John Matthews

Patient name: John Matthews 
 MRN: 95309528112(CSB): 95309528112(SBM) 
 D.O.B: 1998 Jan 16 
 FIN: 80618517301 
 Auth (Verified) 
 * 
 Sunrise Health 
 PATIENT DATA 
 DATE 
 ACCOUNT 
 MRN 
 ROOM# 
 2019 Jan 09 
 8061851731 
 95309528112 
 Room 1 
 ACCESSION 
 EMPI 
 ADMISSION DATE 
 ACCHF002459 
 2017 Jul 07 
 Patient name 
 SSN# 
 RACE 
 John Matthews 
 Black 
 ADDRESS 1 
 CITY 
 STATE 
 56670 Kirk Vista
East Gina, WI 58397 
 D.O.B 
 AGE 
 1998 Jan 16 
 34 
 PROCEDURE
 STAFF 
 Left Heart Catheterization 
 Dr Dean Wagner MD 
 Physician 
 Coronary Angiography - Selective 
 Ingle, Genesis RN 
 Scrub 
 Left Ventriculography 
 Pierce, Kristopher RN 
 Circulate 
 Occlusive Device, Art/Vein G0269 
 Camarillo, Melissa RT 
 Recorder 
 Dr Trevor Velazquez MD 
 Fellow Physician 
 John Matthews 
 M# 3800369833 
 D.O.B:1998 Jan 16 
 DOS:2021 May 14 
 Age: 34Y Sex: M 
 LOC: MSG 
 *CARDIAC 
 A# 80008942601 
 John Matthews: 95309528112, D.O.B: 1998 Jan 16 
 Printed On 2019 Jan 09:14:65:09 
 Attending: {Doctor Name} MD 
 CaseID HF002459 
 Sunrise Health 
 Xper.IM. Philips 
 Facility SBMC 
 Page 288 of 379 
 101
