOWITZ, BRUCE W pos: | AGE: 65 BRUCE MOSKOWITZ, MD Genders M Collected: 08/14/2018 Attn: NATIONWIDE ACCOUNT Phone: Received: 08/14/2018 / 21: 1411 N FLAGLER DR STE 7100 Patient ID: Reported: 08/15/2018 / 1 WEST PALM BEACH, PL 33401-3418 Health 1D: , : : Test Name In Range Out Of Range Reference Range Lab PTH, INTACT AND CALCIUM PTH, INTACT Mi PARATHYROID HORMONE, INTACT 94 H 14-64 pg/ml Interpretive Guide Intact PTH Calcium Normal Parathyroid Norma) Normal Hypoparathyroidism Low or Low Normal Low Hyperparathyroidism Primary Normal or High High Secondary High Normal or Low Tertiary High High Non- Parathyroid Hypercalcemia Low or Low Normal High CALCIUM 9.8 8.6-10.3 ma/aL MI PERFORMING SITE: ME QUEST DENG NOS TICS: MILAM, 19200 COMMIPRCE PARKWAY MIRAMOUL PL 31009-1009 Larosa Deere GLEN E HORTIN MD PID CLIA (Det CLIENT SERVICES: 866.697.8378 SPECIMEN: MR0479871 Quest, Quest Diagnostics, the associated lago and all asiorhated Quest Diagnostics marks are the trademarks of Quest Diagnostics. PAGE 1} OF 1 EFTA00314225

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Q Report Status: Partial ) Quest EPSTEIN, JEFFREY Client Information Client #: 78300020 S6W5S265 MOSKOWITZ, BRUCE W BRUCE MOSKOWITZ, MD Aun: NATIONWIDE ACCOUNT MIEN FLAGLER DR STE 7100 WEST PALM BEACH, FL 33401-3418 Pa t Information EPSTEIN, JEFFREY bos: Gender; M Phone: Patient 1D; Health 1D: “MROA79851. Requisition: 0006030 AGE: 65 Collected: — O8/14/2018 Received: 08/15/2018 (1S) EDT Reported: — 08/16/2018 07:59 EDI Test Nam In Range Out Of Range Reference Range Lab LIPID PANEL, STANDARD CHOLESTEROL, TOTAL 233 H <200 mg/al M1 HDL CHOLESTEROL 29 L >40 mg/dL M1 TRIGLYCERIDES 541 H <150 mg/dL MI LDL-CHOLESTEROL mg/dl (calc) MI LDL cholesterol not calculated. Triglyceride levels greater than 400 mq/dL invalidate calculated LDL results, Reference range: <100 Desirable range <100 mg/dl for primary prevention; <70 mg/di, for patients with CHE or diabetic patients with > cr = 2 CHD risk factors. LDL-C is now calculated using the Martin-Hopkins calculation, which is a validated novel method providing better uracy than the Friedewald equation in the estimation of LDL-C, Marti PM O13 ;330/19) : 2061-2068 Deora ol CHOL, <5.0 (calc) MI NON HDL CHOLESTEROL 204 H <130 mg/dL (calc) MI For patients with diaberes plus ! major ASCVD risk factor, treating to a non-HDL-C goal of <i100 mg/dL (LDL-C of <70 mg/dL} is considered a therapeutic option, HS CRP 1,3 mg/L TP Average relative cardiovascular risk according to AHA/CDC quidelines. For ages >17 Years: hs-CRP mg/L Risk According to AHA/CDC Guidelines <1.0 Lower relative cardiovascular risk. 1,0-3.0 Average relative cardiovascular risk. 3.1-10.0 Higher relative cardiovascular risk. Consider retesting in 1 to 2 weeks ta exclude a benign transient elevation in the baseline CRP value secondary to infection or inflammation. 210.0 Persistent ¢levation, upon retesting, may be associated with infection and inflammation. HOMOCYSTEINE 20.5 H <11.4 umol/t MI Homocysteine is increased by functional deficiency of folate or vitamin Bl2, Testing for methylmalonic acid differentiates bet n th deficiencies. Other causes of increased homo teine include renal failure, folate antagonists such as methotrexate and phenytoin, and exposure to nitrous oxide. CLIENT SERVICES: 866.697.8378 SPECIMEN: MRO479851 PAGE LOFA Quest, Quest Diagnostics, the associated Ingo and all associated Quest Diagaustics marks are the trademarks of Quest Dingnustics. EFTA00314226

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Report Status: Partial (@) Quest re ©! Diagnostics EPSTEIN, JEFFREY Information Specimen Information Client Information Specimen; MRO47985L Client #: EPSTEIN, JEFFREY — : Collected: — 08/14/2018 MOSKOWITZ, BRUCE W AGE: 65 Received: O8/1S/2018 /1S:1 ED Reported: 08/16/2018 (07:59 EDT In Range Out Of Range Reference Range Lab COMPREHENSIVE METABOLIC MI PANEL GLUCOSE 95 65-99 mg/dL Fasting reference interval UREA NITROGEN (BUN) 2k 7-25 mg/db CREATININE 1.16 0.70-1.25 ma/dab For patients 249 years of age, the reference Limit for Creatinine ig approximately 13% higher for people identitied as African-American. eGPR NON-AFR. AMERICAN 66 > OR = 6C mL/min/1.73m2 eGPR AFRICAN AMERICAN 76 > OR = 60 mL/min/1.73m2 BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc) SODIUM 139 135-146 mmol/L POTASSIUM 4.4 3.5-5.3 mmol/L CHLORTDE 105 98-110 mmo? / 2. CARBON DIOXIDE 23 20-32 mmol/ CALCTOM 9.8 8.6-10.3 mg/d, PROTEIN, TOTAL 7.0 6.1-8. i ALBUMIN 4.2 3.6-5. GLOBULIN 2.8 1.9-3. ALBUMIN/GLOBULIN RATIO 1.5 1.0-2. BILIRUBIN, TOTAL 0.8 0.2-1. ALKALINE PHOSPHATASE 55 40-215 U/L AST 23 10-35 U/L ALT 35 9-46 U/L HEMOGLOBIN Alc 5.78 <5.7 % of total Hyb MI For someone without known diabetes, a hemaglobin Ale value between £.7% and 6.4% is consistent with prediabetes and should be confirmed with a follow-up test. For someone with known diabetes, a value <7% indicates that their diabetes is well controlled. Ale targets should be individualized based on duration ot diabetes, age, comorbid conditions, and other considerations. This assay result is consistent with an increased risk of diabetes. Currently, no consensus exists regarding use of hemoglobin Ale for diagnosis of diabetes for children. URIC ACID 8.3 H 4.0-8.0 mg/dL MI Therapeutic target for gout patients: <6.9 mg/dL TSH 2.31 0.40-4,.50 miU/L MI T4 (THYROXINE), TOTAL 7.9 4.9-10.5 meg/dalL MI FREE ‘4 INDEX (17) 2.4 1.4-3.8 T3 UPTAKE 30 22-35 % MI SED RATE BY MODIFIED MI CLIENT SERVICES: 866.697.8378 SPECIMEN; MRO47985L PAGE 2OF 4 ‘Quest, Quest Diagnostics, the assuciated luge and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics, EFTA00314227

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@ ) Quest Diagnostics” Report Status: Partial EPSTEIN, JEFFREY EPSTEIN, JEFFREY pov: Hace: 6s Gender: M Patient ID: Health ID: Test Name WESTERGREN Client #: | MOSKOWITZ, BRUCE W Specimen: MR0O47985L Collected: 08/14/2018 Received: 08/15/2018 / 15:11 EDT Reported: — 08/16/2018 / 07:59 EDT In Range Out Of Range Reference Range 9 < OR = 20 mm/h cBC (INCLUDES DIFF/PLT) MI WHITE BLOOD CELL COUNT 5.9 3.8-10.8 Thousand/uL RED BLOOD CELL COUNT 5.12 4.20-5.80 Million/uL HEMOGLOBIN 15.3 13,2-17.1 g/dL HEMATOCRIT 44.5 38.5-50.0 & MCV 86.9 60.0-100.0 FL MCH 29.5 27.0-33,0 pg MCHC 33.9 32.0-36.0 g/dL RDW 13.8 11.0-15.0 & PLATELET COUNT 248 140-400 Thougand/uL MPV 9.7 7,.5-12.5 £L ABSOLUTE NEUTROPHILS 2879 1500-7800 cells/uL ABSOLUTE LYMPHOCYTES 2018 850-3900 cells/uL ABSOLUTE MONOCYTES 502 200-950 celis/ub ABSOLUTE EOSINOPHILS 443 15-500 cells/uL ABSOLUTE BASOPHILS s9 0-200 cells/uL NEUTROPHILS 43.8 + LYMPHOCYTES 34.2 & MONOCYTES 8.5 % EOSINOPHILS 7.5 + BASOPHILS 1.0 % URINALYSIS, COMPLETE MI See Endnote 1 VITAMIN B12 373 200-1100 pg/mL MI Please Note: Although the reference range for vitamin B12 is 200-1100 pg/mL, it has been reported that between 5 and 103% of patients with values between 200 and 400 pg/mL may experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency; less than 1% of patients with values above 400 pg/mL will have symptoms. C-REACTIVE PROTEIN 1.6 <8.0 mg/L MI EXTRA BLUE-TOP TUBE MI AN EXTRA SPECIMEN WAS RECEIVED WITH NO TEST REQUESTED. THE SPECIMEN WILL BE MAINTAINED IN STORAGE IN CASE ADDITIONAL TESTING IS NEEDED. PLEASE CALL THE CLIENT SERVICE DEPARTMENT FOR FURTHER ASSISTANCE. PROLACTIN 3.9 2.0-18,0 ng/mL MI TESTOSTERONE, TOTAL MI MALES (ADULT), IA TESTOSTERONE, TOTAL, MALES (ADULT), IA 150 L 250-827 ny/db In hypogonadal males, Testosterone, Total, LC/MS/MS, is the recommended assay due to the diminished accuracy of immunoassay at levels below 250 ng/db. This test code (15983) must be collected in 4 red-top tube with no gel. Endnote | HERP OE AAR EMRE EERE ROHR REE POH eee * Test not performed. e * No specimen received. . SEPERATE Oe CLIENT SERVICES: 866,697.8378 SPECIMEN: MRO47985L PAGE 3 OF 4 ‘Quest, Quest Diagnostics, the usociated loge and ull associated Quest Diagnostics marks are the trademurks of Quest Diagnostics. EFTA00314228

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Report Status: Partial } Quest _ _— Diagnostics EPSTEIN, JEFFREY — Patient Information Specimen Information Client Information _ EPSTEIN, JEFFREY Specimen: MRO4798SL. Client #: Collected: 08/14/2018 MOSKOWITZ, BRUCE W Received: O8/1S/2018 / IST EDI Reported; — 08/16/2018 / 07:59 EDT Patient 1D Health ID: Endocrinology Test Name 25-OH Vitamin 1 | Deficiency: <20 ng/mL | Insufficiency: 20 - 29 ng/mL | Optimal: > er = 30 ng/mL | For 25-OH Vitamin D testing on patients on D2-supplementation and patients for whom quantitation of D2 and D3 fractions is required, the | QuestAssureD(TM) 25-OH VIT D, (D2,03), LC/MS/MS is recommended: order code 92888 (patients >2yrs) | For more information on this test, go to: ee i: link is being provided for informational! educational purposes only.) Physician Comments PENDING TESTS: | MERCURY. BLOOD PERFORMING SITE: MI QUEST DIAGNOSIS MIAMI, 10200 COMMERCE PARKWAY. [RRS FL 9025-1978 Lakontes Duosor GLEN E HORTIN MD PHD, OLEA jubartT tse TR QUEST EHAGNOSTICS-TAMPA, 4225 F FOWLER AVE, TAMPACTL 1517-2026 Labvemory Dagete GLEN C MOKTIN SEDPEID CLIA Hawi 120 CLIENT SERVICES; 866.697.8378 SPECIMEN: MRO47985L. PAGE 4 OF 4 Quest, Quest Diagnostics, the associated loge and ull associated Quest Diagnostics marks are the trademarks of Quest Diagaustics, EFTA00314229

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Carnegie Hill Radiology 170 East 77% St New York, NY 10075-1912 er ro Steven D. Wolff, M.D., J Director CARDIAC AND CHEST CTA PATIENT: Epstein, Jeffrey . DATE: July 29, 2018 AGE: 65 Sex; M ioe: REFERRING; Dr, Bernard Kruger HISTORY Abdominal pain. COMPARISON To 2/8/2006. TECHNIQUE A low-dose gated cardiac and chest CTA were performed before and after the intravenous administration of 94 mL of Isovue-370, The images were reviewed and reconstructed on a 3-D workstation, FINDINGS The coronary arteries originate normally from the aortic root and have a normal epicardial course. The left main is widely patent and free of plaque. In the proximal LAD there are focal calcified and soft plaque causing 30% to 49% stenosis, In the mid LAD there are focal calcifications causing 30% to 49% stenosis. The distal LAD is diffusely small in size with a small bulky calcification, The diagonal arteries are small in caliber, The circumflex is widely patent. The obtuse marginal arteries are small in caliber. The RCA is dominant. The proximal and mid RCA is widely patent. The distal RCA and PDA are small in caliber. There is posterior right pleural thickening. No pleural or pericardial effusion is noted. There is no evidence for significant lymphadenopathy. There is diffuse thickening of the esophagus with fluid noted in the posterior mediastinum adjacent to the esophagus, which may be related to an inflammatory process, This was not seen previously, There is heterogeneity of the liver parenchyma, likely fatty liver, The ascending aorta measures 4,0 cm at the level of the sinuses of Valsalva, In the lateral left 6* rib there is a bone island noted. In the right lateral 8 rib there is a bone island noted. There are degenerative changes of the osseous structures. IMPRESSION 1, The coronary calcium score is 84, placing the patient in the 25% to 50* percentile. It previously measured 41. 2. Nonobstractive atherosclerosis is noted in the LAD as described above, No definite obstructive coronary artery disease is noted. 3. There is nonspecific fluid noted in the posterior mediastinum adjacent to a diffusely thickened esophagus, which is indeterminate. This may represent an inflammatory or (continued) Oistinctx Compxner Carvioes (zz) 871-1128 Epstein jeter 2016-57-29 Cwrdisc-CrweOTA MAP{CHA) an EFTA00314230

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Carnegie Hill Radiology Cardiac and Chest CTA Epstein, Jeffrey “July 29,2018 Page 2 of 2 infectious process. Advise correlation with endoscopy, A short-term followup chest CT with contrast is recommended in 2 months to confirm resolution of these findings. 4, Hepaticsteatosis. 5. There is thickening of the right posterior pleura, which may be due to infection and/or inflammation, Ay n— iLL) vo M. Robert Peters, MD Digitedx Comput Sorvioad (212) 631-1928 EFTA00314231

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RIS Fax Server 1/30/2018 9:03:40 AM PAGE 2/004 Fax Server Richard J. Katz, M.D. Timothy W. Deyer, M.D. Steven A Albert, M.D. James W. Brady, M.D. Stephen D, Greenberg, M.D Gwen N, Harris, MD. Douglas R. DeCorato, M.D, Adam J, Wilner, M.D, Gavin L. Duke, MD, Mark H. Pinals, M.D. Paul S, Chol, M.D, AR ” . George Stassa, MD, (ret) Sean K. Herman, MD. Morton Schneider, MLD, (ret) Robert L. Ludwig, M.0. Alison Bender Halmes, M.D, (rat) 519 &523 East 72nd Strent + New York, NY 10024 +3 East 76th Street, Al Fifth Avenue «New York, NY 10021 430 East59th Street, Sutton Place « New York, NY10022+ 424 East 69th Street + New York, NY 10128 Tel: 212-288-1575 » Fax 212-288-7616 » www.eastriverimaging.com BRUCE W MOSKOWITZ, M.D. 41411 NORTH FLAGLER DRIVE SUITE 7100 WEST PALM BEACH, FL 33401 Patient: EPSTEIN, JEFFREY Exam Date: 1/30/18 Acc No: MRN: 0315492 Dear Dr. Moskowitz, CT NECK Clinical History: 65 y/o male with elevated PTH, concern for parathyrold adenoma. Technique: Multidetector helical CT scans of the neck were performed utllizing 4D parathyroid technique, from the superior orbital rim to the thoracic inlet using 2.5 mm slices, prior fo and during the constant infusion of nonionic intravenous contrast. Multiphase postcontrast dynamic Imaging was employed. Images were reconstructed at 1.25mm slice thicknesses at 1.25mm slice Intervals with coronal and sagittal reformats. Comparison: Neck MRI performed 11/30/2016 Findings; The visualized brain parenchyma Is normal. The orbital contents are partially excluded from the field of view but are grossly normal in appearance. EPSTEIN, JEFFREY ACCIIIIE cxam date: 1/2016 on: ACCESS YOUR PATIENTS MAGES AND REPORTS @ WWW.EASTRIVERIMAGING.COM PET/CT » HIGH FIELD MRI + OPEN MRI MULTIDETECTOR VOLUME CT (VCT) « BONE DENSITY + NUCLEAR MEDICINE ULTRASOUND + DIGITAL X-RAY* CORONARY CT ANGIOGRAPHY + VIRTUAL COLONOSCOPY + CT/MR ANGIOGRAPHY EFTA00314232

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RIS Fax Server 1/30/2018 9:03:40 AM PAGE 3/004 Fax Server The masticator spaces are normal. The mastoid air cells and tympanio cavities are clear. Mild scattered paranasal sinus mucosal thickening is seen with areas appearing polypoid In nature. Findings are worse along the left frontal drainage pathway which is occluded. A few of the maxillary and mandibular teeth have been endodontically treated. There is a left 2nd mandibular molar dental implant, Small bilateral mandibular tori are present. The nasopharynx is normal. Prominence of the bilateral palatine tonsils are seen without deep extension, likely reactive in nature. Punctate calcifications involve both palatine tonsils, likely reflecting remote inflammation, Minimal.prominence of the bilateral lingual tonsils Is seen without deep extension, likely reactive in nature. There Is a tiny air-filled right Internal laryngocele, The hypopharynx and larynx are otherwise normal. The true cords are adducted. The major salivary glands including the parotid, submandibular and sublingual glands are normal, The thyroid is mildly heterogeneous. There is a 0.5 cm enhancing nodule within the posterior right midpole of the thyroid. There are no early enhancing parathyroid nodules. No discrete parathyrold mass is prea. There is no evidence for a parathyroid adenoma. There Is no suspicious or pathologically enlarged cervical chain lymphadenopathy. There Is a partially imaged lipoma within the left supraclavicular fossa measuring 4.7 cm in greatest craniocaudad dimension and 2.5 cm in greatest AP dimension. This is unchanged, There Is a bovine configuration of the great vessels arising from the aortic arch, a normal anatomic variant. There is patency of the major vessels of the neck. The pericervical musculature, scalene musculature and stemocleidomastoid muscles are normal asymmetric atrophy. The lung apices are clear. There is no suspicious mediastinal mass or evidence of ectopic parathyroid adenoma within the mediastinum on the images provided, Multilevel cervical spondylosis is seen with disc hemiations and superimposed disc osteophyte complexes resulting in multilevel ventral cord impingement as well as foraminal narrowing with suspected cervical nerve root impingement. PET/CT + HIGH FIELD MRI+ OPEN MAI+ MULTIDETECTOR VOLUME CT (VCT) » BONE DENSITY’+ NUCLEAR MEDICINE ULTRASOUND + DIGITAL X-RAY* CORONARY CT ANGIOGRAPHY * VIRTUAL COLONOSCOPY « CT/MIR ANGIOGRAPHY EFTA00314233

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sae + RIS Fax ‘Server 1/30/2018 9:03:40 AM PAGE 4/004 Fax Server ‘ id polypoid paranasal sinus mucosal thickening with an occluded left frontal drainage thyrold nodule, lipoma, unchanged, Multilevel cervical spondylosis. Very fruly yours, ADAM WILNER, M.D. Electronically Signed By: ADAM WILNER, M.D. Date/Time Transcribed: 1/30/18 9:02am Contrast; Omnipaque Contrast 350mg 100cc Creatinine 1.2mg/dI REPORT cc: CC PATIENT EPSTEIN, JEFFREY ACC: Exom Date: 4/20/18 008: SE & EAST RIVER MEDICAL IMAGING, PC wenweasttverimoyingeom PET/CT * HIGH FIELD MRI + OPEN MRI + AYULTIDETECTOR VOLUME CT (VCT) * BONE DENSITY + NUCLEAR MEDICINE ULTRASOUND + DIGITAL X-RAY * CORONARY CT ANGIOGRAPHY * VIRTUAL COLONOSCOPY + CT/MR ANGIOGRAPHY EFTA00314234

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en 4 Gustave Levy Place #1144 Now York, NY 10029 Mount is) 341-6000 Sinai (242) 831-2851 (fax) Rony Shimony, MD Patient; EPSTEIN, JEFFREY 486 Madison Ave Sinal MR#: 47th Floor DOB; New-York, NY 10022 Accession #: Date of Exam: 12/13/2017 Examination: NM PARATHYROID SCAN 123 DOSING Dear Dr. Shimony: STUDY: Dual Isotope Parathyroid scan INDICATION: The patient presents with hypercalcemia, evaluate for parathyroid adenoma. METHOD: The patient received 0.2 mCi of I-123 orally. Anterior pinhole views. of the neck were then obtained. Then the patient received 20 mCI of Tc-99m Sestamibi intravenously. Anterior pinhole views of the neck are obtained immediately followed by SPECT-CT images of the neck and chest. Agaln, pinhole views of the neck at 2 hours are obtained. The low- dose nondiagnostic CT scan images were obtained solely for the purpose of anatomic co-registration with the SPECT Images. FINDINGS: There Is no prior study for comparison, The |-123 thyroid image shows homogeneous radiotracer distribution in both lobes of the thyrold gland, The bid Sestamibi image shows homogeneous radiotracer distribution In both lobes of the thyrold gian The delayed Sestamibi Image shows equal radiotracer washout from both lobes of the thyroid gland. SPECT-CT images show no abnormal focal uptake In the neck or chest. IMPRESSION: THERE IS NO ABNORMAL FOCAL UPTAKE IN THE NECK OR CHEST TO SUGGEST PARATHYROID ADENOMA. Thank you for the courtesy of this referral. Sincerely, ‘ Sherif | Heiba, MD (Electronically Signed) Contributing Provider(s): 4) Holba, Sherif | 2) KESTENBAUM, DAVID EFTA00314235

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Surgery Office Clinic Note Epstein, Jeffrey E - * Final Report * * Final Report * Referring Physician Past Medical History Dr. Bruce Moskowitz Ongoing Endocrinolosist Primary hyperparathyroidism None Past Surgical History Chief © Jai None Primary Hyperparathyroidism Allergies No active allergies History of Present Illness Mr. Epstein, Jeffrey is a 65-year-old male who presents for surgical evaluation and = Family History treatment, referred by Dr. Bruce Moskowitz. The patient presents with the diagnosis Mother: Deceased; Kidney disease of Primary Hyperparathyroidism and Hypercalcemia. The patient became aware of Father: Deceased; Heart disease the problem for about 10 years. He was previously evaluated by myself at Yale. At Brother (1): Alive and healthy that time, surgery was differed. Sister: None Children: None The patient does have a history of nephrolithiasis (2 episodes 6 years No family history of endocrine disorders. ago). The patient does not take any thiazide diuretics or lithium. Social Hi His symptoms include constipation, trouble concentrating, and exacerbated fatigue. cmanang: None He experiences these symptoms sporadically and they correlate with elevated PTH Drugs: None and calcium levels. The patient has no complaints of hoarseness, dysphagia, or eee tion: Banke difficulty breathing. The patient has no history of radiation treatment to head or pation: Banker neck. Laboratory and imaging are listed below. J have reviewed alllaboratory Home Medications results and images in detail. None Laboratory Studies, August 16th, 2018 (Quest Diagnostics) BUN: 21 [7-25] Creatinine: 1.16 [0.70-1.25] eGFR: 66 [>60] Calcium: 9.8 [8.6-10.3] it was 10.7 last week PTH, Intact: 94 [14-64] Vitamin D, 25-OH: 32 [30-100] TSH: 2.31 [0.40-4.50] Free T4: 2.4 [1.4-3.8] T 150 (250-800) according to the patient his LH and FSH are both normal as per patient had a 24 hour urine for calcium which was normal. Diagnostic Imaging and Procedures Parathyroid Scan, December 2017 (Mount Sinai, New York): IMPRESSION: There is no abnormal focal uptake in the neck or chest to suggest parathyroid adenoma. Result type: Surgery Office Clinic Note Result date: August 20, 2018 13:40 EDT Result status: Auth (Verified) Result title; Endocrine Surgery Consultation Performed by: Alonso, Rafael ARNP on August 20, 2018 13:42 EDT Verified by: Udelsman, Robert MD on August 20, 2018 14:49 EDT Encounter info: 903306115, MCI, Clinic, 08/20/2018 - Printed by: Cuevas, Yessenia OSHA Page 1 of 4 Printed on: 08/24/2018 11:21 EDT (Continued) EFTA00314236

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Surgery Office Clinic Note * Final Report * Neck CT (4D Parathyroid Technique), January 2018 (East River Medical Imaging, New York): IMPRESSION: No evidence for parathyroid adenoma. Mild scattered polypoid paranasal sinus mucosal thickening with an occluded left frontal drainage pathway. A0.5 cm right mid pole thyroid nodule. Left supraclavicular lipoma, unchanged. Multilevel cervical spondylolysis. Para Ultrasound Negative Bone density: as per patient was normal Review of Systems CONSTITUTIONAL: No fever, weight loss, or night sweats. EYES: No visual changes or eye pain. ENT: No sore throat, sinus pain, or ear pain. CARDIOVASCULAR: No chest pain or palpitations. RESPIRATORY: No cough, wheeze, or shortness of breath. GASTROINTESTINAL: No abdominal pain, nausea, or vomiting, + constipation ENDOCRINE: As above only. MUSCULOSKELETAL: No musculoskeletal pain or joint swelling. NEUROLOGICAL: No changes in special senses, no headaches. IMMUNOLOGY: No swollen lymph nodes HEMATOLOGY: No easy bruising or history of excessive bleeding. INTEGUMENTARY; No rashes or skin lesions. ALL OTHER: Negative Physical Exam Vitals & Measurements T: 37.2 °C (Oral) HR: 77 (Peripheral) RR: 16 BP: 123/74 SpO2: 96% WT: 88.5 kg (Measured) BMI: 27.01 Physical exam reveals a well-developed male GENERAL: No resting tremors EYES: Conjunctivae are not injected. No scleral icterus. No exophthalmos. CARDIOVASCULAR; Regular rate and rhythm without murmurs, rubs, or gallops. No carotid bruits. RESPIRATORY: Lungs are clear to percussion and auscultation. MUSCULOSKELETAL: No muscular atrophy. Gait normal. SKIN: Normal skin turgor, no obvious bruising. NEUROLOGIC: Oriented X3. Motor and sensory grossly intact. THYROID: Examination of the neck reveals a normal thyroid gland. VOCAL CORDS: I was unable to visualize his cords by mirror exam. HEMATOLOGY/LYMPHATICS: There is no cervical or supraclavicular lymphadenopathy. Result type: Surgery Office Clinic Note Result date: August 20, 2018 13:40 EDT Result status: Auth (Verified) Result title: Endocrine Surgery Consultation Performed by: Alonso, Rafael ARNP on August 20, 2018 13:42 EDT Verified by: Udelsman, Robert MD on August 20, 2018 14:49 EDT Encounter info: 903306115, MCI, Clinic, 08/20/2018 - Printed by: Cuevas, Yessenia OSHA Printed on: 08/24/2018 11:21 EDT Epstein, Jeffrey € - Page 2 of 4 (Continued) EFTA00314237

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Surgery Office Clinic Note Epstein, Jeffrey E - * Final Report * Assessment/Plan 1, Primary hyperparathyroidism E21.0 --laboratory: 24 hour urine for calcium and creatinine -- Educational session and booklet provided to the patient This patient almost certainly has minor primary HPTH with a history of nephrolithiasis and neurocognitive symptoms, His imaging is negative making him at higher risk for multi-gland disease. I do believe he would be best served by parathyroid surgery and I explained this in detail. He will obtain his 24 hr urine collection in West Palm Beach and we will chat after this study. -- I had a detailed conversation with the patient about his options. Based on the most current laboratory values, imaging studies, and physical examination, I have recommended: [Parathyrold exploration with the intact PTH assay]. | explained the procedure as well as the risks, benefits, and potential complications to the patient. Risks include, but are not limited to, bleeding, infection, hypocalcemia, reaction to anesthesia, and injury to the nerves near the vocal cords. The patient verbalized understanding and has no further questions. We will proceed to surgery at a time convenient for the patient. I, Dr. Robert Udelsman had a face-to-face encounter with this patient, examined the patient and reviewed the APP notes. I have formulated the assessment and plan for this patient and reviewed them with the patient. A total of 40 minutes were spent face-to-face with the patient during this encounter and over half of the time was spent counseling and coordination of care. Discussed the operation, potential complications, post-operative recovery and management, past medical records including laboratory data and diagnostic imaging available at the time of the consult. Dr. Bruce Moskowitz is thanked for involving me in the care of this interesting patient. Robert Udelsman, MD, MBA, FACS, FACE Endocrine Neoplasia Institute Miami Cancer Institute Baptist Health South Florida Signature Line Electronically Signed on 08/21/2018 07:33 Alonso, Rafael ARNP Result type: Surgery Office Clinic Note Result date: August 20, 2018 13:40 EDT Result status: Auth (Verified) Result title: Endocrine Surgery Consultation Performed by: Alonso, Rafael ARNP on August 20, 2018 13:42 EDT Verified by: Udelsman, Robert MD on August 20, 2018 14:49 EDT Encounter info: 903306115, MCI, Clinic, 08/20/2018 - Printed by: Cuevas, Yessenia OSHA Page 3 of 4 Printed on: 08/24/2018 11:21 EDT (Continued) EFTA00314238

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Surgery Office Clinic Note Epstein, Jeffrey € - * Final Report * Electronically Signed on 08/20/2018 14:49 Udelsman, Robert MD Completed Action List: * Perform by Alonso, Rafael ARNP on August 20, 2018 13:42 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 13:51 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 13:51 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 13:53 EDT * Modify by Alonso, Rafae! ARNP on August 20, 2018 13:53 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 13:53 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 14:12 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 14:16 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 14:17 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 14:19 EDT * Modify by Alonso, Rafael ARNP on August 20, 2018 14:20 EDT * Modify by Udelsman, Robert MD on August 20, 2018 14:49 EDT * Sign by Udelsman, Robert MD on August 20, 2018 14:49 EDT Requested by Alonso, Rafael ARNP on August 20, 2018 14:40 EDT * VERIFY by Udelsman, Robert MD on August 20, 2018 14:49 EDT * Sign by Alonso, Rafael ARNP on August 21, 2018 07:33 EDT Requested by Alonso, Rafael ARNP on August 20, 2018 13:42 EDT Result type: Surgery Office Clinic Note Result date: August 20, 2018 13:40 EDT Result status: Auth (Verified) Result title: Endocrine Surgery Consultation Performed by: Alonso, Rafael ARNP on August 20, 2018 13:42 EDT Verified by: Udelsman, Robert MD on August 20, 2018 14:49 EDT Encounter info: | 903306115, MCI, Clinic, 08/20/2018 - Printed by: Cuevas, Yessenia OSHA Page 4 of 4 Printed on: 08/24/2018 11:21 EDT (End of Report) EFTA00314239