Patient data
Patient ID 99990000999 Name Patient 4 name Sex Female DOB Nov. 19, 1932

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Basic Patient Data
Recorded by Physician 3 name @ Facility Test Clinic 1 [JPN999999900099]
Date recorded 02-09-2002 @ Department
Patient ID 0009999999
Name
Patient 4 name
Date of birth 11-19-1932
Sex Female
Address
________________, Miyazaki-ken
Postal code
Telephone No.
Area code - Tel. No. A - Tel. No. B ( )