医療文書の日付編集

Change the dates on this medical claim form to: admission date 2/10/2026 7:21pm, discharge date 5/10/2026 3:00pm, date of surgery 11/10/2026 12:00pm, B/L DJ stending done on 3/10/2026, C/O giddiness on 30/09/2026, H/O B/L DJ stending on 13/9/2026. Keep all other text and details exactly the same.