Lippincott Williams & Wilkins
Patient Name Hospital # Age D.O.B. Provider Name of Insurance Admit Date Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ICD ... ................
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