1. INSTITUTION: Bedlam Hospital
2. LAST NAME/FIRST NAME/MIDDLE INITIAL:
3. SEX: Van Der Haven, Ambroos
4. RELIGION: Catholic
5. MARITAL STATUS: Single
6. AGE AT ADMISSION: 23
7. LEGAL STATUS AT ADMISSION: Voluntary
8. LOCATION FROM WHICH ADMITTED: Rotterdam, the Netherlands
9. EDUCATION: Several universities
10. USUAL OCCUPATION: Student
11. ESTABLISHED DIAGNOSIS, MENTAL DISORDER: Post Traumatic Stress Disorder
12. ESTABLISHED DIAGNOSIS, OTHER CONDITIONS: Severe phobia of fire, smoke, loud noise, restricted to wheelchair due to loss of left leg above the knee
13. WARD: 1