E de la Instituci n donde ocurri el evento DD Fecha de nacimiento del paciente Edad del paciente en el momento del EA Edad Correo electr nico institucional del reportante primario Profesi n del reportante primario 2. MM P gina 1 de 3 INFORMACI N DEL REPORTANTE Origen del reporte Departamento Municipio Nombre del Reportante primario AAAA Fecha de Emisi n: 2025-02-20 A os/Meses/ d as INFORMACI N DEL PACIENTE Documento de identificaci n del paciente CC TI RC NUIP.

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