Patient information

QTF TEST QTFTEST-002

Simulated actor
Connectathon
Last modifier
mtoudic
Last modified date
11/8/22 4:16:44 PM (EST GMT-0500)
First name
QTF TEST
Last name
QTFTEST-002 (Lemke654)
Gender
Female
Date of Birth
12/12/93
Race
White
Marital status
Married
Identity Reliability Code

Birth Delivery Location

City
Revere
State
Massachusetts
Country
USA

Home

Street address line
1085 Grant Boulevard
Zip Code
01945
City
Marblehead
State
MA
Country
USA
Patient Identifiers
  • PID-COMMUNITY1-QTFTEST-002^^^&1.3.6.1.4.1.21367.13.20.2000&ISO (PI)
Email
Primary Residence Number
tel:+1-857-555-2222
Account number
AN210^^^IHEPAM&1.3.6.1.4.1.12559.11.20.1&ISO^AN
Blood group
VIP Indicator
Birth Place Name
UUID
60c4af47-57b5-45b9-a00c-d9c7eaca2bda
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- - 2003
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