From: Lesley Groff
Sent: Wednesday, January 21, 2015 8:01 PM
To: Jeffrey Epstein; Karyna Shuliak
Subject: Forms for Dr. Kline appointment tomorrow
I am sending you 2 forms that I have filled out but need your signature =or the Dr. Kline appt tomorrow at 8:40am. One
is "Receipt of Notice =f Privacy Practices Written Acknowledgement Form" ...the other is a =93Patient Request for Email
Communications" I am not sure if you =ant to sign either...
Karyna, can you please print for Jeffrey and let him have a look at =hem...if he wants to sign them, he can either take the
originals with =im to the appointment tomorrow...or maybe better, you can fax them to =r. Kline's office at
(you can always scan and email to =e and I can fax them if you prefer)
<?xml version=.0" encoding=TF-8"?>
<!DOCTYPE plist PUBLIC "-//Apple//DTD PLIST 1.0//EN" "http://www.apple.com/DTDs/PropertyList-1.O.dtd">
<plist version=.0">
<clict>
<key>conversation-idgkey>
<integer>127290</integer>
<key>date-last-viewed</key>
<integer>0</integer>
<key>date-received</key>
<integer>1421870453</integer>
<key>flags</key>
<integer>8590195713</integer>
<key>gmail-label-ids</key>
<array>
<integer>6</integer>
<integer>2</integer>
</array>
<key>remote-id</key>
<string>475224</string>
</dict>
</plist>
1
EFTA_R1_01647696
EFTA02514228