extract the information in bullet form Patient Name: Date Collected: Accession Number: NAME_1 12/30/2022 R22-069779 DOB: Date Received: Requesting Facility: 05/31/1987 (35) 12/31/2022 NAME_2 Family Medicine Gender: Date Reported: Requesting Physician: CLIA#: 44D2111056 Male 01/03/2023 NAME_3 Lab Director: NAME_4 ICD Code(s): Collection Time: U07.1 11:00AM Status: Final