Patient Profile
Doctor's Information
Jane Doe
Date of Birth: 02/08/2018
Location: 985 Peachtree Ave., Atlanta, GA 30004
Parental Information
Name: Jill Doe
Relation to child: Mother
Email: jilldoe@gmail.com
Phone number: 123-456-7890
Name: John Doe
Relation to child: Father
Email: johndoe@gmail.com
Phone number: 111-222-3333
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Training Sessions
Training 1 Completion:
MEDIUM
speed,
LARGE
size,
BLUE
color,
TRIANGLE
shape
Training 2 Completion:
LOW
speed,
MEDIUM
size,
YELLOW
color,
CIRCLE
shape
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First name
Last name
Date of Birth
Parent 1
Parent 2
Location
Mark Smith
Location: 120 Parkview Dr., Atlanta, GA 30004
Email: drmarksmith@company.com
Phone number: 444-555-6666
Here are your doctor's initial recommendations:
Initial CVI level:
Low
Medium
High
Please review the following initial recommendations I have made.
Speed
Low
Medium
High
Size
Small
Medium
Large
Color
Red
Yellow
Green
Blue
Grayscale
Shape
Square
Triangle
Circle