r BioReference PRELIMINARY
r BioReference PRELIMINARY
LABORATORIES
D
0
T C
R FISCH, HARRY
C1720 - HARRY FISCH, III.
944 PARK AVENUE,
NEW YORK, NY 10028
Acct #: (C1720)
P: (212)879-0800 S1 lI Rm: EPSTEIN, JEFFREY
P BOB: 01/20/1953 Age: 62 y Sex: M
A U/FL: Bed:
Patient ID: T
E Address:9 EAST 71ST STREET,
N NEW YORK, NY 10021
p: (212)772-9416 1 Specimen ID: 100820998
Date Of Report: 10/29/2015 09:10
Date Collected: 10/27/2015 16:44
Date Received: 10/27/2015 22:29
North America Eastern Time
LNotes: NON FASTING
CLINICAL REPORT
Clinical Abnormalities Summary: (May not contain all abnormal results; narrative results may not have
abnormal flags. Please review entire report.)
Cholesterol 210 HI
HDL as % of Cholesterol 14 •
VLDL, CALCULATED
PT
Blood, Urine
TESTOSTERONE, TOT.,S.
Hemoglobin A1C 70 HI
10.0 LO
SMALL *
112.3 LO
5.9 HI Triglycerides
LDL/HDL Ratio 348 HI HDL CHOL., DIRECT 29 LO
3.83 HI LDL Cholesterol 111 HI
INTR.NORM.RATIO(INR) 0.92 LO
FREE TESTOSTERONE 29.82 LO PROLACTIN, SERUM 3.4 LO •
1
Test Result Abnormal e erence n s rev ous esu a e
Total Protein 7.1 5.9-8.4 g/dL
Albumin 4.6 3.5-5.2 g/dL
Globulin 2.5 1.7-3.7 g/dL
AA Ratio 1.8 1.1-2.9
Glucose 95 70-99 mg/dL
Sodium 135 133-145 mmol/L
Potassium 4.2 3.3-5.3 mmol/L
Chloride 96 96-108 mmol/L
CO2 26 22-29 mmol/L
BUN 21 8-23 mg/dL
Creatinine 1.03 0.80-1.30 mg/dL
e-GFR 77 >or=60 mL/min
e-GFR, African American 89 >or=60 mL/min
BUN/Creat Ratio 20.4 10.0-28.0
Calcium 9.7 8.6-10.4 mg/dL
Uric Acid 6.2 3.4-8.5 mg/dL
Iron 57 45-160 ug/dl
Bilirubin, Total 0.5 <1.2 mg/dL
LD 177 135-225 U/L
Alk Phos 62 40-156 U/L
AST 23 <40 U/L
PHOSPHORUS 3.3 2.7-4.5 mg/dL
ALT 25 <41 U/L
GGTP 15 10-71 U/L
-* CARDIOVASCULAR/LIPIDS *--
Cholesterol 210 HI <200 mg/dL
Triglycerides 348 HI <150 mg/dL
BioReference Laboratories, Inc.
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Laboratory Director Printed 11/02/2015 12:27
EFTA00594095
BioReference --tstr LABORATORIES
D
0
C
R FISCH, HARRY
C1720 - HARRY FISCH, III.
944 PARK AVENUE,
NEW YORK, NY 10028
Acct #: (C1720)
P: (212)879-0800 S1 EPSTEIN, JEFFREY
P DOB: 01/20/1953 Age: 62 y Sex: M
A U/FL: Bed:
T Rm:
I Patient ID:
E Address:9 EAST 71ST STREET,
N NEW YORK, NY 10021
T
P: (212)772-9416 IPRELIMINARY
Specimen ID: 100820998
Date Of Report: 10/29/2015 09:10
Date Collected: 10/27/2015 16:44
Date Received: 10/27/2015 22:29
North America Eastern Time
CLINICAL REPORT
Test • Result Abnormal Reference Units Previous Result Date
HDL CHOL., DIRECT 29 LO >40 mg/dL
HDL as % of Cholesterol 14 * >14 %
Evaluation: ABOVE AVG.(MODERATE RISK)
Chol/HDL Ratio 7.2 <7.4 1
Evaluation: AVERAGE RISK
LDL/HDL Ratio 3.83 HI <3.56
LDL Cholesterol 111 HI <100 mg/dL
VLDL, CALCULATED 70 HI 7-32 mg/dL
* HEMATOLOGY *
WBC 6.33 3.40-11.80 x10(3)/uL
RBC 5.01 4.20-5.90 x10(6)/uL
HGB 14.6 12.3-17.0 gm/dL
HCT 41.9 39.3-52.5
MCV 83.6 80.0-100.0 fL
MCH 29.1 25.0-34.1 pg
MCHC 34.8 29.0-35.0 gm/dL
RDW 14.4 10.9-16.9 %
POLYS 51.1 36.0-78.0 %
LYMPHS 37.1 12.0-48.0 %
MONOS 5.8 0.0-13.0
EOS 5.4 0.0-8.0 %
BASOS 0.6 0.0-2.0 %
IMMATURE GRANULOCYTES 0.0 0.0-1.6 %
Platelet Count 257 144-400 x10(3)/oL
MPV 9.0 8.2-11.9 fL
PT 10.0 LO 10.3-12.8 sec
INTR.NORM.RATIO(INR) 0.92 LO 2.00-3.00
CLINICAL INDICATIONS FOR INK USE
Prophylaxis or treatment of venous thrombosis,
systemic embolization, and pulmonary embolus
High-risk patients with mechanical heart valves
Normal Non-Medicated patients
NOTE: INR values below 2.00 for patients on warfarin
therapy would be considered sub-therapeutic
for the above conditions. Reference Range
2.00-3.00
2.50-3.50
0.87-1.19
PIT 27.6 23.6-31.6 sec I [
BioReference Laboratories, Inc.
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Laboratory Director Printed 11/02/2015 12:27
EFTA00594096
BioReferencer LABORATORIES
0
C
R FISCH, HARRY
C1720 - HARRY FISCH, III.
944 PARK AVENUE,
NEW YORK, NY 10028
Acct #: (C1720)
P: (212)879-0800 51 EPSTEIN, JEFFREY
P DOB: 21:20/1953 Age: 62 y Sex: M
A U/FL: Bed:
I Rm:
I Patient ID:
E Address: 9 EAST 71ST STREET,
N NEW YORK, NY 10021
I
P: (212)772-9416 PRELIMINARY
1 Specimen ID: 100820998
Date Of Report: 10/29/2015 09:10
Date Collected: 10/27/2015 16:44
Date Received: 10/27/2015 22:29
North America Eastern Time
CLINICAL REPORT
Test Result Abnormal Reference m Units Previous Result Date
* URINALYSIS *
Color YELLOW YELLOW, STRAW,
AMBER
Character CLEAR CLEAR
Specific Gravity URN 1.023 1.003 - 1.030
pH Urine 5.0 5.0 - 8.0
Protein, Urine NEGATIVE NEGATIVE
Glucose, Urine NEGATIVE NEGATIVE
Ketone, Urine NEGATIVE NEGATIVE
Urobilinogen Urine 0.2 0.2 - 1.0 Units
Bilirubin, Urine NEGATIVE NEGATIVE
Blood, Urine SMALL * NEGATIVE
Nitrites Urine NEGATIVE NEGATIVE
Leukocyte Esterase NEGATIVE NEGATIVE
Crystals Urine NONE NONE
Crystal Amt. Urine NONE NONE
WBC, Urine 0-4 0-4 PER HPF
RBC, Urine NONE SEEN NONE SEEN PER HPF
Epithelial Cells, Ur NONE FEW
Cast, Hyaline, Urine 0-4 0-4 PER LPF
Cast, Granular, Urin NONE SEEN 0-1 PER LPF
Cast, RBC, Urine NONE SEEN 0-1 PER LPF
Bacteria, Urine NONE FEW
* MICROBIOLOGY *
CULTURE, URINE <10,000 NO GROWTH
CFU/ML
(U...
<10,000 CFU/ML (USUALLY CONSIDERED INSIGNIFICANT GROWTH)
SOURCE: URINE
* MISCELLANEOUS *
TSH 2.060 0.178-4.530 uIU/mL
THYR0XINE(T4) 7.5 4.9-12.9 ug/dL
T3 UPTAKE (T3U) 29.1 24.3-39.0 %
THYROXINE, FREE (FT4) 1.06 0.80-1.73 ng/dL
FREE T4 INDEX 2.2 1.5-3.8
T3 (THYRONINE), TOTAL 129 72-180 ng/dL
PSA Total 0.87 <4.00 ng/mL
NOTE: The PSA assay should not be the only test used for diagnostic purposes.
Additional evaluation using DRE, ultrasound, TUR or similar procedures may
be used for this purpose. Predictions of disease recurrence should not be
BioReference Laboratories, Inc.
481 Edward H. Ross Dr I Elmwood Park, N3 07407 I (800) 229-5227 JarnesWelsbergerIll. Page 3 of 5
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EFTA00594097
BioReference
LABORATORIES
D
0
T C
R FISCH, HARRY
C1720 - HARRY FISCH, III.
944 PARK AVENUE,
NEW YORK, NY 10028
Acct #: (C1720)
P: (212)879-0800 S1 EPSTEIN, JEFFREY
P DOB: 01/20/1953 Age: 62 y Sex: M
A U/FL: Bed:
T Rm:
I Patient ID:
E Address: 9 EAST 71ST STREET,
N NEW YORK, NY 10021
T
P: (212)772-9416 PRELIMINARY
1 Specimen ID: 100820998
Date Of Report: 10/29/2015 09:10
Date Collected: 10/27/2015 16:44
Date Received: 10/27/2015 22:29
North America Eastern Time
CLINICAL REPORT
Test Result Abnormal Reference m Units I Previous Result' Date
based solely upon values obtained from serial P5A values obtained on the
patient.
NOTE: Values obtained with different assay methods or kits cannot be
used interchangeably.
NOTE: Results cannot be interpreted as absolute evidence of the presence or
absence of malignant disease.
ASSAY INFORMATION: Method Electrochemiluminescence Immunoassay (Roche Diagnostics).
PSA, FREE 0.31 Not Estab. ng/mL I
NOTE: Results cannot be interpreted as absolute evidence of the
presence or absence of malignant disease. Values obtained
with different assay methods or kits cannot be used
interchangeably.
ASSAY INFORMATION: Method Electrochemiluminescence Immunoassay
(Roche Diagnostics).
% FREE PSA 36 See Below % I
FREE PSA RISK ASSESSMENT
The probability of prostate cancer for men with non-suspicious DRE results, by
age group, using PSA values between 4.000 and 10.000 ng/mL and percent FREE PSA
values is summarized in the table below:
PROBABILITY OF CANCER*
%free PSA (50-59 yrs) (60-69 yrs) (>or.70 yrs)
cor•10 49.2% 57.5% 64.5%
11-18 26.9% 33.9% 40.8%
19-25 18.3% 23.9% 29.7%
>25 9.1% 12.2% 15.8%
*probability of finding prostate cancer by needle biopsy
NOTE: Calculation of percent FREE PSA may not be possible when the value for
TOTAL PSA is in the low normal range. These guidelines are for assays
performed using the Roche E170 immunoassay system.(02/2012;v5)
TESTOSTERONE, TOT.,S. 112.3 LO 193.0-740.0 ng/dL
TESTOSTERONE, BIOAVAIL. 74.6 72.0-460.0 ng/dL
SEX HORM.BIND.GLOB. 14 10-57 nmol/L
FREE TESTOSTERONE 29.82 LO 30.00-150.00 pg/mL
LH 3.7 1.7-8.6 mIU/mL
FSH 4.0 1.5-12.4 mIU/mL
PROLACTIN, SERUM 3.4 LO 4.0-15.2 ng/mL
ESTRADIOL 16.00 7.02-49.06 pg/mL
FIBRINOGEN 362 176-441 mg/dL
Hemoglobin A1C 5.9 HI <5.7 %
HEMOGLOBIN A1c AND eAG REFERENCE RANGES
A1c(%) DIABETES CATEGORY*
<5.7 Normal (non-diabetic)
5.7-6.4 Increased risk of diabetes
BioReference Laboratories, Inc.
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Laboratory Director Printed 11/02/2015 12:27
EFTA00594098
BioReference
D LABORATORIES
T C
R FISCH, HARRY
C1720 - HARRY FISCH, III.
944 PARK AVENUE,
NEW YORK, NY 10028
Acct #: (C1720)
P: (212)879-0800 S1
ITEPSTEIN, JEFFREY
P DOB: 01/20/1953 Age: 62 y Sex: M
U/FL: Bed:
T Rm:
I Patient ID:
E Address:9 EAST 71ST STREET,
N NEW YORK, NY 10021
P: (212)772-9416 PRELIMINARY
1 Specimen ID: 100820998
Date Of Report: 10/29/2015 09:10
Date Collected: 10/27/2015 16:44
Date Received: 10/27/2015 22:29
North Americo Eastern Time
CLINICAL REPORT
Test Result Abnormal Reference Units [Previous Result Date
NOTE: .>6.5 Consistent with
A1c(%) eAG(ESTIMATED AVERAGE PLASMA GLUCOSE)(mg/dL)
6 126
7 154
8 183
9 212
10 240
11 269 diabetes
12 298
*recommended ranges -American Diabetes Association(2010)
Hemolysis, rare hemoglobin variants and thalassemia major may affect glycemic results.
DIHYDROTESTOSTERONE TO FOLLOW SEE REPORT
BioReference Laboratories, Inc.
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Laboratory Director printed 11/02/2015 12:27
EFTA00594099
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[Image 1] The image shows a clinical report form. It includes sections for patient information, clinical findings, and laboratory results. There are numerical values and observations related to the patient's condition and treatment. The form is from a medical facility, as indicated by the logo and the clinical context of the information presented.
[Image 2] The image shows a document with a header that reads "BIOREFERENCE." Below the header, there is a section titled "Clinical Report" with various columns and data points. The document appears to be a clinical report or a medical document, possibly related to a study or clinical trial. The visible columns include "Subject ID," "Age," "Gender," "Weight," "Height," "Blood Pressure," "Blood Glucose," "Bl
[Image 3] The image shows a clinical report form with various sections filled out. It includes patient information, medical history, physical examination findings, and laboratory results. The form is structured with headings and columns for data entry. The patient's name is visible at the top, along with the clinician's name and the date of the report. The form is from a healthcare provider, as indicated by
[Image 4] The image shows a clinical report form with various sections filled out. It includes sections for patient information, clinical findings, and laboratory results. The form is structured with headings, checkboxes, and numerical data. The top of the form has a logo and the name "BIOREFERENCE" which suggests it is a medical or clinical document. The visible text includes patient information such as na
[Image 5] The image shows a clinical report form. It includes sections for patient information, clinical findings, and a summary of the visit. The form is structured with headings and checkboxes for various symptoms and observations. The patient's name is visible, along with the date of the visit. The form is used for documenting the details of a medical visit.