Kelly Carlson

   
 BAYLOR SCOTT & WHITE 
 Williams, Charles Eugene 
 BaylorScott&White 
 HEART AND VASCULAR 
 MRN: 9211633, DOB: March 05, 1986, Sex: M 
 HEALTH 
 HOSPITAL - DALLAS 
 Date of Service January 09, 2022
 621 N HALL ST 
 DALLAS TX 75336-1333
October 15, 2022 - Procedure Pass in Hospital  
 Visit Information 
 Admission Information 
 Arrival Date/Time: 
 Admit Date/Time: 
 June 13, 2015
 IP Adm. Date/Time: 
 Admission Type: 
 Point of Origin: 
 Admit Category: 
 Means of Arrival: 
 Primary Service: 
 Secondary Service: N/A 
 Transfer Source: 
 Service Area: 
 Unit: 
 Admit Provider: 
 Attending Provider: 
 Referring Provider: 

 October 15, 2022 - Procedure Pass in Baylor Scott & White Heart and Vascular Hospital - Dallas 
 Facesheet 
 Patient Information 
 Patient Name 
 Legal Sex 
 DOB 
 Williams, Charles Eugene (3311633) 
 Male 
 March 05, 1986 
 Basic Information 
 Date Of Birth 
 Legal Sex 
 Race 
 Ethnic Group 
 Preferred Language 
 Language for Written 
March 05, 1986 
 Male 
 Black or African 
 Not Hispanic or 
 English 
 Material 
 American 
 Latino 
 English 
 
 Printed on March 05, 1986 10:22 AM 
 Page 133 
 7533 8-33  
 Baylor Scott & White Heart & Vascular Hospital - 00133 
