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KIC000001 - AGE 37 SEX M MS M RELIGION IS RACE OTH PHONE...

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-------------------------------- - . • 1 •• PAGE: 1 ADM.l\1lW _ EMIlRGENCY IlEPARTMIlNT PATJ:JmT _tlil'lQGAAPHIl; INDIANA REGIONJ\L MEDICllL c:ENTER Telephone, (724) 357-·70-00----- *.*** •• *.***** •• ***.* •• ***.***-***~ •• ******** •• **.* •• * .************************************** I" 11m /I /I 1/1 I032947111- FS PATIENT: .ALllA%TA,lIIOIUMM'U) 2406 BYRON COURT INDIANA,PA 15701 UNIT NO. (MR#): M00244147 ACCT #: I032947111 REG. DTE/TIME: 09/29/11 LOCATION, ER 1715 PRIMARY PHY: AHMED,DURRE MIl \ CIa': STATED COMP:RT SIDE PAIN 4 ~YS LAST ADM: LAST OUT: LAST PMD VISIT: ***** •••• *.***** •••• *.*.*.*** ••• ****** •• ** •• ************************************** ••• *.***** BIRTHCATE: 06/21/72
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Unformatted text preview: AGE: 37 SEX: M MS, M RELIGION: IS RACE, OTH PHONE: 724-541-2318 sst: 201-84-8439 EMPLOYER: UBMP PT OCC: NOK: AlABBAD I, GlIADA NOK PH: 724-541-2318 NOK REL: SP Fe, SP Guar Name :~TA,MOHAMMAD SS#:201-84-8439 Phone: 724-541-2318 Address :2406 BYRON COURT Relationship :5 ~ _ INDIANA, PA 15701 occupation Bmp. Name : UNEMPLOYED amp phone •• **.********* •••• *** ••• ** ••••• *** ••••• ****** ••••••••••••••••• *****.** •• ************ •• ****** - I AL ABBADI, GIIADA I I 1. I-CARE CATEGORY A 197844796 N N 2. S F 3. o 4 . • *.*******.* ••• **********************************.* •••••• ** ••••• ***** •• ******.***** •••••• ***...
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