Robert Fry

   
 BAYLOR SCOTT & WHITE 
 Williams, Charles Eugene 
 BaylorScott&White 
 HEART AND VASCULAR 
 MRN: 9211625, DOB: 19/02/93, Sex: M 
 HEALTH 
 HOSPITAL - DALLAS 
 Date of Service 12/11/22
 621 N HALL ST 
 DALLAS TX 75256-1325
05/08/21 - Procedure Pass in Hospital  
 Visit Information 
 Admission Information 
 Arrival Date/Time: 
 Admit Date/Time: 
 17/06/15
 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: 

 05/08/21 - Procedure Pass in Baylor Scott & White Heart and Vascular Hospital - Dallas 
 Facesheet 
 Patient Information 
 Patient Name 
 Legal Sex 
 DOB 
 Williams, Charles Eugene (2511625) 
 Male 
 19/02/93 
 Basic Information 
 Date Of Birth 
 Legal Sex 
 Race 
 Ethnic Group 
 Preferred Language 
 Language for Written 
19/02/93 
 Male 
 Black or African 
 Not Hispanic or 
 English 
 Material 
 American 
 Latino 
 English 
 
 Printed on 19/02/93 10:22 AM 
 Page 125 
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 Baylor Scott & White Heart & Vascular Hospital - 00125 
