Central Cancer Registry Reporting Content IG
2.0.0-ballot - STU 2 Ballot

Central Cancer Registry Reporting Content IG - Downloaded Version 2.0.0-ballot See the Directory of published versions

## Example Patient: Central Cancer Registry Reporting Patient - Example

Page standards status: Informative

Profile: Central Cancer Registry Reporting Patient

Patient: Amy V. Baxter (formerly Amy V. Shaw)

Identifiers:

- Medical Record Number: 1032702 (system: http://CancerOrg.smarthealthit.org)
- Social Security Number: 11-222-3333

Active: true

Gender: female

Birth Date: 1987-02-20

Marital Status: Never Married

Race: White, American Indian or Alaska Native (Shoshone), Asian (Filipino)

Ethnicity: Hispanic or Latino (Mexican, Dominican)

Birthplace: Georgia, US

Addresses:

- 49 Meadow St, Mounds, OK 74047, US (2016-12-06 to 2020-07-22)
- 183 Mountain View St, Mounds, OK 74048, US (2020-07-22 to present)

Telecom:

- Phone: 555-555-5555 (home)
- Email: amy.shaw@example.com

Languages: English

Managing Organization: Cancer Organization (Organization/example-cancer-org)