Other Site Care Providers
DOB: 04/07/1935 (79y)
SSN: 666-00-0008
Gender: Male
| Contact Information |
|---|
|
Home Address
Any Street Any Town, WV 99998 |
|
Temporary Address
Unavailable |
|
Home Phone
(222)555-6666 |
|
Cell Phone
Unavailable |
|
Work Phone
(222)555-7777 |
|
Email
Unavailable |
| Other Contact |
|---|
|
Emergency Contact
Unavailable |
|
Next of Kin
Veteran, Brother |
|
Next of Kin Phone
Unavailable |
|
Next of Kin Address
Unavailable |
| VA Health Benefits |
|---|
|
Insurance
Unavailable |
|
Service Connected
Yes |
| Service Connected Conditions Unavailable |
| Service and Social History |
|---|
|
Veteran Yes |
|
Marital Status Married |
|
Religion Roman Catholic Church |
Location: Inactive(2 Nhcu)
Provider: unassigned
Body Text
Primary Care: RED
Unassigned / Unassigned 1
Inpatient Attending/Provider:
Provider, Thirty / Provider, Twenty
(555) 555-5551