Sarah Davis
 Lakefront Health 
 Nicholas Baker 
 360 Pittman Fall Suite 751
Smithfort, ID 45503 
 MRN: 2797726 BIRTHDATE 27/87/09. Sex M 
 Visit: 02/19/10 
 Patient Demographics 
 PATIENT 
 Patient ID 
 SSN 
 Legal Sex 
 BIRTHDATE 
 
 Sarah Davis 
 2797726 
 xxx-xx-0069 
 Male 
 27/87/09 (46 yrs) 
 Address PSC 7193, Box 0957
APO AE 27852
 Phone 115-155-7966 
 Race 
 Tongan 
 Reg Status 
 PCP 
 Date Last Verified 
 Next Review Date 
 Verified 
 Karsman, Alina, 
 02/03/23 
 03/05/23 
 MD818-271-2400 
 SCIP 
 Mantal Status 
 Religion 
 Language 
 Married 
 Christian 
 English 
 Primary Subscriber 
 Subscriber Name 
 Pat Rel to Sub 
 Subscriber Address 
 Subs Rel to Guar 
 Nicholas Baker 
 Self 
PSC 7193, Box 0957
APO AE 27852
2886 of 5499 
