Patrick Mason

 
 60001 2 
 SS 
 ethos laboratories 
 Lab Director: Leon Glass, Ph.D. NRCC, DABCC 
 Help Line: (877)23004 Fax: (877)23004
 Patient ID: PT023004.PPITR 
 Patient Information 
 Provider Information 
 Specimen Information 
 PATIENT NAME: 
 Patrick Mason 
 CLINIC NAME: 
 Pacific Pain Institute TR 
 DATE COLLECTED: 
 10/2022/09
 D.O.B.: 
 11/1990/23
 PROVIDER NAME: 
 Katherine Castaneda MD 
 TIME COLLECTED: 
 09:35:00 
 HEIGHT: 
 0 
 CLINIC ADDRESS: 
 2410 Merced St 
 DATE RECVD: 
 12/2016/09
 WEIGHT: 
 0 
 CLINC PHONE: 
 (510)23004
 REPORT DATE: 
 11/2016/04
 GENDER: 
 M 
 CLINIC FAX: 
 (510) 23004 
 SAMPLE I.D. #: 
 1413 
 ethos laboratories SNAPSHOT 
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