Medical Information of Jan Jansen

Identification

Surname
Jansen
Given Name(s)
Jan Leo
Date of Birth
2008 januari 1
Place of Birth
Maaskantje
Nationality
Netherlands
Personal Number
012345678
Passport Number
876543210
Gender
Male
Height
1.32 meter
Blood Type
O+

Allergies

None.

Medical Insurance

Company
Volksverzekering
Client Number
123456789
Website
www.volksverzekering.nl

Medication

Medication used by Jan Jansen
NameDoseActive IngredientIndicationProducerRegistration Number
Norit2-6 capsulesActive CarbonDiarrhoeaVemediaRVG 09116 AV
Children Paracetamol1 tablet of 100mgParacetamolFeverCentrafarmRVG 20649=53054

Vaccinations

None.

Medical History

Brain damage. See x-ray image.

General Practitioner

Full Name
Dokter J. Prikkebeen
Phone
+31 xxxxxxxx
E-mail
jp.practice@provider.nl
Address
Parkplein 2, 5588VD Maaskantje
Country
Netherlands

Parent(s)/Legal Guardian

Full Name
Piet Jansen
Relation
Father
Phone
+31 (0)6 xxxxxxxx
+31 (0)46 xxxxxxx
E-mail
pjansen@provider.nl
Address
Molenkamp 13a, 5588PJ Maaskantje
Country
The Netherlands

Full Name
Anna Jansen - Molennaars
Relation
Mother
Phone
+31 (0)6 xxxxxxxx
E-mail
amolennaars@provider.nl
Address
Molenkamp 13a, 5588PJ Maaskantje
Country
The Netherlands

Contact in Case of Emergency

Full Name
Johan Jansen
Relation
Uncle
Phone
+45 xxxxxxxx
E-mail
jjansen@provider.dk
Address
Andersonvej 283, 90000 Aarhus
Country
Denmark