#{messages['net.ihe.gazelle.xdstar.Firstname']}

#{messages['net.ihe.gazelle.xdstar.Middlename']}

#{messages['net.ihe.gazelle.xdstar.Lastname']}

#{messages['net.ihe.gazelle.xdstar.MaidenName_4']} #{messages['net.ihe.gazelle.xdstar.Gender_2']} #{messages['net.ihe.gazelle.xdstar.Birthday']} #{messages['net.ihe.gazelle.xdstar.PatientId_2']} #{messages['net.ihe.gazelle.xdstar.Race']} #{messages['net.ihe.gazelle.xdstar.Religion']}

#{messages['net.ihe.gazelle.xdstar.Country_2']}

#{messages['net.ihe.gazelle.xdstar.State']}

#{messages['net.ihe.gazelle.xdstar.City_2']}

#{messages['net.ihe.gazelle.xdstar.StreetAddress']} #{messages['net.ihe.gazelle.xdstar.Zipcode']} #{messages['net.ihe.gazelle.xdstar.TelephoneNumber']} #{messages['net.ihe.gazelle.xdstar.Email']}