TheJobName ChosenPrinterAlias=TheChosenPrinterAlias TerminalId=TerminalIdValue LinesPerRecord=262 PatientVisitID 4141 LastName MEXICO FirstName ENSENADA MiddleName NamePrefix NameSuffix BirthDate 19550201

MedicalRecordNumber 501073 Gender M Address1 City State Zip AdmitState Regis PreviousAdmitState AdmitDateTime 20040611144736 AttendingPhysicianLastName ED PHYSICIAN Room Bed BillingCode U DischargeDateTime ReferringPhysicianID ReferringPhysicianFirstName ReferringPhysicianLastName ConsultingPhysicianID ConsultingPhysicianFirstName ConsultingPhysicianLastName SSN 000000000

Alias MothersName MaritalStatus S RaceCode Religion HomePhone AccountNumber 1518028 PatientType E NursingStation FinancialClass S AdmitSource P NextOfKinLastName NextOfKinRelationship NextOfKinPhone PrimaryInsCompanyName PrimaryInsAddress1 PrimaryInsCity PrimaryInsState PrimaryInsZip PrimaryInsPhone PrimaryInsGroupNumber PrimaryInsPolicyNumber PrimaryInsRelationship PrimaryInsSubscriberLastName PrimaryInsSubscriberFirstName SecondaryInsCompanyName SecondaryInsAddress1 SecondaryInsCity SecondaryInsState SecondaryInsZip

SecondaryInsGroupNumber SecondaryInsPolicyNumber SecondaryInsRelationship SecondaryInsSubscriberLastName SecondaryInsSubscriberFirstName SecondaryInsEmployerName GuarantorLastName MEXICO GuarantorFirstName ENSENADA GuarantorSSN GuarantorRelationship PT GuarantorAddress1 GuarantorCity GuarantorState GuarantorZip GuarantorPhone GuarantorEmployerName GuarantorEmployerPhone IsDNR False Allergy1 Allergy2 Allergy3 Allergy4 HospitalNumber ClinicCode1 ClinicCode2 ClinicCode3 ClinicCode4 AccomodationCode SmokerCode PriorVisitDate

AdmissionClerk PatientAge Occupation MedSvrCode AccidentDate AccidentCode EthnicityCode SpouseName SpousePhone PatientEmployer PatientEmployAddress POACode LivingWillCode NoticeOfPrivacy SuppressRelCensus SuppressRelSWB TreatAuthCode GuarantorEmpAddr GuarantorEmpCity GuarantorEmpSt PrimaryInsPlan ThirdInsCompanyName ThirdInsPlan ThirdInsAddress ThirdInsCity ThirdInsState ThirdInsZip ThirdInsGroupNumber ThirdInsPolicyNumber ThirdInsSubscriberLastName

ThirdInsSubscriberFirstName ThirdInsRelationship EmergencyContactName EmergencyContactRel EmergencyContactPhone EmergencyContactAddress EmergencyContactCity EmergencyContactState EmergencyContactZip AdmitDiagnosis AdmitPhysicianName PrimaryCarePhysician PRIMARY CARE PHYSICIAN NAME BirthPlace