div class=trans-pagebutton class=gotoPage data-page=1Page 1button div class=trans-imageimg data-url=documentchart-id-first-name-patient-is-policy-holder-responsible-party-responsible-partyhtmlpage=1 data-page=1 class=trans-thumb lazyload alt=Page 1: Chart ID First Name: Patient Is: Policy Holder Responsible Party Responsible Party if someone other than the patient PATIENT REGISTRATION Last Name: loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAQAAAC1HAwCAAAAC0lEQVR42mM8Uw8AAh0BTZud3BwAAAAASUVORK5CYII= data-src=https:reader033fdocumentsinreader033viewer20220420175e752930ec4db449c626861fhtml5thumbnails1jpg width=140 height=200 divdiv