EFTA00522202.pdf

Report Status: Partial raj Quest Diagnostics SHULIAK, Specimen Information Client Information Specimen: MR190205P Client #: 78300020 56W5265 Requisition: 0007032 MOSKOWITZ, BRUCE W DOB: BRUCE MOSKOWITZ, MD Gender: Attn: NATIONWIDE ACCOUNT Collected: 12/06/2018 Phone: 1411 N FLAGLER DR STE 7100 Received: 12/06/2018 I 20:12 EST Patient ID: WEST PALM BEACH, FL 33401.3418 Reported: 12/07/2018 / 05:20 EST Health ID: IT N Tn o rh c Tat. CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE I OF 2 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522202  Report Status: Partial raj —• Quest Diagnostics' SHULIAK, Patient Information Specimen Information Client Information Specimen: MR190205P Client # SHULIAK, Collected: 12/06/2018 MOSKOWITZ, BRUCE W DOB: Received: 12/06/2018 / 20:12 EST Gender: F Reported: 12/07/2018 / 05:20 EST Patient ID: Health ID: PERFORMING SITE: MI QUEST DIAGNOSTICS/JIM.% I0M0 COMMERCE PARKWAY. MIRAMAR. FL 33015.3938 Lai:pommy DINCIOI: JULIE I. FRIEDMAN.MD. CLIA: I0D027731.1 CLIENT SERVICES: 866.697.8378 SPECIMEN: MR190205P PAGE 2 OF 2 Quest. Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics. EFTA00522203