EFTA00522213.pdf

Report Status: Partial raj Quest Diagnostics SHULIAK, KARYNA Patient Information Specimen Information Client Information Specimen: MR190205P Client #: SHULIAK, KARYNA Requisition: 0007032 MOSKOWITZ, BRUCE W DOB: 05/31/1989 AGE: 29 BRUCE MOSKOWITZ, MD Gender: F Attn: NATIONWIDE ACCOUNT Collected: 12/06/2018 Phone: 1411 N FLAGLER DR STE 7100 Received: 12/06/2018 / 20:12 EST Patient ID: WEST PALM BEACH, FL 33401.3418 Reported: 12/10/2018 / 10:27 EST ViliAP Hams Tn Ranee. Out Of Amino Rpfprpncp Ranao Lab CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE 1 OF 4 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522213  RkportStatus:Pardal Quest Diagnostics SHULIAK, - Patient Information Specimen Information Client Information Specimen: MR190205P Client # SHULIAK, KARYNA Collected: 12/06/2018 MOSKOWITZ. BRUCE W DOB: AGE:■ Received: 12/06/2018 / 20:12 EST Gender: F Reported: 12/10/2018 / 10:27 EST Patient ID: Teat Name In Range Out Of Range Reference Range Lab Endnote I Please fax this signed form to Please do not attempt to return this document by other methods. Documents will not be viewed by a representative. Please do not use this fax number for other service requests. CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE 2 OF 4 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522214  Report Status: Partial raj —• Quest Diagnostics' SHULIAK, Patient Information Specimen Information Client Information Specimen: MR190205P Client # SHULIAK, KARYNA Collected: 12/06/2018 MOSKOWITZ, BRUCE W DOB AGE. Received: 12/06/2018 120:12 EST Gender: F Reported: 12/10/2018 10:27 EST Patient ID: PERFORMING SITE: MI QUEST DIAGNOSTICSNIIAMI IMO COMMERCE PARKWAY. MIRAMAR. FL 33015.3938 Laboratory Diector: JULIE L FRIEDMAN.MD. CLIA: 11/D0277311 TP QUEST DIAGNOSTICSTAMPA. 1225 E FOWLER AVE TAMPA. FL 33617.2026 Laboratory Director GLEN L HORTIN.MD.PIID. CUA: 1000291120 CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE 3 OF 4 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522215  Report Status: Partial 1 1) Quest Diagnostics SHULIAK, KARYNA Patient Information Specimen Information Client Information Specimen: MR190205P Client W SHULIAK, KARYNA Collected: 12/06/2018 mosicowin, BRUCE W DOB: Received: 12/06/2018 / 20:12 EST Gender: F Reported: 12/10/2018 10:27 EST Patient ID: Teat Name In Range Out Of Range Reference Range Lab PERFORMING SITE: TP QUEST DIAGNOSTICSTAMPA 4223 E FOWLER AVE TAMPA FL 33617.2026 MEDICAL DIRECTOR: GLEN L HORTIN.MD.PHDCLIA NO: 1000291120 CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE 4 OF 4 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522216