Patient information

Atestarhacc Qz

Simulated actor
Connectathon
Last modifier
matt
Last modified date
12/30/19 5:25:45 PM (CET GMT+0100)
First name
Atestarhacc
Last name
Qz
Gender
Male
Date of Birth
12/23/57
Marital status
Identity Reliability Code

Home

Street address line
100 Main St
Zip Code
54401
City
Wausau
State
WI
Patient Identifiers
  • DDS-27^^^&1.3.6.1.4.1.12559.11.40.11&ISO
  • 639869^^^&1.2.840.114350.1.13.98.2.7.3.688884.100&ISO
Email
Primary Residence Number
+1-715-555-4562
Account number
Blood group
VIP Indicator
Birth Place Name
UUID
19fc93fc-1ba2-4d23-a192-8b18f56fc85a
Socio-professional occupation
Socio-professional group
Lunar Date
- -
Number of weeks of gestation
SMS Consent
No
Patient history
Visit number
Patient status
Patient class
Last modified date
Action