Patient information

QTF TEST QTFTEST-004

Simulated actor
Connectathon
Last modifier
mtoudic
Last modified date
11/8/22 4:23:31 PM (EST GMT-0500)
First name
QTF TEST
Last name
QTFTEST-004
Gender
Female
Date of Birth
1/15/11
Race
White
Marital status
Identity Reliability Code

Birth Delivery Location

City
Boston
State
Massachusetts
Country
USA

Home

Street address line
359 Schmitt Track Unit 80
Zip Code
02155
City
Somerville
State
MA
Country
USA
Patient Identifiers
  • PID-COMMUNITY1-QTFTEST-004^^^&1.3.6.1.4.1.21367.13.20.2000&ISO (PI)
Email
Primary Residence Number
tel:+1-774-555-4444
Account number
Blood group
VIP Indicator
Birth Place Name
UUID
60d1b421-6307-4ff6-816e-bc4634fe81ce
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- - 1942
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