This document is a patient authorization form for the release of medical information from Mount Sinai to a third party. The patient, Jeffrey Epstein, authorizes the disclosure of medical information related to his Manhattan medical records, specifically an MRI dated 12/14/2016. The information is to be disclosed to his personal assistant, Lesley Groff, at the address 9 East 71st Street, New York, NY 10021. The reason for disclosure is a patient request.
documents/EFTA00313615.pdf
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