Kelsey Morris
 Sunnydale General 
 Ronald Kirk 
 27477 Cory Extensions
Joeville, MO 56671 
 MRN: 5040703 dob 13-03-1986. Sex M 
 visiting date: 26-05-2020 
 Patient Demographics 
 PATIENT NAME 
 Patient ID 
 SSN 
 Legal Sex 
 dob 
 
 Kelsey Morris 
 5040703 
 xxx-xx-0056 
 Male 
 13-03-1986 (51 yrs) 
 Address 46172 Martinez Tunnel Suite 457
Lake Michele, VI 71131
 Phone 106-270-6208 
 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 
 Ronald Kirk 
 Self 
46172 Martinez Tunnel Suite 457
Lake Michele, VI 71131
4246 of 5499 
