Rickey Smith

Patient: Rickey Smith 
 MRN: 51998103290(CSB): 51998103290(SBM) 
 birth date: 1990 Jul 30 
 FIN: 80956453801 
 Auth (Verified) 
 * 
 Valley View Hospital 
 PATIENT DATA 
 DATE 
 ACCOUNT 
 MRN 
 ROOM# 
 2023 Jul 29 
 8095645381 
 51998103290 
 Room 1 
 ACCESSION 
 EMPI 
 Admitting Date 
 ACCHF002459 
 2020 Jan 03 
 Patient 
 SSN# 
 RACE 
 Rickey Smith 
 Black 
 ADDRESS 1 
 CITY 
 STATE 
 518 Robinson Spur
Port Jeffrey, VA 07432 
 birth date 
 AGE 
 1990 Jul 30 
 76 
 PROCEDURE
 STAFF 
 Left Heart Catheterization 
 Dr Robin Krueger 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 Kevin Williams MD 
 Fellow Physician 
 Rickey Smith 
 M# 3800369833 
 birth date:1990 Jul 30 
 D.O.S:2017 Jul 14 
 Age: 76Y Sex: M 
 LOC: MSG 
 *CARDIAC 
 A# 80008942601 
 Rickey Smith: 51998103290, birth date: 1990 Jul 30 
 Printed On 2023 Jul 29:14:65:09 
 Attending: {Doctor Name} MD 
 CaseID HF002459 
 Valley View Hospital 
 Xper.IM. Philips 
 Facility SBMC 
 Page 194 of 379 
 101
