| Patient | Delphine Burwell |
| Date of birth | July 8, 1993 |
| Sex | Female |
| Race | |
| Ethnicity | |
| Contact info | Primary Home: 6415 Ravenhollow Court FITCHBURG, WI 53593, USA Tel: +1-410-377-2787 |
| Patient IDs | IDC2210008 1.2.840.114350.1.13.5325.1.7.3.688884.100 555-55-5555 2.16.840.1.113883.4.1 |
| Document Id | c412dec8-bd81-11e6-8704-d2068206269d 1.2.840.114350.1.13.5325.1.7.1.1 |
| Document Created: | December 8, 2016, 14:06:11, CST |
| Performer (primary care physician) |
| Author | Epic - Version 8.4 |
| Contact info |
| Document maintained by | Current Stage 1 Primary <b> |
| Contact info | 124 Ok Corral Avenue Suite 1704B 250 snakes on a plane 4th Line MADISON, WI 53719, USA Tel: +1-608-771-0280 |
| Focus: Care Coordination |
| Nature: Integrated |
| Setting: Personal |
| From 1996 to present |
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| Focus: Condition |
| Nature: Clinical |
| Setting: Specialty |
| From October 1, 2016 to present |
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