Derrick Kelley

Patient: Derrick Kelley 
 MRN: 22146643324(CSB): 22146643324(SBM) 
 DATE OF BIRTH: Apr 06, 1992 
 FIN: 80258633701 
 Auth (Verified) 
 * 
 Valley Medical Center 
 PATIENT DATA 
 DATE 
 ACCOUNT 
 MRN 
 ROOM# 
 Aug 23, 2023 
 8025863371 
 22146643324 
 Room 1 
 ACCESSION 
 EMPI 
 admitting date 
 ACCHF002459 
 May 06, 2017 
 Patient 
 SSN# 
 RACE 
 Derrick Kelley 
 Black 
 ADDRESS 1 
 CITY 
 STATE 
 9180 Hardy Hollow
Port Aprilburgh, HI 46422 
 DATE OF BIRTH 
 AGE 
 Apr 06, 1992 
 37 
 PROCEDURE
 STAFF 
 Left Heart Catheterization 
 Dr David Savage 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 Duane Moore Jr. MD 
 Fellow Physician 
 Derrick Kelley 
 M# 3800369833 
 DATE OF BIRTH:Apr 06, 1992 
 dos:Jun 09, 2017 
 Age: 37Y Sex: M 
 LOC: MSG 
 *CARDIAC 
 A# 80008942601 
 Derrick Kelley: 22146643324, DATE OF BIRTH: Apr 06, 1992 
 Printed On Aug 23, 2023:14:65:09 
 Attending: {Doctor Name} MD 
 CaseID HF002459 
 Valley Medical Center 
 Xper.IM. Philips 
 Facility SBMC 
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