Jennifer Wilson
 Harbor Community Health 
 Patient Name: Vanessa Roberts 
 Harbor Community Health 
 MRN: 00059315, BIRTHDATE: 16 Aug 1999, Sex: M 
 Harbor Community Health 
 580 Ricky Grove Apt. 019
Campbellbury, OK 73212 
 Acct #: 2364057 
 Patient Info 
 Patient Name 
 Account Number 
 Gender 
 BIRTHDATE (Age) 
 Jennifer Wilson (00059315) 
 2364057 
 Male 
 16 Aug 1999 (63 year old) 
 Patient Demographics 
 Address 
 Phone 
 342 Brian Well
Clarkside, ND 99128 
 412-521-7856 (Home)
 Emergency Contact(s) 
 Name 
 Relation 
 Home 
 Work 
 Mobile 
 Vanessa Roberts 
 Girlfriend 
 412-521-7856 
 Epic Admission Information 
 Arrival Date/Time: 
 04/17/2018 1005 
 admission date/Time: 
 14 Apr 2019 1005 
 IP Adm. Date/Time: 
 Admission Type: 
 Emergency 
 Point of Origin: 
 Emergency Room 
 Means of Arrival: 
 Walk In 
 Primary Service 
 Emergency 
 Secondary Service: 
 Transfer Source: 
 Home 
 Service Area: 
 MEMORIALCARE 
 Unit: 
 CHLB EMERGENCY 
 SERVICE AREA 
 Admit Provider: 
 Attending Provider: 
 Dr Wendy Lewis, MD 
 Referring Provider 
 discharge date/Time 
 14 May 2019 1155 
 19 of 107 
 06/15/2021