Patient information

SAM ADAM

Simulated actor
Patient Demographic Supplier
Last modifier
Anonymous
Last modified date
11/1/21 2:45:58 PM (CET GMT+0100)
First name
SAM (SAM)
Last name
ADAM
Mother's maiden name
Bauwens
Gender
M
Date of Birth
4/18/64
Marital status
Identity Reliability Code
VALI

Home

Street address line
Jozef Vanden Weghestraat
Zip Code
8600
City
Diksmuide
Country
BEL

Birth Delivery Location

Zip Code
8370
City
Blankenberge
INSEE Code
99131
Country
BEL
Patient Identifiers
  • 640418 989 37^^^BE&1.3.6.1.4.1.21297.100.1.1&ISO (NH)
  • DDS-54265^^^DDS&1.3.6.1.4.1.12559.11.36.9&ISO (PI)
  • 10665^^^GZL_INTEROP&2.16.840.1.113883.2.8.3.7&ISO (PI)
  • 164049913178167^^^ASIP-SANTE-INS-NIR&1.2.250.1.213.1.4.10&ISO (INS)
  • 164049913178167^^^ASIP-SANTE-INS-NIA&1.2.250.1.213.1.4.9&ISO (INS)
Email
Account number
AN1752^^^GZL_INTEROP&2.16.840.1.113883.2.8.3.7&ISO^AN
Blood group
VIP Indicator
Birth Place Name
UUID
0194768a-f1d2-406f-9cfc-1593ed6e89fb
Socio-professional occupation
2
Socio-professional group
68
Number of weeks of gestation
SMS Consent
No
Date de naissance carte Vitale
- 0 - 1964
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
  • 2021-11-01 14:46:02.323 - Patient has been created
Visit number
Patient status
Patient class
Last modified date
Action