Abigail Jensen

Hillside Healthcare 
32081 Samuel Harbor
North Charlotte, DC 37208
 Facility Phone #: 470-970-3841 
 PATIENT: Abigail Jensen 
 D.O.B 22 July 1990 Age: 40 years 
 Sex M 
 MRN: 3899806053(SBM) 
 admission date: 15 January 2022 
 Acct #: 10324293144 
 Disch Date: 14 February 2022 
 Pt loc: SBMC 6TNS; 643;55 
 Physician: 
 Dr Kenneth Medina DO 
 PCP: 
 PCP,Not on Staff 
 Operative and Procedure Reports 
 Electronically Signed By: 
 Dr Bryan Anderson MD 
 On 19 March 2015 23:49 
 Co Signature By: 
 Dr Mr. Justin Simpson MD 
 On 19 March 2015 23:49 
 Modified Signature By: 
 Dr Bryan Anderson MD 
 On 19 March 2015 23:49 
 Date/Time Printed 24 July 2016 12:52 PST 
 Report Request ID: 233041713 
 Page 219 of 379 
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