09/10/2026 · Scheduled Dental Intake
Dental Assistant · Demo Student · Signed
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Ellis, JordanDOB 07/09/1968 · 58 yearsPatient ID 0043 · Sample patient
Allergy: PenicillinHives · Reviewed 09/10/2026
Demographics
- Name
- Ellis, Jordan
- Date of Birth
- 07/09/1968
- Age
- 58 years
- Sex
- Male
- Patient ID
- 0043
Clinical Information
Previous ankle sprain; patient reports ongoing stiffness with activity.
Medication reconciliation pending instructor review.
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