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Patient Signature Date,Patient FeeSchedule From Date,Patient FeeSchedule To Date,Patient Account Number,Patient Age,Patient Age Groups,Patient Characteristic,Patient Deceased,Patient Date of Birth,Patient Demographic Pharmacy IsPrimary,Patient Demographic Don't Send Statement,Patient Exact Age,Patient FeeSchedule Name,Patient Employer Name,Patient Employer Address,Patient Employer Address 2,Patient Employer City,Patient Employer State,Patient Employer Zipcode,Patient Employer Phone Number,Patient Ethnicity,Patient Gender,Patient Language,Patient Misc Info,Patient Misc Value,Patient MRN,Patient Name,Patient First Name,Patient Last Name,Patient Middle Initial,Patient Full Name (First Name First),Patient Full Address,Patient Address Line1,Patient Address Line2,Patient City,Patient State,Patient Zip Code,Patient Phone Number,Patient Work Phone Number,Patient Cell Number,Patient Email,Patient SSN,Patient Primary Pharmacy Name,Patient Race,Patient Release of Information,Patient Status,Patient Student Status,Primary Service Location,Responsible Party Account Number,Responsible Party Date of Birth,Responsible Party Employer Name,Responsible Party Name,Responsible Party Full Address,Responsible Party Address Line1,Responsible Party Address Line2,Responsible Party City,Responsible Party State,Responsible Party Zip Code,Responsible Party Phone Number,Responsible Party SSN,Web Enabled,Patient Demographic Primary Pharmacy ID,Patient ID,Primary Service Location ID
,,,,4,Under 18 Yrs,,No,4/25/2017,No,Yes,4 Years 07 Months 11 Days,,n/a,,,,,,,,female,,,,,"Hartsell, Sharon ",Sharon,Hartsell,,Sharon Hartsell,"7012 Trimble Drive Fort Worth TX, 76134",7012 Trimble Drive,,Fort Worth,TX,76134,817-293-8104,000-000-0000,817-480-3872,shartsell@sbcglobal.net,,,,Yes,Active,,,,,,,,,,,,,,,No,,79485,