~ tC BR ei apart Specimen ID PF Acct +: Phone: Rte: 67 Control ID: i Ellen S Marmur MD SHULIAK, KARYNA 12 East 87th vee “a 1A New York NY 1 AMMO TM Pati i Specimen Details Physician Details DOB: Date collected: 10/31/2018 0000 Local Ordering: E MARMUR Agely/m/d) Date received: 11/01/20 Referring: Gender: F SSN: Dateentered: 11/01/ 8 1D Patient 10: Date reported: 11/01/2018 0611 € np: FINAL REPORT d by state and federal law EFTA00522657

--=PAGE_BREAK=--

| LauCorp (BRI aici ee eeenenmenme sree: Patient: SHULIAK, KARYNA Specimen 1D: bos Patient 1D: Date collected: 10/31/2 0 Local TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB 11/01/18 0611 ET FINAL REPORT d confidential health in! ted by state and federal law © 1995-2018 Laboratory C n error, please call BOC All Rights EFTA00522658