# Profoundd archive — Epstein Files
# Bates number: EFTA00305909
# Title:        Health0 iagrtiCLabOratOryl nc. 0002442 -0168002
# Dataset:      9
# Pages:        1
# Tags:         epstein, doj, dataset-9
# Source PDF:   https://profoundd.com/epstein-docs/EFTA00305909/download
# Doc viewer:   https://profoundd.com/epstein-docs/EFTA00305909
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#----------------------------------------------------------------------

=== SUMMARY ===
Health0 iagrtiCLabOratOryl nc. 0002442 -0168002 or. Morph P.13130anaciiiiitatily Mega GJA No. 490/100708 I CAP No. 7224971 I NH No. 1629209853 INSTRUCTIONS 1) please Min allol the yelew Ng Weed amain% tiding the clognosn code vecton at (Mum tenon of chit requeaston 21 Have the patient sin the Relent and Assignment ol Stoat; semen below 3) lea, Inc. will accept an Malone Demographic Sheet n sublets...le for Panne information provided it melees all required SIIIIIIPSPOI4 II I40-9 codes we Mt Part


=== EXTRACTED TEXT ===
Health0 iagrtiCLabOratOryl nc. 0002442 -0168002 
or. Morph P.13130anaciiiiitatily Mega 
GJA No. 490/100708 I CAP No. 7224971 I NH No. 1629209853 
INSTRUCTIONS 1) please Min allol the yelew Ng Weed amain% tiding the clognosn code 
vecton at (Mum tenon of chit requeaston 
21 Have the patient sin the Relent and Assignment ol Stoat; semen below 
3) lea, Inc. will accept an Malone Demographic Sheet n sublets...le for Panne 
information provided it melees all required SIIIIIIPSPOI4 II I40-9 codes we Mt 
Part of your demographic sheet. please pr Me +copy of the Patient Problem List 
including al ICOJACM cabs For diagnoses. conditions. or symptoms. 
PhOtChins 10, <Rhea indohcluats aut hooted to order tests, should on), 
order tests that we intensely necessary and reasonable LAST 
FIRS1 
0002442-0166002 
LAST 
FIRST 
0002442-0168002 
MATION 
it last Name: Win Middle Initial: 
pmj„„11,1,Jt  1 1 1 1 1 1 1 4,1.j 1 1 1 1 1 
City: IRAN: Cell/Home Insane: Work Phone:
Email Address: Pip Code: 
Social In :Ltspir. hots i Weft ht:LAST  LAST 
FIRST  FIRST 
0002412-0168002 00024C-0160002 
UST 
FIRST 
0002442-016600: LAST 
FIRST 
0002442-0110002 
SP. Arts 
Dr. Paw Ate 
4487 Philbrook Squire 
San Diego, CA 92130 
Dori!, Ph 
PECIMEN INFORMA Rowing Lab. 
Collection Date: * 
Phlebotomist's Initials 
an: dme of last dose: Phone 
am/pm Fasting:3g Set H's NO 
"IA 
sINSURANCE: Please attach a copy oF ROTH Skies et Patient's insurance card. Medicare Number: 
0 SELF PAY: HDL Inc. will bill the patient. im Fr 
ASSIGNMENT OF BENEFITS Ai a mu:ten. Di I every reasonable effort to obtain reimbursement for ordered tests. I au 
• Tor, re HOI. Inf to re:eait to %led co ie. its carriers, and any insurance carrier or health plan providing medical 
benelits to me. any 'one motion that may be needed for claim purposes. I consent to submit my sample to SIDS 
. tor testing. I am making an assignment of Medicare. Medicaid. and/or insurance benefits to HDL Inc. 
ea to myInstance: I understand that it ray insurance company pays me dreg* for services rendered by SIDI.. Inc. 
I am responsible for forwarding such payment to HDL, Inc. I also understand that I am responsible for any de 
ductibse/copayrnent. as required by my plan. Important: Insurance regulations regime MX inc. to seekpap-rent. I 
Permit a copy of this authors/alias to be in place of the original. Gene& Informed Consent: If ordered by my ph 
vessel. I consent to haeng genetic analysis performed at the request ol my physician and the results of the analysts 
made toilet:410 my 4...Wolin 64Y results are solely used by my physician to obtain information for therapeutic 
a diagnostic purposes This signed request authorues Het Inc. to perform the test and deiced° the results to my 
medical practitioner No tests Other than those requested by my physician wit be performed. 
Patient Signature PIr an 
o B 
LOLP & HDLP 
oAI
Lore/ mess 
IWtoe)-P(O
Los-C RP-PLA2 
h 
Frbdricon 
HEIL 2 
Gelman-3 Homecysterna 
13 Fin & Total 
Reverse T3 
14 Free & Total 
191 
Testosterone 
Fres Ttstobletons 
IGF-1 
sdLDL 
NT-pro BNP Clete ID: 
Phcoic ■ 
Date BAB 
6/5 /15 
KI cny 
Cortisol AspelnWorks 
Glucose Tolerance Test FSH 
Uric Acid Progesterone 
AO* e swan. Cyststrn-C 
Feria V Leiden Sterols tN 
Prothrornbin Mute& Onmee-3 
Iron & II BC DHEA.S MTHFR 
Iron VII D SHBG 1St 
RBC Folios \Main 012 
LDUC DPMP 
Leona Adrocriectr 
Apolpoproten A I 82172 
0Apospaproten 8 82172 
DH042 C Subclass 81664 
❑LOL.P 8 Hobe Ilsy Neal 83704 
0 ONO massed refer 83695 
0 sdiot.c 83700 
Awes l rir=74?n::..rnn82565. Wor 84431 
0 7/Isaiah:manes 83789. 82570 
O fibrinogen 85384 
Ohs Cfle 86141 
0 lisiPLA, 83698 
OMPO $3516 IrTIFFIFF.32777 
83180 
❑FM/M CA 
OGIamst 
OHtneglotsn Sic 
❑ sernecysteine 
O 84631 
82726 
82947 
85036 
83090 
83525 
❑ ROC Fonts 82747. 25014 
❑Unc Acid 84550 
O Vitae^ 6.r 82607 
025 hydrcoevitamin D82652 Routine Pane s 
(see reverie fide for derails) 
*Ca Genotype 81401 
OCYPX19 (Nem' Response) 81229 
CI FaCtOr nekton 81241 
0 MTHF8C6774 8.3129.9C MutatiOnS 81291 
O Proihrombin Mutation 81240 
OCYP2C9 ri •s1 8. MAGI chtscsao 8122781355 
Earrillaill AillriErallilli r ung 70 
❑vs.A. total 84153 
SH 844)3 
O14.1 Free 844)1 
O14 84436 
BT3. free 
13 64481 
8.480 O Basic Metabolic Panel 
• Comp Metabolic Panel 
❑ Complete Blood Count w/dIfferendel 
El Diabetes Prevention and Management Panel (DPMP) 
• Hepatic function Panel 
o Lipid Panel 
• Omega-3 and Omega-6 Fatty Acid Profile 
O Oral Glucose Tolerance Test (OGTT) 
O Renal Panel 
❑ Noncholesterol Sterols & Stand' 
LI Thyroid Cascade asK, hisNli reflexes to )4. free 71. and Ti) 
LI Thyroid Panel (194.13. 14. and free T41 80048 
80053 
85025 
80076 
80061 
82541, 82544 
82542 
Additional Tests On Back 
Please write the test name and COT code 
°Name. 
ONa 
Cltiame: CPT' 
CPT' 
faleigNOSI5 CODE(S) REQUIRED. PLEASE CHECK AU. CODES THAT APPLY. WRITE ADOOKINAL CODES IN THE YELLOW HIGHLIGHTED SECTION AT THE BOTTOM Of THIS FORM. The codes below are listed as a corMmience. This is not an allinClulive list.
INIMICRIERNIM 011naertmuice. magnate 
ORPM•ftlifitaCiel, benign 
Jura:demos.% tantsecifed 
jitypenensive heart disease, n.µgnant 
Jlerpenensive Man Or benign. a/oMantracer. 
Dhhiptinenvve heart Or benign. w/ heart (elute 
DItypenentive heart dr. umpire w/o heart failure 
Danes& NO5 
DChant pats unseen...0 
Dub. name artery 
]Coronary atherosclerosis due mulched logn 
OCardiovascutar disease. unspecified FASCVOI 
Diarnoly Nuance cardsnausibe disease Y17.49 Oltaalrfigratoss. moderate 263 0 0 Personal h. of tobacco use 
%Family hedoryischemic heart di V17.3. OOthe. 8 cornetts deectenoes Wit $121 266 2 0 liovtine annual health check-up 
J Carotid artery colusidenosts, wto infanta, 433.10Retarnin 0 deficiency 268 9 0 Long term (current) use of meacanons 
3 Alf ial hbralloOn 427.3gOOsteoporosis.1405 713 CO OLOODDISOODON jAtnbroscletosts of ocher 'pentad arteries (non coroners/440 8 iCHspenhcarsterolernia 2724 [Ilion deficsency anerma. unspecified 
LI Athssrov.ltrunc vascular 2.12, 505 440.9 CI Pare hyeergiecendernignementighteetrinu272 1 0 rotatedekleaCy leternto 
ENO oatill&NUMMON.MITAIOLK OHyperhpetemu. rinsed 272 2 0 Memo& denciergy. unspecified 
istypothuicidism unsettled 244.9 °Hyped...Sena NO5 272.4 DArstmia. unspecified 
Additional Codes: 
. . _......... . . ijoiatietes meatus, n controaid 
rot 0 MOiabetes meatus. II untontnYkd 
401 1 C 99ectel screening for dabetes meatus 
401.9 OFTediabetes. abn glucose eisperglyceenia 
401 00eCktrated/ampaired fasting glucose 
10.7 160 Personal history of gestanOnal diabetes 
402 11 0 rangy htucry of clobetes molten 
40290 OHsperparaterchoidism. unspecified 
413 9 0 HypoparalliwOdopt 
746 500 Testicular hypefunown. NOS 
424 01)14ormiser/enesocrine disorder. ttinpeOfted 
414.6 ONututional deficiency 
429 2 OPAalnutotion. severe 25000 D unspent's., disorder of metabolism 
25002 D Screeerg for lied disorders 
v77 I Oinsulin resistance/ Dysmatabolic syndrome 
79029 0 Obesity, unspeohea 
790.21 BIONl a StIAPTOtAS. STATUS VI2 21 Of atque malaise. weakness. NOS 
V180 OMemon Loss 
251.00 Oatrormat gat 
252.1 Clad, ohcoortio4nat 
257.2 0 Weight loss. atincrreal 
259.9 ()Abnormal blood chemistry lab endings 
V12 00ther abnormal hndings of. blood tests 
262 0900.4c 0 usa and abuse 272.9 OThionstotroPenia. unSPetiatd 
v7791 MENTAL NSOIMMS 
277 7 00tpressen NOS. Peretove mot, 311.0 
278.00 Chiba depressor duster, recurrent episode296 30 
0Alzhenner's dr 331.0 
780,79 INSPIRATORY 780 93 050e (Shortness of breath) 
781.2 0 Dyspota. respratory Insuffiateer 
7813 OCO4th 
785 21 Disbnotmat meat troy 
790 6 OSeelling. mats or lump in Chest 
790.99 Otiose cheese. NO5 
3053 Drama/ history of lung cancer 
V15.82 0Astestos hiposiae, pence/OH 
v700 SIMMOINIUMIN. v5889 IDGCROMenia 
CRINITOMMIArt 2209 0Screeneu for Prostate Cancer (MN 
281.2 00evaltdP54 
2819 OProstate Cancer 
285.9 Diemen prostanc nmenroohy Mehl 287.5 
786.05 
786.09 
786 2 
793 19 
786 6 
518 89 
V161 
V1584 
53021 
V7644 
"a," las.° 640 AO 
EFTA00305909