EFTA00313966.pdf

MEARISTVER MEDICAL IMAGING. PC ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES I. EPSTEIN, JEFFREY , have received the Notice of Privacy Practices from East River Medical Imaging, PC. PATIENT SIGNATURE 5/30/18 in lieu of patient signature, I, , a 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 DATE PATICNT NAMC. FPSTFIN, .irgFRPV 0315192 S000/C00045 IVA KV oz:s OTOZ/OC/S0 EFTA00313966