Emma Parker

   
 BAYLOR SCOTT & WHITE 
 Williams, Charles Eugene 
 BaylorScott&White 
 HEART AND VASCULAR 
 MRN: 9211620, DOB: 17 May 1997, Sex: M 
 HEALTH 
 HOSPITAL - DALLAS 
 Date of Service 19 Mar 2022
 621 N HALL ST 
 DALLAS TX 75206-1320
09 Jul 2020 - Procedure Pass in Hospital  
 Visit Information 
 Admission Information 
 Arrival Date/Time: 
 Admit Date/Time: 
 16 Mar 2017
 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: 

 09 Jul 2020 - Procedure Pass in Baylor Scott & White Heart and Vascular Hospital - Dallas 
 Facesheet 
 Patient Information 
 Patient Name 
 Legal Sex 
 DOB 
 Williams, Charles Eugene (2011620) 
 Male 
 17 May 1997 
 Basic Information 
 Date Of Birth 
 Legal Sex 
 Race 
 Ethnic Group 
 Preferred Language 
 Language for Written 
17 May 1997 
 Male 
 Black or African 
 Not Hispanic or 
 English 
 Material 
 American 
 Latino 
 English 
 
 Printed on 17 May 1997 10:22 AM 
 Page 120 
 7520 8-20  
 Baylor Scott & White Heart & Vascular Hospital - 00120 
