Luis MendezLuis Mendez ♂ CGP2025-7

Age: 25 Birthdate: 02/01/2000

Allergies: No Known Allergies/NKA

Admission: 10/22/2025 (15) Care Team

Clinical LOC: Detox (17)

Location:

Coral Gables Programs
(GMT-05:00) Eastern Time (US & Canada)

F11.14 Opioid abuse with opioid-induced mood disorder

Date 1^st contact

Rep on intake call

1^st contact name

1^st contact phone

1^st contact relationship

02/06/2025

Pablo Martinez

n/a

n/a

n/a

CID:

Location: Coral Gables Programs

Hx

Program: n/a

Hx

Admission Date Hx 10/22/2025 08:40 AM	Referrer	Contact? No	Anticipated Discharge Date Hx
Discharge/Transition Date Hx	Discharge/Transition to

PATIENT INFORMATION HAS NOT BEEN VALIDATED - PLEASE VALIDATE

Patient Information

Luis Mendez

Current Address:
123 Easy Street
Miami, FL 33134 United States

Email: kipu.pgm+9871654981@gmail.com
Portal Account Email: kipu.pgm+9871654981@gmail.com

Date of Birth: 02/01/2000 SSN:

Birth Sex: Male

Pronouns:

Preferred Language:

Marital Status:

Sobriety date: n/a

Hx

Race:
Ethnicity:

Payment Method

Private Pay

created at 09/30/2025 01:20 PM by Pablo Martinez
last updated at 10/22/2025 08:40 AM by Pablo Martinez

Insurance Information

Contacts

Allergies and Food Restrictions

Allergies

No Known Allergies/NKA

Diets

Regular Diet

External Apps

External App Name	Unique Patient ID	Action

Lab Testing

Lab Bill To

Lab Guarantor Type

Lab Guarantor

Lab Guardian

Lab Patient Class

Unassigned

Unassigned

Unassigned

Unassigned

Not Applicable

Lab Primary Insurance

Lab Secondary Insurance

Unassigned

Unassigned

Hx

Patient Record Source: 09/30/2025 01:20 PM: Readmit: 3839: CGP2025-4: Coral Gables Programs: Pre-Admission: Coral Gables Programs: : : Pablo Martinez

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