Patient Information

Name:

Demo Patient

Address:

444 MONTGOMERY ST
CHICOPEE, MA 01020

Phone (H):

413-598-9999

Medical InformationEdit

Conditions:

H1n1 Influenza

Medications:

ASPIRIN 325 MG OR TABS, AMOXIL 500 MG OR TABS

Allergies:

Fish

Note:

Medical information may have been changed by patient.

ContactsEdit

PCP:

James R. Schumacher, MD
413-598-9999

Insurance InformationEdit

Payor:

Medicare

Plan:

Medicare Supp 80/20

Member ID:

123456789A

Subscriber:

Demo Patient