[MEDICAL] Rico Marshall

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Rico Marshall
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Joined: Tue Apr 12, 2022 5:58 pm

[MEDICAL] Rico Marshall

Post by Rico Marshall »

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I. PATIENT INFORMATION
  • Title: (select one)
    • [X] Mr.
    • [] Mrs.
    • [] Ms.
    • [] Other
    First Name:
    Rico

    Middle Name: (optional)
    David

    Last Name:
    Marshall

    Gender: (select one)
    • [X] Male
    • [] Female
    Date of Birth:
    31/OCT/1989

    Address:
    218 Ineseno Road

    ZIP / Postal Code:
    5402

II. CONTACT INFORMATION
  • Phone Type: (select one)
    • [X] Mobile
    • [] Home
    • [] Work
    • [] Other
    Phone Number:
    4120412

    Email:
    [email protected]

III. APPOINTMENT DETAILS
  • Has the patient been seen at Pillbox Hill Medical Center in the past?
    • [X] Yes
    • [] No
    Does the patient have a diagnosis?
    • [X] Yes
    • [] No
    If so, please describe:
    Confidential - Seeing psychiatrist

    Reason for Appointment: Recently was shot, right shoulder and right thigh. Would like a check-up regarding this and tests for nerve damage.
    ANSWER

    Is this condition or injury related to work?
    • [] Yes
    • [X] No
    Is this condition or injury related to an auto accident?
    • [] Yes
    • [X] No
    Department:
    • [X] Medical
    • [] Psychology
    Dates & Times for Appointment: (list your available dates and times in the next 7 days - use more lines if needed and mark with an 'X' your preferred one. Note that we cannot guarantee exact scheduling, but we will do our best to accommodate the patient's wishes.)
    • [X] 04/DEC/2022 - 14:00-20:00
      [X] 05/DEC/2022 - 19:15
      [X] 06/DEC/2022 - 19:15
      [X] 07/DEC/2022 - 19:15
      [X] 08/DEC/2022 - 19:15
      [X] 09/DEC/2022 - 19:15
    Preferred Doctor for Appointment: (check the list of doctors here and pick one based on personal preference. Note that this is optional and if you don't choose one, one will be automatically assigned to you.)
    Camilla Winters
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