Q 2006 1 PD10 I 00100088 BAPTIST MEDICAL CENTER FALMANN, CAROL (907)555-5555 FALMANN@GBCJAX.COM 8540 CRUDENTIAL DRIVE JACKSONVILLE FL 32205

0000101188 555467122 4 1980-07-02 2 32216 3 1 2005-08-16 2005-08-16 01 F 659.71 665.51 3 648.91 3 V25.2 3 V27.0 3 V02.51 3 2005-08-14 72.79 2005-08-14 75.69 2005-08-14 2005-08-14 72.79 2005-08-14 75.69 2005-08-14 ME79231 ME79231 972 0 0 0 0 1213 1222 1224 0 0 134 1264 0 972 4506 0 0 161 0 0 0 36 11704 1