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Alex
Patient ID: A6294
Personal Information
Date of Birth
May 15, 1985
Phone
(555) 123-4567
alex@example.com
Address
123 Health Street, Medical City, MC 12345
Insurance Information
BlueCross BlueShield
ActivePolicy #: BCBS-12345678
Group #: 987654
Coverage: 01/01/2025 - 12/31/2025