Patient information

Mary Haase

Simulated actor
Patient Identity Source
Last modifier
Anonymous
Last modified date
5/9/19 11:37:46 AM (CEST GMT+0200)
First name
Mary
Last name
Haase
Mother's maiden name
Quinlan
Gender
Female
Date of Birth
7/2/54
Religion
Christian: Protestant
Race
White
Marital status
Identity Reliability Code

Home

Street address line
Pfaff Drive
Zip Code
60423
City
Frankfort
State
Illinois
Country
USA
Patient Identifiers
  • DDS-65594^^^DDS&1.3.6.1.4.1.12559.11.1.4.1.2&ISO (PI)
Email
Account number
AN8903^^^IHEPAM&1.3.6.1.4.1.12559.11.1.2.2.5&ISO^AN
Blood group
VIP Indicator
Birth Place Name
Socio-professional occupation
Socio-professional group
Lunar Date
- - 1954
Number of weeks of gestation
SMS Consent
No
Patient history
  • 2019-05-09 11:37:55.66 - Patient has been created
  • 2019-05-09 11:37:59.486 - 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
Visit number
Patient status
Patient class
Last modified date
Action