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Primary Recipient: Secondary Recipient: Recipient: Tel Fax Web Mail Home Vacation Home Pirmary Home Work Place Pub {$code=' '?} affiliate agent assigned entity commissioning party contact emergency contact next of kin signing authority guardian guardian citizen covered party {$code=' '?} of ,


code: healthcare service accommodation account accession financial adjudication consent container registration clinical trial timepoint event disciplinary action encounter incident inform invoice element working list monitoring program care provision procedure registration review substance administration speciment treatment substitution transportation verification financial transaction primary performer performer verifier secondary performer admitting physician anesthesist anesthesia nurse attending physician discharging physician first assistant surgeon midwife nurse assistant primary care physician primary surgeon rounding physician second assistant surgeon scrub nurse third assistant January February March April May June July August September October November December , , , : : + - , EST , CST , MST , PST