Charles Nolan
 Pineview General Hospital 
 Sarah Bartlett 
 3164 Briana Trail Apt. 804
Angelfort, WI 20943 
 MRN: 9150779 birth date 1998-19-01. Sex M 
 Visit Day: 2020-21-09 
 Patient Demographics 
 patient name 
 Patient ID 
 SSN 
 Legal Sex 
 birth date 
 
 Charles Nolan 
 9150779 
 xxx-xx-0067 
 Male 
 1998-19-01 (35 yrs) 
 Address 07047 Daniel Rue
Nicholasfurt, IA 33565
 Phone 478-408-5844 
 Race 
 Tongan 
 Reg Status 
 PCP 
 Date Last Verified 
 Next Review Date 
 Verified 
 Karsman, Alina, 
 02/03/23 
 03/05/23 
 MD818-271-2400 
 SCIP 
 Mantal Status 
 Religion 
 Language 
 Married 
 Christian 
 English 
 Primary Subscriber 
 Subscriber Name 
 Pat Rel to Sub 
 Subscriber Address 
 Subs Rel to Guar 
 Sarah Bartlett 
 Self 
07047 Daniel Rue
Nicholasfurt, IA 33565
2614 of 5499 
