Lisa Vazquez
 Seaside Medical 
 Patient: Emily Koch MD 
 Seaside Medical 
 MRN: 00061043, DOB: 1991-04-13, Sex: M 
 Seaside Medical 
 3821 Martin Lake
Nathanland, MO 45891 
 Acct #: 8609825 
 Patient Info 
 Patient 
 Account Number 
 Gender 
 DOB (Age) 
 Lisa Vazquez (00061043) 
 8609825 
 Male 
 1991-04-13 (67 year old) 
 Patient Demographics 
 Address 
 Phone 
 15277 Barbara Stream Suite 148
West Jamesbury, ME 93689 
 472-167-4362 (Home)
 Emergency Contact(s) 
 Name 
 Relation 
 Home 
 Work 
 Mobile 
 Emily Koch MD 
 Girlfriend 
 472-167-4362 
 Epic Admission Information 
 Arrival Date/Time: 
 04/17/2018 1005 
 admitting date/Time: 
 2021-02-17 1005 
 IP Adm. Date/Time: 
 Admission Type: 
 Emergency 
 Point of Origin: 
 Emergency Room 
 Means of Arrival: 
 Walk In 
 Primary Service 
 Emergency 
 Secondary Service: 
 Transfer Source: 
 Home 
 Service Area: 
 MEMORIALCARE 
 Unit: 
 CHLB EMERGENCY 
 SERVICE AREA 
 Admit Provider: 
 Attending Provider: 
 Dr James Cantu, MD 
 Referring Provider 
 discharge date/Time 
 2021-03-19 1155 
 104 of 107 
 06/15/2021