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Screening ID:
100001 |
Randomization ID:
123456 |
Accession ID:
888888 |
Initials:
AAA |
DOB:
12-Nov-1973 |
Gender:
Male |
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Mailing Address:
1234 Main Street, New Hope, MN 55428-3623 |
Phone:
763-404-1443 |
Fax:
763-553-9796 |
Email:
abccompany@somewhere.com |
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Name: James Mills |
Mailing Address:
111 Somewhere Ave, New York, NY 12345 |
Phone:
555-555-5678 |
Fax:
555-555-2323 |
Email:
jamesmills@monitor.com |
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