101 Ridge Road Apple Creek , MI 42328 DOS : 1 / 1 / 20XX Private payer ( Medicare rules for 65 and older ) ENCOUNTER INFORMATION Cardiac Catheterization Angiography Report / Diagnostic Report PATIENT INFORMATION Patient : Patient ID : 527XXXX Study Date : 1 / 1 / 20XX Performing : Referring : Age : 79 Gender : Male Height : 193 cm Account # : 427XXX BSA : 2.10 m2 Weight : 88.9 kg Performing : ANESTHESIA : Conscious Sedation - Time : 30 minutes