Patient information

Kay-01 Shuman-02

Simulated actor
Patient Identity Source
Last modifier
Anonymous
Last modified date
6/3/19 11:44:28 AM (CEST GMT+0200)
First name
Kay-01
Last name
Shuman-02
Mother's maiden name
Somerville
Gender
Female
Date of Birth
3/8/11
Religion
Christian: Protestant
Race
Other race
Marital status
Identity Reliability Code

Home

Street address line
Lang Avenue
Zip Code
91744
City
West Puente Valley
State
California
Country
USA
Patient Identifiers
  • DDS-65666^^^DDS&1.3.6.1.4.1.12559.11.1.4.1.2&ISO (PI)
Email
Account number
AN8940^^^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
- - 2011
Number of weeks of gestation
SMS Consent
No
Patient history
  • 2019-06-03 11:44:50.112 - Patient has been created
  • 2019-06-03 11:44:50.137 - 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_IN201302UV02 message
  • 2019-06-03 11:44:54.223 - Patient has been created
  • 2019-06-03 11:44:54.232 - 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_IN201302UV02 message
Visit number
Patient status
Patient class
Last modified date
Action
VN9602^^^IHEPAM&1.3.6.1.4.1.12559.11.1.2.2.5&ISO^VN ADMITTED I 6/25/19 4:23:22 PM (CEST GMT+0200)