20 CAR § 413-315 – Admission and discharge record

(a) Record number.
(b) Date and time of admission.
(c) Name.
(d) Last known address.
(e) Age.
(f) Date of birth.
(g) Sex.
(h) Marital and/or legal status.
(i) Name, address, and telephone number of attending physician and dentist.
(j) Name, address, and telephone number of parent or next of kin, guardian, and individual to be notified in case of accident.
(k) Social Security number.
(l) Medicaid/Medicare number.
(m) Date and time of discharge or death.
(n) Admitting and final diagnosis.