12/8/05 1:34 PM
AdmitPatient
3.9
Cody
William
F
01/01/1975
M
Bill
1234 Oak Rd
#5
Scott County
Iowa
90211
(222)222-2223
wbill@msn.com
(333)333-3334
M
111-11-1112
Don't call before 10am.
I take these medications: blah blah blah. Allergic to pen. Don't lay back too far, etc.
Cody
William
F
1234 Oak Rd
#4
Scott County
Iowa
90210
(222)222-2222
wbill@msn.com
(333)333-3333
01/01/1946
M
other
111-11-1111
M
Aetna
1234 Main St.
Suite 5
Tulsa
OK
44744
(800)123-1234
12-55656
Metro Waste
Metro Waste
1/1/03
Cody
William
F
parent
1/5/83
Y
123-45-6789
51
1001
M
6
Percents: 100/80/50. 1 yr wait on major. No flo cov.