Patient information

Lavera Champion

Simulated actor
Patient Identity Cross-Reference Manager
Last modifier
vhofman
Last modified date
2/8/22 12:40:24 PM (EST GMT-0500)
First name
Lavera
Last name
Champion
Mother's maiden name
Singleton
Gender
Female
Date of Birth
12/24/89
Religion
Christian: Protestant
Race
White
Marital status
Identity Reliability Code

Home

Street address line
East 19th Street
Zip Code
67601
City
Hays
State
Kansas
Country
USA
Patient Identifiers
  • DDS-72923^^^DDS&1.3.6.1.4.1.12559.11.46.3&ISO (PI)
Email
Account number
Blood group
VIP Indicator
Birth Place Name
UUID
d88bb94a-c378-4a4e-b525-f6bd492d4d0b
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- - 2010
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