Hospital Registration
| Date: | December 5, 1995 |
| Pages: | 1 |
-OP REGISTRATION
[This is a barely legible hospital form from 12/5/95.]
Name: MCPHERSON LISA
Prior Stay: 405-01-0149
Patient's Legal Address: [crossed out: "999 Homeless"] 901 Osceola Ave Apt 205
Tele 813 999-9999
Patient's Employer: AMC Publishing
Employer Address: Clearwater
Responsible Party: MCPHERSON LISA
Responsible Party's Address: 999 HOMELESS
Tele: 813 999-9999
Tele: 445 1269
Occurrence: 12-05-95
Notify in Emergency: JOHNSON JANIS
Home Tele: 813 XXX-XXXX
How Patient Arrived: AMB FRIEND
Complaint: Evaluation
Accident: Date: 12-05-05
Onset of Illness: Date: 12-05-95
Attending Physician: NILES D J