Patient information

Michael Bergstrom

Simulated actor
Patient Identity Source
Last modifier
Meenal T
Last modified date
4/30/19 12:20:52 PM (CEST GMT+0200)
First name
Michael
Last name
Bergstrom
Mother's maiden name
Loftin
Gender
Male
Date of Birth
5/8/67
Religion
Christian: Roman Catholic
Race
White
Marital status
Identity Reliability Code

Home

Street address line
Edgehill Drive
Zip Code
15905
City
Westmont
State
Pennsylvania
Country
USA
Patient Identifiers
  • DDS-65563^^^DDS&1.3.6.1.4.1.12559.11.1.4.1.2&ISO (PI)
Email
Account number
AN8880^^^IHEPAM&1.3.6.1.4.1.12559.11.1.2.2.5&ISO^AN
Blood group
VIP Indicator
Birth Place Name
UUID
13e5422f-8b0a-4ff0-b96f-92306a440460
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- - 1967
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
  • 2019-04-30 12:20:57.051 - Patient has been created by meenal
  • 2019-04-30 12:21:01.868 - Patient has been sent to SUT (1.3.6.1.4.1.12559.11.1.2.2.5.1 1.3.6.1.4.1.12559.11.1.2.2.5.11) within a PRPA_IN201301UV02 message by meenal
Visit number
Patient status
Patient class
Last modified date
Action
VN13686^^^IHEPAM&1.3.6.1.4.1.12559.11.1.2.2.5&ISO^VN ADMITTED I 1/31/22 12:42:17 PM (CET GMT+0100)