Personal health record / My profile
Mary Johnson
Your information, ready when you need it.
Mary JohnsonMJ
About you
Your core identity and contact information.
PrefixNot provided
First nameMary
Middle nameNot provided
Last nameJohnson
SuffixNot provided
Former or maiden nameNot provided
Preferred nameMary
Date of birthMay 14, 1985
SexFemale
Mobile phone(555) 014-8821
Emailmary.johnson@example.test
Home address125 Palm Avenue, Boynton Beach, FL 33437
Emergency access
The people and services to contact when it matters.
Primary emergency contactJames Johnson · Spouse
(555) 014-2290
(555) 014-2290
Local services911 · Police · Fire · Ambulance
Preferred hospitalSt. Mary's Medical Center
Application information
Details you may need when completing insurance, Medicaid, Medicare, or provider forms.
Private application details
These details are kept separate from routine provider sharing. You choose what to include when completing or sharing an application.
These details are kept separate from routine provider sharing. You choose what to include when completing or sharing an application.
Driver license / state IDFlorida · ••••••4821
Citizenship / residencyU.S. citizen
Household statusMarried
Household members2 adults · 1 child
EmployerPrivate employer
Preferred languageEnglish
🔒 Sensitive identifiers are masked
Health summary
The essentials providers may need to know.
Primary care providerDr. Elena Ruiz · Harbor Family Medicine
Medications1 active medication
AllergiesNo known allergies recorded
ImmunizationsReview immunization history
Important preferences
Choices that help others support you.
Preferred pharmacyPublix Pharmacy · Boynton Beach
Advance directivesNot added yet
CommunicationText message preferred