[MEDICAL] Bonnie Taylor

[Thiago Larrañaga]

I. PATIENT INFORMATION

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• Title: (select one)
  • [] Mr.
  • [x] Mrs.
  • [] Ms.
  • [] Other
  First Name:
  Bonnie
  
  Middle Name:
  
  
  Last Name:
  Taylor
  
  Gender: (select one)
  • [] Male
  • [X] Female
  Date of Birth:
  20/Oct/2001
  
  Address:
  1068, San Adreas Ave. Floor 2.
  
  ZIP / Postal Code:
  901
  

II. CONTACT INFORMATION

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• Phone Type: (select one)
  • [X] Mobile
  • [] Home
  • [] Work
  • [] Other
  Phone Number:
  101001
  
  Email:
  LSMAIL(( Snack ))
  

(( Discord: ))
Baboon#5190


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:
  Pregnant and due in a couple of days.
  
  Reason for Appointment: Please let us know why the patient needs this appointment. (i.e. symptoms or part of the body that is affected.)
  Pregnant and due in a couple of days.
  
  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.)
  • [] 02/Mar/2023- 01:00
    [] 03/Mar/2023- 01:00
    [] 04/Mar/2023- 01:00
  Preferred Doctor for Appointment:
  OBGYN || Mallory Lefebvre