Patient information

THOMAS WILLEMS

Simulated actor
Patient Demographic Consumer
Last modifier
Gazelle_PAM_FR
Last modified date
10/4/21 4:02:56 PM (CEST GMT+0200)
First name
THOMAS (THOMAS)
Last name
WILLEMS
Mother's maiden name
Adam
Gender
Masculin
Date of Birth
4/21/16
Marital status
Identity Reliability Code
Validé

Address

Street address line
Rue des Anciens Combattants
Zip Code
4683
City
Oupeye
Country
BEL

Address

Zip Code
2990
City
Wuustwezel
Country
BEL

Birth Delivery Location

INSEE Code
99131
Country
BEL
Patient Identifiers
  • 160421 331 14^^^BE&1.3.6.1.4.1.21297.100.1.1&ISO (NH)
  • DDS-54211^^^DDS&1.3.6.1.4.1.12559.11.36.9&ISO (PI)
  • 10638^^^GZL_INTEROP&2.16.840.1.113883.2.8.3.7&ISO (PI)
  • 116049913154635^^^ASIP-SANTE-INS-NIR&1.2.250.1.213.1.4.10&ISO (INS)
  • 116049913154635^^^ASIP-SANTE-INS-NIA&1.2.250.1.213.1.4.9&ISO (INS)
Email
Account number
AN1705^^^GZL_INTEROP&2.16.840.1.113883.2.8.3.7&ISO^AN
Blood group
VIP Indicator
Birth Place Name
UUID
6294384f-f77e-4f92-bbc6-56f21320b989
Socio-professional occupation
Socio-professional group
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- -
Date de naissance corrigé
No
Mode d'obtention de l'identité
Justificatif d'identité
Valide jusqu'au
Date d'interrogation du téléservice INSi
Patient history
  • 2021-10-04 16:02:56.887 - Patient has been received from SUT (PAM_FR Gazelle) within a ADT^A28^ADT_A05 message
  • 2021-10-04 16:02:56.891 - Patient has been created
Visit number
Patient status
Patient class
Last modified date
Action