screening results...

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Screening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C. Chief Medical Officer Dear Mr. Sample, Thank you for your recent participation at the health screening held at Danbury Senior Center. Congratulations on taking an important proactive step in maintaining your future good health! Your Results Your screening results are enclosed. They have been reviewed by a board-certified physician. The following page provides a summary view of all your results. We’ve provided you an additional copy of this page that we encourage you to share with your doctor even if your results are normal. The rest of the report contains more detailed information about each screening test. We suggest you keep your results with your other personal health records. Next Steps At Life Line Screening, we believe in prevention. We are here to help you lead a fuller and healthier life. With that in mind, here are 3 important steps you can take to maintain your good health: Share With Your Doctor: Preventive screenings can indicate the presence of a possible problem, but remember that the results of these screenings must be interpreted in the context of your clinical history. Your personal doctor can help with that interpretation. Screening tests can alert you to diseases long before symptoms occur. This is important for early diagnosis and treatment by your doctor. Stay Up-To-Date: Enroll in our FREE Power of Prevention E-Newsletter by signing up online at www.LifeLineScreening.com/welcome. Every month, you’ll receive important health news , valuable information on new health products and services, and discounts for you or your family & friends. Schedule Regular Follow-Ups: Screenings should be part of your ongoing health regimen. We will keep track of your past screening history, and notify you when it’s time to be re-screened. For most people, screenings every 12 – 24 months are medically appropriate. Mark your calendar, and plan to make health screening a regular event! Again, congratulations on taking this important step in managing your preventive health routine. At Life Line Screening, we are here to help you every step of the way. Life Line Screening Park Center Plaza II Suite 200 6150 Oak Tree Blvd. • Independence, OH 44131 www.LifeLineScreening.com 1-800-897-9177 Page 1 of 10 Report Date: May 8, 2012 John Q. Sample 123 Main St Anytown, TX 12345 12-0428_CLV,10000000 - 050812 Sample, John

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Page 1: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Screening Results Enclosed

Sincerely,

Andrew J. Manganaro,

M.D., F.A.C.S., F.A.C.C.

Chief Medical Officer

Dear Mr. Sample,

Thank you for your recent participation at the health screening held at Danbury Senior Center.Congratulations on taking an important proactive step in maintaining your future good health!

Your ResultsYour screening results are enclosed. They have been reviewed by a board-certified physician. The followingpage provides a summary view of all your results. We’ve provided you an additional copy of this page that weencourage you to share with your doctor even if your results are normal. The rest of the report contains moredetailed information about each screening test. We suggest you keep your results with your other personalhealth records.

Next StepsAt Life Line Screening, we believe in prevention. We are here to help you lead a fuller and healthier life. Withthat in mind, here are 3 important steps you can take to maintain your good health:

• Share With Your Doctor: Preventive screenings can indicate the presence of a possible problem, butremember that the results of these screenings must be interpreted in the context of your clinical history.Your personal doctor can help with that interpretation. Screening tests can alert you to diseases long beforesymptoms occur. This is important for early diagnosis and treatment by your doctor.

• Stay Up-To-Date: Enroll in our FREE Power of Prevention E-Newsletter by signing up online atwww.LifeLineScreening.com/welcome. Every month, you’ll receive important health news , valuableinformation on new health products and services, and discounts for you or your family & friends.

• Schedule Regular Follow-Ups: Screenings should be part of your ongoing health regimen. We will

keep track of your past screening history, and notify you when it’s time to be re-screened. For mostpeople, screenings every 12 – 24 months are medically appropriate. Mark your calendar, and plan tomake health screening a regular event!

Again, congratulations on taking this important step in managing your preventive health routine. At Life LineScreening, we are here to help you every step of the way.

Life Line Screening • Park Center Plaza II Suite 200 • 6150 Oak Tree Blvd. • Independence, OH 44131www.LifeLineScreening.com • 1-800-897-9177

Page 1 of 10

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Report Date: May 8, 2012

John Q. Sample123 Main StAnytown, TX 12345

12-0428_CLV,10000000 - 050812Sample, John

!20120507:SA120507.080:0001;

Page 2: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CarotidArtery

Disease

Normal Mild Moderate SignificantLeft:

PSV: < 110cm/s Plaque Buildupand

Blood FlowApril 2013

Normal Mild Moderate SignificantRight:

PSV: < 110cm/s

AtrialFibrillation

Normal Abnormal

No AtrialFibrillation

Heart Rate: 55Beats/min

4-limbEKG

April 2013

AbdominalAortic

Aneurysm

Normal Abnormal <3cmAbdominalAorta Size

April 2015

PeripheralArterialDisease

Normal> .90

Abnormal< .90

Unableto Compress

Left Side:1.17 Ankle

BrachialIndex

April 2014

Normal> .90

Abnormal< .90

Unableto Compress

Right Side:1.17

OsteoporosisLow Risk

> -1.2Moderate Risk

-1.3 to -2.5High Risk

< -2.6 -1.0Bone Mineral

Density (BMD)April 2014

Body MassIndex

Underweight<18.5

Normal18.5-24.9

Moderate Risk25-29.9

High Risk>30 27.3

lbs/in2

Height: 5'08"Weight: 180 lbs

April 2013

Screening Results

YES NODoctor Consultation Recommended: P

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Participant Copy

Page 2 of 10

Normal Mild Moderate Borderline Findings of Possible SignificanceKey

Page 3: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CompleteLipidPanel

Desirable<200 mg/dL

Borderline200-239

High Risk>240 174

TotalCholesterol

mg/dL

April 2013

Protected AgainstHeart Disease

>60 mg/dL

Desirable40-59

Risk forHeart Disease

<40 mg/dL77

HDLCholesterol

mg/dL

Optimal<100 mg/dL

Near/AboveOptimal100-129

Borderline130-159

High160-189

Very High>190 mg/dL 99

LDLCholesterol

mg/dL

Normal<150 mg/dL

BorderlineHigh

150-199

High200-499

Very High>500 mg/dL 136

Triglyceridesmg/dL

GlucoseNormal

<100 mg/dLPre-diabetes

100-125Diabetes

>126 mg/dL 96 GLU mg/dL April 2013

C-ReactiveProtein

Low Risk<1 mg/L

Moderate Risk1-3 mg/L

High Risk>3 mg/L 0.07 CRP mg/L April 2013

Page 3 of 10

Certain blood tests were processed at Home Healthcare Laboratory of America (a LabCorp Company)320 Premier Court, Suite 220, Franklin, Tennessee 37067�

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Normal Mild Moderate Borderline Findings of Possible SignificanceKey

Page 4: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Your Results

Condition Details What Does it Mean to Me?

Carotid Artery Disease

One of the leading causes of stroke is fatty plaque buildupin the carotid arteries, which may block adequate bloodflow to the brain. The carotid arteries are the main bloodsupply to the brain and are located on each side of theneck. Our screening is not meant to be a comprehensivediagnostic exam, but rather a screening to visualize thepresence of plaque which may affect the blood flow to thebrain. Your Carotid Artery Disease Screening results arereported as one of four (4) categories which describe theamount of plaque buildup identified: Within NormalRange, Mild to Moderate, Moderate, and Findings ofPossible Significance.

Within Normal Range: Essentially minimal to mildplaque buildup. Blood flow velocities within normallimits. Your Carotid Artery Disease Screening results areWithin Normal Range. This means that we haveidentified a negligible to minimal amount of plaquebuildup in both of your carotid arteries, which isinsignificant. The blood flow in your carotid arteries isalso within normal range. Since the plaque buildup is notaffecting the rate of blood flow, the velocity measurementsfor the internal carotid arteries will not be statedspecifically in this report. However, your velocities fellbelow 110 centimeters per second, which is within normallimits.

Atrial Fibrillation

Atrial Fibrillation or AF is the most common type ofirregular heart rhythm or arrhythmia. During AF, theupper chambers of the heart beat rapidly and irregularlyso that blood is not completely pumped out of the heart.This can cause blood to collect in the heart and form ablood clot. If the clot travels to the brain, it can cause astroke. Our screening is a 4-limb EKG and is not meant tobe a comprehensive 12-lead EKG (electrocardiogram). It isa screening to identify only the presence or absence of anatrial fibrillation heart rhythm at the time of the screening.

Normal: Your Atrial Fibrillation Screening results areNormal. No Atrial Fibrillation detected. This means thatat the time of your screening, your heart rhythm did notshow evidence of atrial fibrillation.

Abdominal Aortic Aneurysm

The aorta is the largest artery in the body, traveling fromyour breastbone to the level of your navel. Medicalconditions, such as high blood pressure and fatty plaquebuildup, can weaken the walls of the aorta, causing anenlargement or aneurysm. An aneurysm can form in anysection of the aorta, but they are most common in the bellyarea (abdominal aorta).

Our screening uses an ultrasound examination of theabdominal aorta to screen for the presence of either typeof aneurysm that is 3 cm or greater.

Normal: No abdominal aortic aneurysm has beendetected. Our physician has reviewed the ultrasoundimages and measurements of the aorta and bifurcation ofthe iliac arteries. All measurements are within normallimits.

Peripheral Arterial Disease

Peripheral arterial disease or PAD is a condition in whichfatty plaque builds up in the arteries leading to the armsand legs. One way to screen for PAD is by measuring theAnkle-brachial index (ABI). A small ultrasound device isused to measure your systolic pressures in both of thearms and legs. A ratio less than 0.90 indicates plaquebuildup and possible peripheral arterial disease. A ratioof 0.90 or greater is considered normal.

Normal: Your Peripheral Arterial Disease Screeningresults are Normal. ABI index of 0.90 or greater. Thismeans the pressures in your ankles are almost as high orhigher than the pressures in your arms, which is a normalresult.

Page 4 of 10

12-0428_CLV,10000000 - 050812Sample, John

Page 5: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Page 5 of 10

Osteoporosis Risk Assessment

Osteoporosis is a condition in which the bones areseverely weakened and brittle. As a result, fracturesoccur easily. Life Line Screening performs anosteoporosis risk assessment using quantitativeultrasound to measure the density of the heel bone. Theheel is measured because its bone is similar to that foundin the spine or hip, where osteoporotic fractures occurmost.

This screening is a risk assessment for bone loss and is notmeant to diagnose osteoporosis. Further evaluation anddiagnostics may be considered. Talk to your physicianabout your risk factors for bone loss.

Your T-score is -1.0 , which is Low Risk for Bone

Diminishment.You may wish to speak to your physician regarding riskfactor management and proactive steps such asweight-bearing exercise and calcium and vitamin Dsupplementation.

Body Mass Index

Body Mass Index (BMI) is a number calculated from aperson's weight and height, that correlates with total bodyfat amount. BMI screening is used to assess excess weight.If your weight and height were measured at the screeningevent, these values were used to calculate your BMI.Otherwise, your self-reported weight and height wereused. Based on the calculated BMI, the National Heart,Lung, and Blood Institute categorizes a person's BMI asUnderweight, Normal, Overweight or Obese. The term"Overweight" means having extra body weight frommuscle, bone, fat, and/or water. The term "Obese" meanshaving a high amount of extra body fat. Being overweightor obese puts you at higher risk of developing serioushealth problems, including heart disease, high bloodpressure, type 2 diabetes, gallstones, breathing problems,and certain cancers. It is important to achieve a healthyweight to reduce your risk of these conditions. Treatmentfor overweight and obesity includes lifestyle changes,such as reducing calories, following a healthy eating planand being physically active.

BMI is calculated as:Weight in Pounds *703/Height in Inches2

Overweight: Your Body Mass Index 27 lbs/in2 (25-29.9).This is considered Overweight according to the NationalHeart, Lung, and Blood Institute guidelines and is aModerate Health Risk. You should consult your physicianto determine if you should lose weight. Medical expertsrecommend that you lose weight if you have two or morerisk factors for heart disease or have a high waistcircumference (men > 40 in or women > 35 in). If you donot have a high waist circumference and have less thantwo risk factors, then it’s important that you not gain anymore weight. To maintain your weight, adopt a healthyeating plan and aim for 60 minutes of physical activitymost days of the week.

12-0428_CLV,10000000 - 050812Sample, John

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Page 6: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Condition Details What Does it Mean to Me?

Total Cholesterol

Cholesterol comes from the foods we eat (anything fromanimals) and from our body (liver). Excessive cholesterolis a risk factor for heart disease, stroke and type 2 diabetes.

Normal: Your Total Cholesterol is 174mg/dL (<200). It iswithin the Normal Range and meets the NationalCholesterol Education Program (NCEP) recommendationof total cholesterol below 200 mg/dL.

HDL (High-Density Lipoprotein)

HDL carries excess cholesterol away from your arteries.The higher your HDL, the better. An HDL of 60 mg/dL orhigher is beneficial and considered protective againstheart disease.

High: Your HDL Cholesterol is 77 mg/dL (> 60). It is Highand meets the NCEP recommended level of 40 mg/dL ormore.

LDL (Low-Density Lipoprotein)

LDL is the main source of cholesterol that contributes tothe buildup of fatty plaque in your arteries.

Normal: Your LDL Cholesterol is 99 mg/dL (<100)Itmeets the NCEP recommendation of LDL cholesterolbelow 100 mg/dL.

Triglyceride

Triglycerides are another contributing cause of plaquebuildup, which can cause artery blockage and heartdisease. Triglycerides circulate in your blood, but whenyou have excess levels, they are stored in the body’s fatcells.

Normal: Your Triglyceride level is 136 mg/dL (<150). It isNormal and meets the NCEP recommendation oftriglycerides below 150 mg/dL.

Glucose

Glucose is only one indicator for diabetes risk. Obesity,family history, ethnicity, age, blood pressure andcholesterol are also risk factors that should be consideredin assessing your overall diabetes risk.

Normal: Your Glucose level is 96 mg/dL (<100). It isNormal according to the American Diabetes Associationguidelines.

C-Reactive Protein

CRP is part of your immune system and becomes elevatedin your blood as a result of infection or inflammation.Although CRP is an independent risk factor forcardiovascular disease, it is a non-specific and should notbe used to identify risk alone. Other risk factors includingage, family history, blood pressure, smoking status,weight, exercise level and stress level are also consideredwhen assessing cardiovascular disease risk.

Low Risk: Your C-reactive Protein (CRP) level is 0.07mg/dL (<1.0). This means you are at Low Risk fordeveloping cardiovascular disease.

Page 6 of 10Your Results

12-0428_CLV,10000000 - 050812Sample, John

Page 7: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Take ActionTALK TO YOUR DOCTOR

Screening results are solely for informational purposes and are not medical advice. Please remember that the results ofthese screenings must be interpreted in the context of your clinical history. We recommend sharing your results withyour personal physician, so they can fully evaluate your screening results and recommend a treatment plan for you, ifnecessary. IMPORTANT: It is possible to have a normal screen with Life Line Screening and still suffer a stroke or aheart attack. Life Line Screening screens for the leading causes of stroke, however, we do not screen for every possiblecause of stroke and no screening can screen for every possible variation of vascular disease. Please note, we do notscreen your heart for heart attack risk. Specifically, we do not screen the coronary arteries, the arteries surrounding theheart. If you are experiencing symptoms of a heart attack or stroke, SEEK MEDICAL ATTENTION IMMEDIATELY. Donot delay, regardless of your Life Line Screening results.

KEEP INFORMED

Don’t forget to sign-up for our free monthly electronic newsletter to receive ongoing health benefits atwww.LifeLineScreening.com/welcome.

COPIES OF ULTRASOUND IMAGES AND EKGS

We keep a copy of ultrasound images and EKGs on file for 4 years. For a minimal service fee, you may obtainadditional copies of your carotid artery, aorta ultrasound images and EKG printout. Please call 1-800-897-9177 andselect option 3 to order through our Customer Service department.

YOUR RISK FACTORS

Based on your screening results and answers to the health questions, below are your risk factors which elevate yourrisk for cardiovascular disease and other chronic conditions. Certain risk factors can be controlled (modifiable), whileothers cannot (non-modifiable).

*Source: This section retrieves information from test results and from your self-reported medical history.

Modifiable Risk Factors* Non-Modifiable Risk Factors*•Overweight•Exposure to 2nd hand smoke

•Age

Screenings in California are provided by Life Line Mobile Screening in a physician owned practice.Screenings in Kansas are performed by Life Line Screening of America, Ltd. on behalf of Life Line Screening Physicians, P.A.Screenings in New Hampshire, New Jersey and New York are performed by Life Line Medical Screening, LLC (Dr. AndrewManganaro, 70 Niagara Street, Buffalo NY, 14202). Life Line Screening does not engage in the practice of medicine in thosestates. This information is not intended to induce referrals by Life Line Screening to Life Line Medical Screening, LLC for anyprofessional medical service.

Page 7 of 10

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Page 8: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

This Page Intentionally Left Blank

Page 8 of 10

Page 9: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Introduction to Life Line Screening for Physicians and Medical StaffWho We Are

Life Line Screening is the leading provider of community-based preventive wellness services in the U.S.Established in 1993, we are dedicated to helping people live fuller, healthier lives by identifying riskfactors for stroke, cardiovascular disease and osteoporosis. The mission of Life Line Screening is to makepeople aware of an undetected health problem and encourage these individuals to seek follow up carewith their physicians. We are committed to providing the highest quality preventive screenings at anaffordable rate. Life Line Screening's corporate headquarters is in Independence, Ohio.

What We Screen For

We offer screenings to detect carotid artery stenosis, atrial fibrillation, abdominal aortic aneurysms,peripheral arterial disease and diminished bone density. Our participants are generally age 50 and overand are asymptomatic although they tend to have significant risk factors such as hypertension,hypercholesterolemia, smoking, diabetes mellitus, or a family history of stroke. In most states, we also dofinger-stick blood screenings for lipid panel, glucose, C-reactive protein, and liver enzymes.

How We Screen

Our sonographers are highly skilled and are either registered or eligible to be registered with the AmericanRegistry of Diagnostic Medical Sonographers (ARDMS) or Cardiovascular Credentialing International(CCI). All screenings are performed in accordance with the latest medical literature recommendations forcategorization of normal and abnormal results. Sonographers adhere to strict protocols to ensureconsistency and accuracy. We use the same state-of-the art Doppler color flow ultrasound technologyfound in hospitals. Individuals with abnormal test results are urged to contact their personal physicianswho can then order further testing and any treatment considerations. Life Line Screening is a non-referralcompany. We do not refer individuals for further examinations or consultation to any particular doctor nordo we permit our physician reviewers to self-refer. No Medicaid, Medicare or insurance billing isinvolved.

Validity and Medical Oversight

Life Line Screening's vascular screenings have been independently reviewed by researchers at twoacademic institutions. Excellent concordance was found between Life Line Screening's findings and anICAVL accredited laboratory. Medical supervision is provided by our National Chief Medical Officer,Andrew Manganaro, MD, FACS, FACC. Reviewing physicians are board-certified, licensed physicians. Weare also CLIA certified as a moderately-complex lab.

Contact Us

If you have any questions about Life Line Screening services, please contact our dedicated physician line at877-557-7497 or email us at [email protected].

Selected References

! Role of carotid duplex imaging in carotid screening programs-an overview. Saleem MA et al.University Hospital, Cambridge UK. Cardiovascular Ultrasound, May 2008, 6:34.

! KC Kent, et al. The Cost-effectiveness of a Quick-Screen Program for Abdominal Aortic Aneurysms.Department of Surgery, Weil Medical College of Cornell University, New York PresbyterianHospital. Surgery. 2002; 132:399-407.

! Bluth EI, Sunshine JH, Lyons JB, et al. Power Doppler Imaging: Initial Evaluation as a ScreeningExamination for Carotid Artery Stenosis. Radiology. 2000; 215:791-800.

! Chestnut C. Osteoporosis, An Underdiagnosed Disease. JAMA 2001; 286:2865-2866.! Hirsh AT, et al. Peripheral arterial disease detection, awareness, and treatment in

primary care. JAMA 2001; 286:1317-1324.

Page 9 of 10

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Page 10: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Life Line Screening Results: Physician Copy

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Page 10 of 10

Screening Test Measurement Result Risk CategoryIncidentalfindings

Carotid ArteryDisease

Blood flow cm/s

Left:PSV: < 110cm/s

Right:PSV: < 110cm/s

Left: NormalRight: Normal

Atrial Fibrillation 4-Limb EKG

No AtrialFibrillation DetectedHeart Rate: 55Beats/min

Normal

Abdominal AorticAneurysm

cm <3cm Normal

Peripheral ArterialDisease

Ankle Brachial IndexLeft Side: 1.17Right Side: 1.17

Left: NormalRight: Normal

OsteoporosisBone MineralDensity

-1.0 Low Risk

Complete LipidPanel

mg/dL

TC: 174LDL: 99HDL: 77Trig: 136

TC: DesirableLDL: OptimalHDL: Protective AgainstHeart DiseaseTrig: Normal

Glucose mg/dL 96 Normal

C-Reactive Protein mg/L 0.07 Low Risk

BMI Body Mass Index 27.3 Moderate Risk

12-0428_CLV,10000000 - 050812Sample, John

Page 11: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Screening Results Enclosed

Sincerely,

Andrew J. Manganaro,

M.D., F.A.C.S., F.A.C.C.

Chief Medical Officer

Dear Mr. Sample,

Thank you for your recent participation at the health screening held at Danbury Senior Center.Congratulations on taking an important proactive step in maintaining your future good health!

Your ResultsYour screening results are enclosed. They have been reviewed by a board-certified physician. The followingpage provides a summary view of all your results. We’ve provided you an additional copy of this page that weencourage you to share with your doctor even if your results are normal. The rest of the report contains moredetailed information about each screening test. We suggest you keep your results with your other personalhealth records.

Next StepsAt Life Line Screening, we believe in prevention. We are here to help you lead a fuller and healthier life. Withthat in mind, here are 3 important steps you can take to maintain your good health:

• Share With Your Doctor: Preventive screenings can indicate the presence of a possible problem, butremember that the results of these screenings must be interpreted in the context of your clinical history.Your personal doctor can help with that interpretation. Screening tests can alert you to diseases long beforesymptoms occur. This is important for early diagnosis and treatment by your doctor.

• Stay Up-To-Date: Enroll in our FREE Power of Prevention E-Newsletter by signing up online atwww.LifeLineScreening.com/welcome. Every month, you’ll receive important health news , valuableinformation on new health products and services, and discounts for you or your family & friends.

• Schedule Regular Follow-Ups: Screenings should be part of your ongoing health regimen. We will

keep track of your past screening history, and notify you when it’s time to be re-screened. For mostpeople, screenings every 12 – 24 months are medically appropriate. Mark your calendar, and plan tomake health screening a regular event!

Again, congratulations on taking this important step in managing your preventive health routine. At Life LineScreening, we are here to help you every step of the way.

Life Line Screening • Park Center Plaza II Suite 200 • 6150 Oak Tree Blvd. • Independence, OH 44131www.LifeLineScreening.com • 1-800-897-9177

Page 1 of 10

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Report Date: May 8, 2012

John Q. Sample123 Main StAnytown, PA 12345

12-0428_CLV,10000000 - 050812Sample, John

!20120507:SA120507.080:0002;

Page 12: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CarotidArtery

Disease

Normal Mild Moderate Significant

Left:PSV: 119cm/sEDV: 45cm/s Plaque Buildup

andBlood Flow

April 2013

Normal Mild Moderate Significant

Right:PSV: 87cm/sEDV: 25cm/s

AtrialFibrillation

Normal Abnormal

No AtrialFibrillation

Heart Rate: 58Beats/min

4-limbEKG

April 2013

AbdominalAortic

Aneurysm

Normal Abnormal <3cmAbdominalAorta Size

April 2015

PeripheralArterialDisease

Normal> .90

Abnormal< .90

Unableto Compress

IncidentalFinding

Left Side:0.90 Ankle

BrachialIndex

April 2014

Normal> .90

Abnormal< .90

Unableto Compress

Right Side:0.91

OsteoporosisLow Risk

> -1.2Moderate Risk

-1.3 to -2.5High Risk

< -2.6 -1.1Bone Mineral

Density (BMD)April 2014

Body MassIndex

Underweight<18.5

Normal18.5-24.9

Moderate Risk25-29.9

High Risk>30 27.3

lbs/in2

Height: 5'08"Weight: 180 lbs

April 2013

Screening Results

YES NODoctor Consultation Recommended: P

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Participant Copy

Page 2 of 10

Normal Mild Moderate Borderline Findings of Possible SignificanceKey

Page 13: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CompleteLipidPanel

Desirable<200 mg/dL

Borderline200-239

High Risk>240 174

TotalCholesterol

mg/dL

April 2013

Protected AgainstHeart Disease

>60 mg/dL

Desirable40-59

Risk forHeart Disease

<40 mg/dL77

HDLCholesterol

mg/dL

Optimal<100 mg/dL

Near/AboveOptimal100-129

Borderline130-159

High160-189

Very High>190 mg/dL 99

LDLCholesterol

mg/dL

Normal<150 mg/dL

BorderlineHigh

150-199

High200-499

Very High>500 mg/dL 136

Triglyceridesmg/dL

GlucoseNormal

<100 mg/dLPre-diabetes

100-125Diabetes

>126 mg/dL 96 GLU mg/dL April 2013

C-ReactiveProtein

Low Risk<1 mg/L

Moderate Risk1-3 mg/L

High Risk>3 mg/L 0.07 CRP mg/L April 2013

Page 3 of 10

Certain blood tests were processed at Home Healthcare Laboratory of America (a LabCorp Company)320 Premier Court, Suite 220, Franklin, Tennessee 37067�

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Your Results

Condition Details What Does it Mean to Me?

Carotid Artery Disease

One of the leading causes of stroke is fatty plaque buildupin the carotid arteries, which may block adequate bloodflow to the brain. The carotid arteries are the main bloodsupply to the brain and are located on each side of theneck. Our screening is not meant to be a comprehensivediagnostic exam, but rather a screening to visualize thepresence of plaque which may affect the blood flow to thebrain. Your Carotid Artery Disease Screening results arereported as one of four (4) categories which describe theamount of plaque buildup identified: Within NormalRange, Mild to Moderate, Moderate, and Findings ofPossible Significance.

Moderate: Plaque buildup in moderate range resulting inmoderately increased blood flow velocities. Your CarotidArtery Disease Screening results are Moderate. Thismeans that we have identified a moderate amount ofplaque buildup in one or both of your carotid arteries,which is having a slight increased effect on the blood flow.The specific velocity measurements of the blood flow(PSV=peak systolic velocity and EDV=end diastolicvelocity) are noted in the summary results table. Anormal velocity is less than 110 centimeters per second.We recommend you share these results with yourprimary care physician to discuss risk factormanagement.

Atrial Fibrillation

Atrial Fibrillation or AF is the most common type ofirregular heart rhythm or arrhythmia. During AF, theupper chambers of the heart beat rapidly and irregularlyso that blood is not completely pumped out of the heart.This can cause blood to collect in the heart and form ablood clot. If the clot travels to the brain, it can cause astroke. Our screening is a 4-limb EKG and is not meant tobe a comprehensive 12-lead EKG (electrocardiogram). It isa screening to identify only the presence or absence of anatrial fibrillation heart rhythm at the time of the screening.

Normal: Your Atrial Fibrillation Screening results areNormal. No Atrial Fibrillation detected. This means thatat the time of your screening, your heart rhythm did notshow evidence of atrial fibrillation.

Abdominal Aortic Aneurysm

The aorta is the largest artery in the body, traveling fromyour breastbone to the level of your navel. Medicalconditions, such as high blood pressure and fatty plaquebuildup, can weaken the walls of the aorta, causing anenlargement or aneurysm. An aneurysm can form in anysection of the aorta, but they are most common in the bellyarea (abdominal aorta).

Our screening uses an ultrasound examination of theabdominal aorta to screen for the presence of either typeof aneurysm that is 3 cm or greater.

Normal: No abdominal aortic aneurysm has beendetected. Our physician has reviewed the ultrasoundimages and measurements of the aorta and bifurcation ofthe iliac arteries. All measurements are within normallimits.

Peripheral Arterial Disease

Peripheral arterial disease or PAD is a condition in whichfatty plaque builds up in the arteries leading to the armsand legs. One way to screen for PAD is by measuring theAnkle-brachial index (ABI). A small ultrasound device isused to measure your systolic pressures in both of thearms and legs. A ratio less than 0.90 indicates plaquebuildup and possible peripheral arterial disease. A ratioof 0.90 or greater is considered normal.

Normal: Your Peripheral Arterial Disease Screeningresults are Normal. ABI index of 0.90 or greater. Thismeans the pressures in your ankles are almost as high orhigher than the pressures in your arms, which is a normalresult.

Incidental Findings:

Your Systolic arm pressure is

Left arm = 164 Right arm = 170

Systolic arm pressure of >140 mm/Hg may be suggestiveof hypertension. SEE YOUR PHYSICIAN

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Page 5 of 10

Osteoporosis Risk Assessment

Osteoporosis is a condition in which the bones areseverely weakened and brittle. As a result, fracturesoccur easily. Life Line Screening performs anosteoporosis risk assessment using quantitativeultrasound to measure the density of the heel bone. Theheel is measured because its bone is similar to that foundin the spine or hip, where osteoporotic fractures occurmost.

This screening is a risk assessment for bone loss and is notmeant to diagnose osteoporosis. Further evaluation anddiagnostics may be considered. Talk to your physicianabout your risk factors for bone loss.

Your T-score is -1.1 , which is Low Risk for Bone

Diminishment.You may wish to speak to your physician regarding riskfactor management and proactive steps such asweight-bearing exercise and calcium and vitamin Dsupplementation.

Body Mass Index

Body Mass Index (BMI) is a number calculated from aperson's weight and height, that correlates with total bodyfat amount. BMI screening is used to assess excess weight.If your weight and height were measured at the screeningevent, these values were used to calculate your BMI.Otherwise, your self-reported weight and height wereused. Based on the calculated BMI, the National Heart,Lung, and Blood Institute categorizes a person's BMI asUnderweight, Normal, Overweight or Obese. The term"Overweight" means having extra body weight frommuscle, bone, fat, and/or water. The term "Obese" meanshaving a high amount of extra body fat. Being overweightor obese puts you at higher risk of developing serioushealth problems, including heart disease, high bloodpressure, type 2 diabetes, gallstones, breathing problems,and certain cancers. It is important to achieve a healthyweight to reduce your risk of these conditions. Treatmentfor overweight and obesity includes lifestyle changes,such as reducing calories, following a healthy eating planand being physically active.

BMI is calculated as:Weight in Pounds *703/Height in Inches2

Overweight: Your Body Mass Index 27 lbs/in2 (25-29.9).This is considered Overweight according to the NationalHeart, Lung, and Blood Institute guidelines and is aModerate Health Risk. You should consult your physicianto determine if you should lose weight. Medical expertsrecommend that you lose weight if you have two or morerisk factors for heart disease or have a high waistcircumference (men > 40 in or women > 35 in). If you donot have a high waist circumference and have less thantwo risk factors, then it’s important that you not gain anymore weight. To maintain your weight, adopt a healthyeating plan and aim for 60 minutes of physical activitymost days of the week.

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Condition Details What Does it Mean to Me?

Total Cholesterol

Cholesterol comes from the foods we eat (anything fromanimals) and from our body (liver). Excessive cholesterolis a risk factor for heart disease, stroke and type 2 diabetes.

Normal: Your Total Cholesterol is 174mg/dL (<200). It iswithin the Normal Range and meets the NationalCholesterol Education Program (NCEP) recommendationof total cholesterol below 200 mg/dL.

HDL (High-Density Lipoprotein)

HDL carries excess cholesterol away from your arteries.The higher your HDL, the better. An HDL of 60 mg/dL orhigher is beneficial and considered protective againstheart disease.

High: Your HDL Cholesterol is 77 mg/dL (> 60). It is Highand meets the NCEP recommended level of 40 mg/dL ormore.

LDL (Low-Density Lipoprotein)

LDL is the main source of cholesterol that contributes tothe buildup of fatty plaque in your arteries.

Normal: Your LDL Cholesterol is 99 mg/dL (<100)Itmeets the NCEP recommendation of LDL cholesterolbelow 100 mg/dL.

Triglyceride

Triglycerides are another contributing cause of plaquebuildup, which can cause artery blockage and heartdisease. Triglycerides circulate in your blood, but whenyou have excess levels, they are stored in the body’s fatcells.

Normal: Your Triglyceride level is 136 mg/dL (<150). It isNormal and meets the NCEP recommendation oftriglycerides below 150 mg/dL.

Glucose

Glucose is only one indicator for diabetes risk. Obesity,family history, ethnicity, age, blood pressure andcholesterol are also risk factors that should be consideredin assessing your overall diabetes risk.

Normal: Your Glucose level is 96 mg/dL (<100). It isNormal according to the American Diabetes Associationguidelines.

C-Reactive Protein

CRP is part of your immune system and becomes elevatedin your blood as a result of infection or inflammation.Although CRP is an independent risk factor forcardiovascular disease, it is a non-specific and should notbe used to identify risk alone. Other risk factors includingage, family history, blood pressure, smoking status,weight, exercise level and stress level are also consideredwhen assessing cardiovascular disease risk.

Low Risk: Your C-reactive Protein (CRP) level is 0.07mg/dL (<1.0). This means you are at Low Risk fordeveloping cardiovascular disease.

Page 6 of 10Your Results

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Take ActionTALK TO YOUR DOCTOR

Screening results are solely for informational purposes and are not medical advice. Please remember that the results ofthese screenings must be interpreted in the context of your clinical history. We recommend sharing your results withyour personal physician, so they can fully evaluate your screening results and recommend a treatment plan for you, ifnecessary. IMPORTANT: It is possible to have a normal screen with Life Line Screening and still suffer a stroke or aheart attack. Life Line Screening screens for the leading causes of stroke, however, we do not screen for every possiblecause of stroke and no screening can screen for every possible variation of vascular disease. Please note, we do notscreen your heart for heart attack risk. Specifically, we do not screen the coronary arteries, the arteries surrounding theheart. If you are experiencing symptoms of a heart attack or stroke, SEEK MEDICAL ATTENTION IMMEDIATELY. Donot delay, regardless of your Life Line Screening results.

KEEP INFORMED

Don’t forget to sign-up for our free monthly electronic newsletter to receive ongoing health benefits atwww.LifeLineScreening.com/welcome.

COPIES OF ULTRASOUND IMAGES AND EKGS

We keep a copy of ultrasound images and EKGs on file for 4 years. For a minimal service fee, you may obtainadditional copies of your carotid artery, aorta ultrasound images and EKG printout. Please call 1-800-897-9177 andselect option 3 to order through our Customer Service department.

YOUR RISK FACTORS

Based on your screening results and answers to the health questions, below are your risk factors which elevate yourrisk for cardiovascular disease and other chronic conditions. Certain risk factors can be controlled (modifiable), whileothers cannot (non-modifiable).

*Source: This section retrieves information from test results and from your self-reported medical history.

Modifiable Risk Factors* Non-Modifiable Risk Factors*•Current smoker•Lack of Exercise•Overweight•Exposure to 2nd hand smoke

•Age

Screenings in California are provided by Life Line Mobile Screening in a physician owned practice.Screenings in Kansas are performed by Life Line Screening of America, Ltd. on behalf of Life Line Screening Physicians, P.A.Screenings in New Hampshire, New Jersey and New York are performed by Life Line Medical Screening, LLC (Dr. AndrewManganaro, 70 Niagara Street, Buffalo NY, 14202). Life Line Screening does not engage in the practice of medicine in thosestates. This information is not intended to induce referrals by Life Line Screening to Life Line Medical Screening, LLC for anyprofessional medical service.

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This Page Intentionally Left Blank

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Page 19: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Introduction to Life Line Screening for Physicians and Medical StaffWho We Are

Life Line Screening is the leading provider of community-based preventive wellness services in the U.S.Established in 1993, we are dedicated to helping people live fuller, healthier lives by identifying riskfactors for stroke, cardiovascular disease and osteoporosis. The mission of Life Line Screening is to makepeople aware of an undetected health problem and encourage these individuals to seek follow up carewith their physicians. We are committed to providing the highest quality preventive screenings at anaffordable rate. Life Line Screening's corporate headquarters is in Independence, Ohio.

What We Screen For

We offer screenings to detect carotid artery stenosis, atrial fibrillation, abdominal aortic aneurysms,peripheral arterial disease and diminished bone density. Our participants are generally age 50 and overand are asymptomatic although they tend to have significant risk factors such as hypertension,hypercholesterolemia, smoking, diabetes mellitus, or a family history of stroke. In most states, we also dofinger-stick blood screenings for lipid panel, glucose, C-reactive protein, and liver enzymes.

How We Screen

Our sonographers are highly skilled and are either registered or eligible to be registered with the AmericanRegistry of Diagnostic Medical Sonographers (ARDMS) or Cardiovascular Credentialing International(CCI). All screenings are performed in accordance with the latest medical literature recommendations forcategorization of normal and abnormal results. Sonographers adhere to strict protocols to ensureconsistency and accuracy. We use the same state-of-the art Doppler color flow ultrasound technologyfound in hospitals. Individuals with abnormal test results are urged to contact their personal physicianswho can then order further testing and any treatment considerations. Life Line Screening is a non-referralcompany. We do not refer individuals for further examinations or consultation to any particular doctor nordo we permit our physician reviewers to self-refer. No Medicaid, Medicare or insurance billing isinvolved.

Validity and Medical Oversight

Life Line Screening's vascular screenings have been independently reviewed by researchers at twoacademic institutions. Excellent concordance was found between Life Line Screening's findings and anICAVL accredited laboratory. Medical supervision is provided by our National Chief Medical Officer,Andrew Manganaro, MD, FACS, FACC. Reviewing physicians are board-certified, licensed physicians. Weare also CLIA certified as a moderately-complex lab.

Contact Us

If you have any questions about Life Line Screening services, please contact our dedicated physician line at877-557-7497 or email us at [email protected].

Selected References

! Role of carotid duplex imaging in carotid screening programs-an overview. Saleem MA et al.University Hospital, Cambridge UK. Cardiovascular Ultrasound, May 2008, 6:34.

! KC Kent, et al. The Cost-effectiveness of a Quick-Screen Program for Abdominal Aortic Aneurysms.Department of Surgery, Weil Medical College of Cornell University, New York PresbyterianHospital. Surgery. 2002; 132:399-407.

! Bluth EI, Sunshine JH, Lyons JB, et al. Power Doppler Imaging: Initial Evaluation as a ScreeningExamination for Carotid Artery Stenosis. Radiology. 2000; 215:791-800.

! Chestnut C. Osteoporosis, An Underdiagnosed Disease. JAMA 2001; 286:2865-2866.! Hirsh AT, et al. Peripheral arterial disease detection, awareness, and treatment in

primary care. JAMA 2001; 286:1317-1324.

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Page 20: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Life Line Screening Results: Physician Copy

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Page 10 of 10

Screening Test Measurement Result Risk CategoryIncidentalfindings

Carotid ArteryDisease

Blood flow cm/s

Left:PSV: 119cm/sEDV: 45cm/s

Right:PSV: 87cm/sEDV: 25cm/s

Left: ModerateRight: Normal

Atrial Fibrillation 4-Limb EKG

No AtrialFibrillation DetectedHeart Rate: 58Beats/min

Normal

Abdominal AorticAneurysm

cm <3cm Normal

Peripheral ArterialDisease

Ankle Brachial IndexLeft Side: 0.90Right Side: 0.91

Left: NormalRight: Normal

Doppler

pressure � 140

mm/hg

OsteoporosisBone MineralDensity

-1.1 Low Risk

Complete LipidPanel

mg/dL

TC: 174LDL: 99HDL: 77Trig: 136

TC: DesirableLDL: OptimalHDL: Protective AgainstHeart DiseaseTrig: Normal

Glucose mg/dL 96 Normal

C-Reactive Protein mg/L 0.07 Low Risk

BMI Body Mass Index 27.3 Moderate Risk

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Screening Results Enclosed

Sincerely,

Andrew J. Manganaro,

M.D., F.A.C.S., F.A.C.C.

Chief Medical Officer

Dear Mr. Sample,

Thank you for your recent participation at the health screening held at Danbury Senior Center.Congratulations on taking an important proactive step in maintaining your future good health!

Your ResultsYour screening results are enclosed. They have been reviewed by a board-certified physician. The followingpage provides a summary view of all your results. We’ve provided you an additional copy of this page that weencourage you to share with your doctor even if your results are normal. The rest of the report contains moredetailed information about each screening test. We suggest you keep your results with your other personalhealth records.

Next StepsAt Life Line Screening, we believe in prevention. We are here to help you lead a fuller and healthier life. Withthat in mind, here are 3 important steps you can take to maintain your good health:

• Share With Your Doctor: Preventive screenings can indicate the presence of a possible problem, butremember that the results of these screenings must be interpreted in the context of your clinical history.Your personal doctor can help with that interpretation. Screening tests can alert you to diseases long beforesymptoms occur. This is important for early diagnosis and treatment by your doctor.

• Stay Up-To-Date: Enroll in our FREE Power of Prevention E-Newsletter by signing up online atwww.LifeLineScreening.com/welcome. Every month, you’ll receive important health news , valuableinformation on new health products and services, and discounts for you or your family & friends.

• Schedule Regular Follow-Ups: Screenings should be part of your ongoing health regimen. We will

keep track of your past screening history, and notify you when it’s time to be re-screened. For mostpeople, screenings every 12 – 24 months are medically appropriate. Mark your calendar, and plan tomake health screening a regular event!

Again, congratulations on taking this important step in managing your preventive health routine. At Life LineScreening, we are here to help you every step of the way.

Life Line Screening • Park Center Plaza II Suite 200 • 6150 Oak Tree Blvd. • Independence, OH 44131www.LifeLineScreening.com • 1-800-897-9177

Page 1 of 10

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John Q. Sample123 Main StAnytown, 12345

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ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CarotidArtery

Disease

Normal Mild Moderate SignificantLeft:

PSV: < 110cm/s Plaque Buildupand

Blood FlowApril 2013

Normal Mild Moderate SignificantRight:

PSV: < 110cm/s

AtrialFibrillation

Normal Abnormal

No AtrialFibrillation

Heart Rate: 59Beats/min

4-limbEKG

April 2013

AbdominalAortic

Aneurysm

Normal Abnormal <3cmAbdominalAorta Size

April 2015

PeripheralArterialDisease

Normal> .90

Abnormal< .90

Unableto Compress

IncidentalFinding

Left Side:1.18 Ankle

BrachialIndex

April 2014

Normal> .90

Abnormal< .90

Unableto Compress

Right Side:1.13

OsteoporosisLow Risk

> -1.2Moderate Risk

-1.3 to -2.5High Risk

< -2.6 -1.1Bone Mineral

Density (BMD)April 2014

Body MassIndex

Underweight<18.5

Normal18.5-24.9

Moderate Risk25-29.9

High Risk>30 27.3

lbs/in2

Height: 5'08"Weight: 180 lbs

April 2013

Screening Results

YES NODoctor Consultation Recommended: P

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Participant Copy

Page 2 of 10

Normal Mild Moderate Borderline Findings of Possible SignificanceKey

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ScreeningYour Results

Compared to Generally Accepted Risk CategoriesMeasurement

ClinicalMeasures

RecommendedNext Screening

CompleteLipidPanel

Desirable<200 mg/dL

Borderline200-239

High Risk>240 225

TotalCholesterol

mg/dL

April 2013

Protected AgainstHeart Disease

>60 mg/dL

Desirable40-59

Risk forHeart Disease

<40 mg/dL61

HDLCholesterol

mg/dL

Optimal<100 mg/dL

Near/AboveOptimal100-129

Borderline130-159

High160-189

Very High>190 mg/dL 154

LDLCholesterol

mg/dL

Normal<150 mg/dL

BorderlineHigh

150-199

High200-499

Very High>500 mg/dL 52

Triglyceridesmg/dL

GlucoseNormal

<100 mg/dLPre-diabetes

100-125Diabetes

>126 mg/dL 69 GLU mg/dL April 2013

C-ReactiveProtein

Low Risk<1 mg/L

Moderate Risk1-3 mg/L

High Risk>3 mg/L 3.2 CRP mg/L April 2013

Page 3 of 10

Certain blood tests were processed at Home Healthcare Laboratory of America (a LabCorp Company)320 Premier Court, Suite 220, Franklin, Tennessee 37067�

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Your Results

Condition Details What Does it Mean to Me?

Carotid Artery Disease

One of the leading causes of stroke is fatty plaque buildupin the carotid arteries, which may block adequate bloodflow to the brain. The carotid arteries are the main bloodsupply to the brain and are located on each side of theneck. Our screening is not meant to be a comprehensivediagnostic exam, but rather a screening to visualize thepresence of plaque which may affect the blood flow to thebrain. Your Carotid Artery Disease Screening results arereported as one of four (4) categories which describe theamount of plaque buildup identified: Within NormalRange, Mild to Moderate, Moderate, and Findings ofPossible Significance.

Within Normal Range: Essentially minimal to mildplaque buildup. Blood flow velocities within normallimits. Your Carotid Artery Disease Screening results areWithin Normal Range. This means that we haveidentified a negligible to minimal amount of plaquebuildup in both of your carotid arteries, which isinsignificant. The blood flow in your carotid arteries isalso within normal range. Since the plaque buildup is notaffecting the rate of blood flow, the velocity measurementsfor the internal carotid arteries will not be statedspecifically in this report. However, your velocities fellbelow 110 centimeters per second, which is within normallimits.

Atrial Fibrillation

Atrial Fibrillation or AF is the most common type ofirregular heart rhythm or arrhythmia. During AF, theupper chambers of the heart beat rapidly and irregularlyso that blood is not completely pumped out of the heart.This can cause blood to collect in the heart and form ablood clot. If the clot travels to the brain, it can cause astroke. Our screening is a 4-limb EKG and is not meant tobe a comprehensive 12-lead EKG (electrocardiogram). It isa screening to identify only the presence or absence of anatrial fibrillation heart rhythm at the time of the screening.

Normal: Your Atrial Fibrillation Screening results areNormal. No Atrial Fibrillation detected. This means thatat the time of your screening, your heart rhythm did notshow evidence of atrial fibrillation.

Abdominal Aortic Aneurysm

The aorta is the largest artery in the body, traveling fromyour breastbone to the level of your navel. Medicalconditions, such as high blood pressure and fatty plaquebuildup, can weaken the walls of the aorta, causing anenlargement or aneurysm. An aneurysm can form in anysection of the aorta, but they are most common in the bellyarea (abdominal aorta).

Our screening uses an ultrasound examination of theabdominal aorta to screen for the presence of either typeof aneurysm that is 3 cm or greater.

Normal: No abdominal aortic aneurysm has beendetected. Our physician has reviewed the ultrasoundimages and measurements of the aorta and bifurcation ofthe iliac arteries. All measurements are within normallimits.

Peripheral Arterial Disease

Peripheral arterial disease or PAD is a condition in whichfatty plaque builds up in the arteries leading to the armsand legs. One way to screen for PAD is by measuring theAnkle-brachial index (ABI). A small ultrasound device isused to measure your systolic pressures in both of thearms and legs. A ratio less than 0.90 indicates plaquebuildup and possible peripheral arterial disease. A ratioof 0.90 or greater is considered normal.

Normal: Your Peripheral Arterial Disease Screeningresults are Normal. ABI index of 0.90 or greater. Thismeans the pressures in your ankles are almost as high orhigher than the pressures in your arms, which is a normalresult.

Incidental Findings:

Your Systolic arm pressure is

Left arm = 144 Right arm = 152

Systolic arm pressure of >140 mm/Hg may be suggestiveof hypertension. SEE YOUR PHYSICIAN

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Osteoporosis Risk Assessment

Osteoporosis is a condition in which the bones areseverely weakened and brittle. As a result, fracturesoccur easily. Life Line Screening performs anosteoporosis risk assessment using quantitativeultrasound to measure the density of the heel bone. Theheel is measured because its bone is similar to that foundin the spine or hip, where osteoporotic fractures occurmost.

This screening is a risk assessment for bone loss and is notmeant to diagnose osteoporosis. Further evaluation anddiagnostics may be considered. Talk to your physicianabout your risk factors for bone loss.

Your T-score is -1.1 , which is Low Risk for Bone

Diminishment.You may wish to speak to your physician regarding riskfactor management and proactive steps such asweight-bearing exercise and calcium and vitamin Dsupplementation.

Body Mass Index

Body Mass Index (BMI) is a number calculated from aperson's weight and height, that correlates with total bodyfat amount. BMI screening is used to assess excess weight.If your weight and height were measured at the screeningevent, these values were used to calculate your BMI.Otherwise, your self-reported weight and height wereused. Based on the calculated BMI, the National Heart,Lung, and Blood Institute categorizes a person's BMI asUnderweight, Normal, Overweight or Obese. The term"Overweight" means having extra body weight frommuscle, bone, fat, and/or water. The term "Obese" meanshaving a high amount of extra body fat. Being overweightor obese puts you at higher risk of developing serioushealth problems, including heart disease, high bloodpressure, type 2 diabetes, gallstones, breathing problems,and certain cancers. It is important to achieve a healthyweight to reduce your risk of these conditions. Treatmentfor overweight and obesity includes lifestyle changes,such as reducing calories, following a healthy eating planand being physically active.

BMI is calculated as:Weight in Pounds *703/Height in Inches2

Overweight: Your Body Mass Index 27 lbs/in2 (25-29.9).This is considered Overweight according to the NationalHeart, Lung, and Blood Institute guidelines and is aModerate Health Risk. You should consult your physicianto determine if you should lose weight. Medical expertsrecommend that you lose weight if you have two or morerisk factors for heart disease or have a high waistcircumference (men > 40 in or women > 35 in). If you donot have a high waist circumference and have less thantwo risk factors, then it’s important that you not gain anymore weight. To maintain your weight, adopt a healthyeating plan and aim for 60 minutes of physical activitymost days of the week.

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Condition Details What Does it Mean to Me?

Total Cholesterol

Cholesterol comes from the foods we eat (anything fromanimals) and from our body (liver). Excessive cholesterolis a risk factor for heart disease, stroke and type 2 diabetes.

Borderline-High: Your Total Cholesterol is 225 mg/dL(200-239). It is Borderline-High and fails to meet theNational Cholesterol Education Program (NCEP)recommendation of total cholesterol below 200 mg/dL.

HDL (High-Density Lipoprotein)

HDL carries excess cholesterol away from your arteries.The higher your HDL, the better. An HDL of 60 mg/dL orhigher is beneficial and considered protective againstheart disease.

High: Your HDL Cholesterol is 61 mg/dL (> 60). It is Highand meets the NCEP recommended level of 40 mg/dL ormore.

LDL (Low-Density Lipoprotein)

LDL is the main source of cholesterol that contributes tothe buildup of fatty plaque in your arteries.

Borderline-High: Your LDL Cholesterol is 154 mg/dL(130-159) It fails to meet the NCEP recommendation ofLDL cholesterol below 100 mg/dL.

Triglyceride

Triglycerides are another contributing cause of plaquebuildup, which can cause artery blockage and heartdisease. Triglycerides circulate in your blood, but whenyou have excess levels, they are stored in the body’s fatcells.

Normal: Your Triglyceride level is 52 mg/dL (<150). It isNormal and meets the NCEP recommendation oftriglycerides below 150 mg/dL.

Glucose

Glucose is only one indicator for diabetes risk. Obesity,family history, ethnicity, age, blood pressure andcholesterol are also risk factors that should be consideredin assessing your overall diabetes risk.

Normal: Your Glucose level is 69 mg/dL (<100). It isNormal according to the American Diabetes Associationguidelines.

C-Reactive Protein

CRP is part of your immune system and becomes elevatedin your blood as a result of infection or inflammation.Although CRP is an independent risk factor forcardiovascular disease, it is a non-specific and should notbe used to identify risk alone. Other risk factors includingage, family history, blood pressure, smoking status,weight, exercise level and stress level are also consideredwhen assessing cardiovascular disease risk.

High Risk: Your C-reactive Protein (CRP) level is 3.2mg/dL (>3.0 - 10.0). This means you are at High Risk fordeveloping cardiovascular disease. We recommend yousee your primary care physician to fully evaluate your riskfor cardiovascular disease.

Page 6 of 10Your Results

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Page 27: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Take ActionTALK TO YOUR DOCTOR

Screening results are solely for informational purposes and are not medical advice. Please remember that the results ofthese screenings must be interpreted in the context of your clinical history. We recommend sharing your results withyour personal physician, so they can fully evaluate your screening results and recommend a treatment plan for you, ifnecessary. IMPORTANT: It is possible to have a normal screen with Life Line Screening and still suffer a stroke or aheart attack. Life Line Screening screens for the leading causes of stroke, however, we do not screen for every possiblecause of stroke and no screening can screen for every possible variation of vascular disease. Please note, we do notscreen your heart for heart attack risk. Specifically, we do not screen the coronary arteries, the arteries surrounding theheart. If you are experiencing symptoms of a heart attack or stroke, SEEK MEDICAL ATTENTION IMMEDIATELY. Donot delay, regardless of your Life Line Screening results.

KEEP INFORMED

Don’t forget to sign-up for our free monthly electronic newsletter to receive ongoing health benefits atwww.LifeLineScreening.com/welcome.

COPIES OF ULTRASOUND IMAGES AND EKGS

We keep a copy of ultrasound images and EKGs on file for 4 years. For a minimal service fee, you may obtainadditional copies of your carotid artery, aorta ultrasound images and EKG printout. Please call 1-800-897-9177 andselect option 3 to order through our Customer Service department.

YOUR RISK FACTORS

Based on your screening results and answers to the health questions, below are your risk factors which elevate yourrisk for cardiovascular disease and other chronic conditions. Certain risk factors can be controlled (modifiable), whileothers cannot (non-modifiable).

*Source: This section retrieves information from test results and from your self-reported medical history.

Modifiable Risk Factors* Non-Modifiable Risk Factors*•Lack of Exercise•Overweight

•Age

Screenings in California are provided by Life Line Mobile Screening in a physician owned practice.Screenings in Kansas are performed by Life Line Screening of America, Ltd. on behalf of Life Line Screening Physicians, P.A.Screenings in New Hampshire, New Jersey and New York are performed by Life Line Medical Screening, LLC (Dr. AndrewManganaro, 70 Niagara Street, Buffalo NY, 14202). Life Line Screening does not engage in the practice of medicine in thosestates. This information is not intended to induce referrals by Life Line Screening to Life Line Medical Screening, LLC for anyprofessional medical service.

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Introduction to Life Line Screening for Physicians and Medical StaffWho We Are

Life Line Screening is the leading provider of community-based preventive wellness services in the U.S.Established in 1993, we are dedicated to helping people live fuller, healthier lives by identifying riskfactors for stroke, cardiovascular disease and osteoporosis. The mission of Life Line Screening is to makepeople aware of an undetected health problem and encourage these individuals to seek follow up carewith their physicians. We are committed to providing the highest quality preventive screenings at anaffordable rate. Life Line Screening's corporate headquarters is in Independence, Ohio.

What We Screen For

We offer screenings to detect carotid artery stenosis, atrial fibrillation, abdominal aortic aneurysms,peripheral arterial disease and diminished bone density. Our participants are generally age 50 and overand are asymptomatic although they tend to have significant risk factors such as hypertension,hypercholesterolemia, smoking, diabetes mellitus, or a family history of stroke. In most states, we also dofinger-stick blood screenings for lipid panel, glucose, C-reactive protein, and liver enzymes.

How We Screen

Our sonographers are highly skilled and are either registered or eligible to be registered with the AmericanRegistry of Diagnostic Medical Sonographers (ARDMS) or Cardiovascular Credentialing International(CCI). All screenings are performed in accordance with the latest medical literature recommendations forcategorization of normal and abnormal results. Sonographers adhere to strict protocols to ensureconsistency and accuracy. We use the same state-of-the art Doppler color flow ultrasound technologyfound in hospitals. Individuals with abnormal test results are urged to contact their personal physicianswho can then order further testing and any treatment considerations. Life Line Screening is a non-referralcompany. We do not refer individuals for further examinations or consultation to any particular doctor nordo we permit our physician reviewers to self-refer. No Medicaid, Medicare or insurance billing isinvolved.

Validity and Medical Oversight

Life Line Screening's vascular screenings have been independently reviewed by researchers at twoacademic institutions. Excellent concordance was found between Life Line Screening's findings and anICAVL accredited laboratory. Medical supervision is provided by our National Chief Medical Officer,Andrew Manganaro, MD, FACS, FACC. Reviewing physicians are board-certified, licensed physicians. Weare also CLIA certified as a moderately-complex lab.

Contact Us

If you have any questions about Life Line Screening services, please contact our dedicated physician line at877-557-7497 or email us at [email protected].

Selected References

! Role of carotid duplex imaging in carotid screening programs-an overview. Saleem MA et al.University Hospital, Cambridge UK. Cardiovascular Ultrasound, May 2008, 6:34.

! KC Kent, et al. The Cost-effectiveness of a Quick-Screen Program for Abdominal Aortic Aneurysms.Department of Surgery, Weil Medical College of Cornell University, New York PresbyterianHospital. Surgery. 2002; 132:399-407.

! Bluth EI, Sunshine JH, Lyons JB, et al. Power Doppler Imaging: Initial Evaluation as a ScreeningExamination for Carotid Artery Stenosis. Radiology. 2000; 215:791-800.

! Chestnut C. Osteoporosis, An Underdiagnosed Disease. JAMA 2001; 286:2865-2866.! Hirsh AT, et al. Peripheral arterial disease detection, awareness, and treatment in

primary care. JAMA 2001; 286:1317-1324.

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Page 30: Screening Results Enclosedi.lifelinescreening.com/en-us/RichTextboxImages/File/LLS0508_B_Group_2.pdfScreening Results Enclosed Sincerely, Andrew J. Manganaro, M.D., F.A.C.S., F.A.C.C

Life Line Screening Results: Physician Copy

John Q. Sample

Screening Date: April 28, 2012

Location: Danbury Senior Center

Fasting: YD.O.B.: 01/01/1954

Page 10 of 10

Screening Test Measurement Result Risk CategoryIncidentalfindings

Carotid ArteryDisease

Blood flow cm/s

Left:PSV: < 110cm/s

Right:PSV: < 110cm/s

Left: NormalRight: Normal

Atrial Fibrillation 4-Limb EKG

No AtrialFibrillation DetectedHeart Rate: 59Beats/min

Normal

Abdominal AorticAneurysm

cm <3cm Normal

Peripheral ArterialDisease

Ankle Brachial IndexLeft Side: 1.18Right Side: 1.13

Left: NormalRight: Normal

Doppler

pressure � 140

mm/hg

OsteoporosisBone MineralDensity

-1.1 Low Risk

Complete LipidPanel

mg/dL

TC: 225LDL: 154HDL: 61Trig: 52

TC: BorderlineLDL: BorderlineHDL: Protective AgainstHeart DiseaseTrig: Normal

Glucose mg/dL 69 Normal

C-Reactive Protein mg/L 3.2 High Risk

BMI Body Mass Index 27.3 Moderate Risk

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