There was a medical emergency Philadelphia

Firstly, what is your ticket number?
Thanks. What date did you receive the ticket?
What time did you receive the ticket (Include AM/PM)?
Who was the person you were taking to the hospital? Leave blank if it was yourself.
What was the medical emergency?
What is the name of the hospital/doctor's office where you were fined?
What is the address of the above location?
What is the postal code of that location?
Ok, what is your full name?
Finally, what is your email?

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