1) Date of birth a) 15 March 1962 b) Canada c) Mr d) American e) 07823 786 345 f) Tom Banks 2) Country of birth a) Mexican b) Mexico c) Mr d) Canadian e) 07823 786 345 f) Tom Banks 3) Title a) 15 March 1962 b) Canada c) Mr d) friend e) 07823 786 345 f) Tom Banks 4) Full name a) 15 March 1962 b) Canada c) Mr d) Canadian e) 07823 786 345 f) Tom Banks 5) Cell number a) 15 March 1962 b) Canada c) Mr d) 4789 0111 3434 8574 e) 778-555-1234 f) Tom Banks 6) Nationality a) 15 March 1962 b) Canada c) Mr d) Canadian e) 07823 786 345 f) Tom Banks 7) Emergency Contact a) Annie Banks b) Mexican c) 07823 786 345 d) Canada e) Burnaby f) hospital 8) Sex a) boy b) man c) male d) my friend e) neighbour f) husband 9) Reason for visit a) Tom Banks b) Canada c) medicine d) headache e) pharmacy f) walk-in clinic 10) Medical History a) diabetes b) medicine c) Mexico d) Tom Banks e) pharmacy f) Canada

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