Patient information

QTF TEST QTFTEST-001

Simulated actor
Connectathon
Last modifier
mtoudic
Last modified date
11/8/22 4:10:17 PM (EST GMT-0500)
This patient is dead on 11/13/09 12:00:00 PM (EST GMT-0500)
First name
QTF TEST
Last name
QTFTEST-001 (Blanda868)
Gender
Female
Date of Birth
9/18/58
Race
White
Marital status
Married
Identity Reliability Code
Deceased date/time
11/13/09 12:00:00 PM (EST GMT-0500)

Birth Delivery Location

Zip Code
02169
City
Boston
State
MA
Country
USA

Home

Street address line
577 Schmeler Frontage road Unit 7
Zip Code
02169
City
Quincy
State
MA
Country
USA
Patient Identifiers
  • PID-COMMUNITY1-QTFTEST-001^^^&1.3.6.1.4.1.21367.13.20.2000&ISO (PI)
Email
Primary Residence Number
tel:+1-617-555-1111
Account number
Blood group
VIP Indicator
Birth Place Name
UUID
5ce3070c-25b9-4fc1-b467-b3c7ad7d312d
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- - 1953
Date de naissance corrigé
No
Mode d'obtention de l'identité
Justificatif d'identité
Valide jusqu'au
Date d'interrogation du téléservice INSi
Patient history
Visit number
Patient status
Patient class
Last modified date
Action