Jessica Davis
 Greenfield Healthcare 
 PATIENT NAME: Olivia Allen 
 Greenfield Healthcare 
 MRN: 00095686, birth date: December 27, 1994, Sex: M 
 Greenfield Healthcare 
 019 Owens Fort Suite 939
Port Sierraport, IA 52057 
 Acct #: 1094135 
 Patient Info 
 PATIENT NAME 
 Account Number 
 Gender 
 birth date (Age) 
 Jessica Davis (00095686) 
 1094135 
 Male 
 December 27, 1994 (44 year old) 
 Patient Demographics 
 Address 
 Phone 
 1945 William Shoal Suite 077
Navarrofurt, AK 47378 
 216-773-9132 (Home)
 Emergency Contact(s) 
 Name 
 Relation 
 Home 
 Work 
 Mobile 
 Olivia Allen 
 Girlfriend 
 216-773-9132 
 Epic Admission Information 
 Arrival Date/Time: 
 04/17/2018 1005 
 date of admit/Time: 
 March 24, 2015 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 Christopher Figueroa, MD 
 Referring Provider 
 Date of Discharge/Time 
 April 23, 2015 1155 
 61 of 107 
 06/15/2021