[MEDICAL] Azrael Patterson

[Azrael Patterson]

I. PATIENT INFORMATION

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• Title: (select one)
  • [x] Mr.
  • [] Mrs.
  • [] Ms.
  • [] Other
  First Name:
  Azrael
  
  Middle Name: (optional)
  ANSWER
  
  Last Name:
  Patterson
  
  Gender: (select one)
  • [x] Male
  • [] Female
  Date of Birth:
  10/MAR/1982
  
  Address:
  600 Cougar Aven
  
  ZIP / Postal Code:
  600
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [x] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  ANSWER
  
  Email:
  [email protected] (( Poetic Justice))
  

III. APPOINTMENT DETAILS

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• 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:
  Contusion following a trauma induced by a car accident (N/A if the answer to the previous question is 'No')
  
  Reason for Appointment: Please let us know why the patient needs this appointment. (i.e. symptoms or part of the body that is affected.)
  Check up and blood analysis
  
  Is this condition or injury related to work?
  • [] Yes
  • [x] No
  Is this condition or injury related to an auto accident?
  • [x] Yes
  • [] 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.)
  • [] Anytime - between 16:00 - 00:00
  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.)
  N/A

[Azrael Patterson]

I'd like a reschedule for tonight if possible.

[Azrael Patterson]

17/08/22: 4 p.m.