HARRY FISCH, MD (PIN #D91790)

HARRY FISCH, MD (PIN #D91790) 944 Park Avenue New York, NY 10028 Patient Name:lers-CAS'el EPSI-CIA/ Date of Birth: OFFICE VISIT New Patient Level II 99202 FEE New Patient Level III 99203 Li 25 Established Patient Visit Level II 99212 Established Patient Visit Level III 99213 SURGICAL PROCEDURES Biopsy of Testis (Needle) 54500 FEE Biopsy of Testis (Incisional} 54505 Epididymovastostomy (Unilateral) 54900 Epididymovastostomy (Bilateral) 54901 Hydrocelectomy {Unilateral} 55040 Hydrocelectomy (Bilateral) 55041 TUR Ejaculatory Ducts 52402 Varicocelectomy (Unilateral) 55530 Varicocelectomy (Bilateral} 55530(50) Vasovasostomy {Unilateral} 55400 Vasovasostomy {Bilateral) 55400(50) Vasectomy 55250 DIAGNOSTIC TEST TO BE SCHEDULED 1111 Transrectal Prostate Sonogram Testicular Sonogram Testicular Sonogram w/Doppler Penile Duplex Doppler Bladder Ultrasound Cystoscopy CHARGE PYMT Sao CASH ID Number: (212) 879-0800 Date of Service: Unit Number: DI HY Bladder Scan 51798 FEE Cystoscopy 52000 Transrectal Prostate 76872 Testicular (Scrotal) 76870 Testicular w/Doppler 93975 Ultrasound Bladder 76856 DIAGNOSIS Acute Prostatitis 601.0 Azoospermia 606.0 BPH 600.00 Chronic Prostatitis 601.1 Condyloma of Penis 078.10 Hematuria 599.7 Hydrocele 603.9 Infertility, Male 606.9 Orchitis/Epicliclymitis 604.9 Peyronie's Disease 607.85 Pituitary Dysfunction 253.8 Prostate Cancer 185.0 Renal Stone 592.0 Testicular Failure >c , 257.2 Testicular Pain 608.9 till 599.0 Varicocele 456.4 Voluntary Sterilization V25.2 CHECK RECEIVED I certify that I have rendered the above service: EFTA00304570