https://i.imgur.com/TvmpR4O.png I. PATIENT INFORMATION Title: (select one) [X] Mr. [] Mrs. [] Ms. [] Other First Name: Arnold Middle Name: (optional) N/A Last Name: Angel Gender: (select one) [X] Male [] Female Date of Birth: 29/APR/1985 Address: 60 Lillith Foot Lane, Los Santos ZIP / Postal Code: ...

https://i.imgur.com/TvmpR4O.png I. PATIENT INFORMATION Title: (select one) [X] Mr. [] Mrs. [] Ms. [] Other First Name: Arnold Middle Name: (optional) N/A Last Name: Angel Gender: (select one) [X] Male [] Female Date of Birth: 29/APR/1985 Address: 60 Lillith Foot Lane, Los Santos ZIP / Postal Code: ...