NAMe
address
'SEX M/F
WARD
TIME
AM
DA7Z
HOSP.
NO.
SUR-
NAME
8303207 I
* PORE-3 u^t
_^ _
'
'jlCfWfH
SEX M/F
? WARD
A
TIME *“
DATĘ
r c.
U\G.
V. V.