MEDICAL DOCUMENT

TRANSLATION ATTESTATION

This translated document has been reviewed by a second linguist (certifying linguist), identified
below, who attests that the following is a true, faithful, accurate and complete translation of the
source material.

Signature of Original* Linguist

Full Name of Original Linguist:
Date:
*Original linguist must be a first level translator.

Signature of Certifying* Linguist

Full Name of Certifying Linguist:
Date:
*Certifying linguist must be a second level reviewer. The original translator cannot certify.
 National Health Service - Veneto Region
AZIENDA ULSS No. 8 BERICA
Viale F. Rodolfi no. 37 - 36100 VICENZA
REGIONAL CODE 050 - U.L.SS. CODE 508 TAX CODE AND VAT NUMBER
02441500242
Phone 0444 753111 - Fax 0444 753809 Mail protocollo@aulss8.veneto.it Certified
[Logo: VENETO REGIONREGIONAL email:
AUTHORITY ULSS8 [Local Health Care protocollo.centrale.aulss8@pecveneto.it www.aulss8.veneto.it
Authority] BERICA]
Complex Operative Unit of Hematology
Address: San Bortolo Hospital, viale Rodolfi 37, 36100 Vicenza
Acting Director Dr. Alberto TosettoALBERTO TOSETTO
Tel 0444 753518 - Department 0444 753607

To the attending physician of Mr.

BEASLEY DAVID FRANKLIN JR
VIALE DELLA PACE PO BOX, 1433 193
99999, VICENZA
Dear colleague,

I’m sending you the result of the examination of your patient BEASLEY DAVID FRANKLIN JR performed on 19 August 2022.

Clinical Conclusions/Decisions and Schedule:

Patient evaluatedin evaluation for suspected chronic myeloproliferative disorder, type chronic myeloid leukemia.

Medical history: no reported pathologies; the patient does not take any drugs regularly; no allergies to drugs are known; 1 brother in
good health; no family history of crcardiovascular diseases; paternal grandfather suffering from lymphoma.

Anomalous BCR-ABL translocation research tested positive for p210 transcript .

The analysis of the bone marrow shows exuberant myeloid series with mild maturation delay with a blast cells rate of about 2-3% of
the cellularity.

Today’s CBC shows a basically unchanged picture compared to yesterday’s collection with a mild reduction of the platelet count. Hb
128 g/L, WBC 78.6x10^9/L, PLTs 62x10^9/L.

I explained the patient that the result of the molecular analysis confirms the diagnosis of chronic myeloid leukemia (SOKAL low;
EUTOS: low).
I explained described the pathology to the patient and briefly outlined the therapeutic approach based on the use of tyrosine kinase
inhibitors (TKIs).
Furthermore, I explained that, for a more adequate choice of the TKIs to use, it is necessary to wait for the outcomes of the blood
chemistry and instrumental exams.
At the moment, due to the stability of the leukocyte count and the slight reduction of the platelets, the start of hydroxyurea
(Oncocarbide) is postponed.

The patient is expected on 24th August at the CML outpatient clinic for follow-up consultation and complete blood count.

Due to the reduced platelets count, we recommend abstaining from physical activity.

Available for clarifications or needs

Best RRegards
Dr. OMAR PERBELLINI
[Signature]

Digitally signed by PERBELLINI Omar on 22 August 2022 at 0931 hrs

Page 1 of 4
VENETO REGION - A.U.L.S.S. [LOCAL HEALTH CARE COMPANYAUTHORITY] No. 8 “BERICA”
MEDICAL LABORATORY
Director: Dr. Davide Giavarina

MICROBIOLOGY
Director: Dr. Mario Rassu
Health : BSLDDF89L06Z404X BEASLEY David Franklin
CardTax code
D.O.B. : 06 July 1989 VLE DELLA PACE PO BOX 1433 193
Requested by 36100 VICENZA
Check In : 19 August 2022 1034 hrs Request : 2089506840
number
Printed on : 19 August 2022 1052 hrs OriginSource : AMB.Hematology Ematologia CUP
[Hematology Outpatient clinic of the Single
Appointment Center]

Reference
Test Result Unit of Measurement values
values
HEMATOLOGY

Sg-HEMOCROMOCYTOMETRIC EXAMINATION

WHITE BLOOD CELLS (WBC) * 78.6 x10^9/L 3.5 11.0

RED BLOOD CELLS (RBC) * 3.97 x10^12/L 4.10 5.65
HEMOGLOBIN (Hb) 128 g/L 125 169
MEAN CORPUSCULAR
VOLUME [Illegible] (MCV) * 100.3 fL 82.0 100.0
HEMATOCRIT (HCT) 0.40 L/L 0.38 0.49
MEAN CORPUSCULAR
HEMOGLOBIN (MCH) 32.2 pg 27.0 34.0
MEAN MEAN
CORPUSCULAR
HEMOGLOBIN
CONCENTRATION
CONCENTRATION (MCHC) 320 g/L 313 355
RBC DISTRIBUTION
INDEX [Illegible]INDEX (RDW) * 16.3 percent 12.0 15.0
PLATELETS (PLT) * 62 x10^9/L 110 330
DIFFERENTIAL COUNT OF NUCLEATED ELEMENTS
NEUTROPHILS 87.9% * 69.1 x10^9/L 1.9 5.3
NUCLEATED RED BLOOD
(NRBC) 0.13 x10^9/L
CELLS

Representation of a report automatically signed with a digital signature and stored electronically according to the regulations in force
at the Authority.

*** Full Report ***

Page 2 of 4
Secretary phone/fax: 0444 753402/753714 - e-mail: laboratorio.analisi@aulss8.veneto.it Page 001

Page 3 of 4