“a ‘LabCorp Patient Report Specimen | meas Acct # Phone: EEE «=—Rte: 67 Control ID: Ellen S Marmur MD SHULIAK, KARYNA 12 East 87th Street Ste 1A New York NY 10128 Physician Details Patient Detai Specimen Details cos: Date collected: (9/242018 0000 Local Ordering: E MARMUR Age(y/m/d) mm Date received: 11/30/2018 Referring: Gender: F SSN: Dateentered: 11/30/2018 1D: Patient 10: EE Date reported: 11/30/2018 0610 ET NPI General Comments & Additional Information Clinical Info: SRC Alternate Control Number: 16719 Alternate Patient ID ma Total Volume: Not Provided Fasting: No Ordered Items eT FINAL REPORT private and confidential health information protected by state and federal law 1995-2018 Laboratory Corpo document in error, please call 800-631-5250 All Rights Reserved - Ent date Issued: 11/30/18 0611 Page | of This document contains rica® Holdings if you have received Version: 1.0 EFTA00522654

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ey Patent honey Patient: SHULIAK, KARYNA Specimen 10: nnn 0 Patient 10: Control ID || Date collected UNITS REFERENCE INTERVAL LAB FINAL REPORT al health informatio ease call 800-631-525 EFTA00522655

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Be Patent ener Patie KARYNA specimen (0 bos Patient iO: control 10: Date collected: 34/93{848; 0000 Loca “ Bel RESULT FLAG UNITS REFERENCE INTERVAL LAB 8 TS RS FT ES ei 6 OL TR ORT! SMITE A AE FORM EEN oe ee TN SO SR Date Issued: 11/30/18 0611 ET FINAL REPORT Page 3 of 3 This document contains private and confidential health information protected by state and federal law 1995-2018 Laboratory Corporation of America® Holdings If you have received this document in error, please call 800-631-5250 All Rights Reserved - Enterprise Report Version: 1.00 EFTA00522656