[MEDICAL] Debbie Blevins

[Akane Karanomori]

I. PATIENT INFORMATION

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• Title: (select one)
  • [] Mr.
  • [] Mrs.
  • [X] Ms.
  • [] Other
  First Name:
  Debbie
  
  Middle Name: (optional)
  N/A
  
  Last Name:
  Blevins
  
  Gender: (select one)
  • [] Male
  • [X] Female
  Date of Birth:
  13/APR/1995
  
  Address:
  102 Spanish Avenue
  
  ZIP / Postal Code:
  10241
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [X] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  4289700
  
  Email:
  [email protected] (( SimonX6 ))
  

III. APPOINTMENT DETAILS

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• Has the patient been seen at Pillbox Hill Medical Center in the past?
  • [] Yes
  • [X] No
  Does the patient have a diagnosis?
  • [X] Yes
  • [] No
  If so, please describe:
  Previously diagnosed with OCA albinism
  
  Reason for Appointment: Please let us know why the patient needs this appointment. (i.e. symptoms or part of the body that is affected.)
  Need to obtain another diagnosis by a San Andreas certified doctor to present for employment & other related activities
  
  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] 24/SEP/2022 - 18:00-21:00
    [X] 25/SEP/2022 - 18:00-21:00
    [] 26/SEP/2022 - 18:00-21:00
    [] 27-30/SEP/2022 - 18:00-22:00
  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

[Akane Karanomori]

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• Dear Dr. Winters,
  
  I appreciate you reaching out to me, I have looked over the offered list of dates and times and have chosen the one I want to attend below.
  
  03/10/22: 10:00 p.m.
  
  Kind regards,
  Debbie Blevins