Admitted to: --- |
Date of Injury: --- |
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D.O.B/Age when admitted: --- |
Cause of Incident: --- |
||
Transferred to QVH: --- |
Injuries: --- |
||
No. of Operations at East Grinstead: --- |
IDENTITY CARD
This is to certify that the patient mentioned below and whose description is stated hereon is the authorised holder of this Identity card.
Forename: N. E. |
Surname: Berrington Pickett |
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Service No: --- |
Nationality: South African |
Awards/Honours: --- |
Patient Unit: --- |
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Profession: --- |
Patient Rank: --- |
Death: --- |
Age at Death: --- |
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Dr Rank: |
Dr Unit: |
Notes:
Glossary: