1. INSTITUTION: Bedlam Hospital
2. LAST NAME/FIRST NAME/MIDDLE INITIAL: Giravivna, Vesna
3. SEX: Female
4. RELIGION: Based on indicators upon arrival, Judaism
5. MARITAL STATUS: Not Available, presumed Single
6. AGE AT ADMISSION: 24, Est.
7. LEGAL STATUS AT ADMISSION: Involuntary
8. LOCATION FROM WHICH ADMITTED: Odessa, Ukraine
9. EDUCATION: Secondary School
10. USUAL OCCUPATION: Artist, Formally Unemployed
11. ESTABLISHED DIAGNOSIS, MENTAL DISORDER: Suffers from Dissociative Fugue Disorder
12. ESTABLISHED DIAGNOSIS, OTHER CONDITIONS: Severe stress following fugue state, propensity to wander
13. WARD: 1
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