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Patient: Parker Ito 1/4/1992

Mobile: (202) 555-0120 (Voice or Text OK)

Patient Comments: None

Patient Information

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Legal Name:
Parker Ito
Date of Birth:
1/4/1992
Account Number:
DEMO-0011
Address:
100 Sample Ave
Springfield, IL 60000
Time Zone:
CT - Central Time, UTC-6 with DST
Mobile Phone:
(202) 555-0120 (Voice & Text messages OK)
Email:
parker.ito@example.com
Appt Reminders:
Default Practice Setting (Text and Email)
Administrative Sex:
Gender Identity:
Sexual Orientation:
Race:
Ethnicity:
Languages:
Smoking Status:
Marital Status:
Employment:
Religious Affiliation:
HIPAA:
Signed HIPAA NPP on 10/4/2024
Has not signed HIPAA NPP sent on 1/15/2026
PCP Release:
Not set
PAD:

Contacts

Lena Briar · Authorized support contact · (202) 555-0142

Practice contacts