Cheryl Gutierrez
 Forest Hill Hospital 
 Patient Name: Christina Schaefer 
 Forest Hill Hospital 
 MRN: 00076593, BIRTHDATE: 1991 June 23, Sex: M 
 Forest Hill Hospital 
 2716 Melissa Highway Suite 745
Michaelton, ID 47443 
 Acct #: 1182240 
 Patient Info 
 Patient Name 
 Account Number 
 Gender 
 BIRTHDATE (Age) 
 Cheryl Gutierrez (00076593) 
 1182240 
 Male 
 1991 June 23 (71 year old) 
 Patient Demographics 
 Address 
 Phone 
 4163 Anderson Stream
Theresatown, MP 91479 
 527-577-4803 (Home)
 Emergency Contact(s) 
 Name 
 Relation 
 Home 
 Work 
 Mobile 
 Christina Schaefer 
 Girlfriend 
 527-577-4803 
 Epic Admission Information 
 Arrival Date/Time: 
 04/17/2018 1005 
 admission date/Time: 
 2022 August 01 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 Danny Thomas, MD 
 Referring Provider 
 Date of Discharge/Time 
 2022 August 31 1155 
 5 of 107 
 06/15/2021