Directive | Description | Verification | Supporting Document(s) |
---|---|---|---|
Resuscitation status | Do not resuscitate | Dr. Patricia Primary, Feb 19, 2011 |
|
Substance | Reaction |
---|---|
Penicillin | Nausea |
Codeine | Wheezing |
Encounter | Performer | Location | Date |
---|---|---|---|
Checkup Examination | Performer Name | Community Urgent Care Center | September 27, 2012 at 1:00pm |
Diagnosis | Age At Onset |
---|---|
Myocardial Infarction (cause of death) | 57 |
Diabetes | 40 |
Functional Category | Effective Dates | Results of Evaluation |
---|---|---|
Functional Assessment | March 11, 2013 | Independent Walking |
ADL/IADL: Bathing | March 11,2013 | Independent |
Vaccine | Date | Status | Series number |
---|---|---|---|
|
Nov 1999 | Completed | N/A |
|
Dec 1998 | Completed | N/A |
|
Dec 1998 | Completed | N/A |
|
1997 | Refused | N/A |
Hepatitis B | Aug 1, 2013 | Completed | 3rd |
Implants
Cardiac Pacemaker
Upper GI Prosthesis
Upper GI Prosthesis
Medication | Directions | Start Date | Status | Indications | Fill Instructions |
---|---|---|---|---|---|
Proventil 0.09 MG/ACTUAT inhalant solution | 2 puffs q6 hours PRN wheezing | Jan 3, 2011 | Active | Asthma | Generic Substitition Allowed |
Atenolol 25 MG Oral Tablet | 1 every 12 hours Orally | Mar 18, 2012 | Active | Hypertension | -none- |
Payer name | Policy type / Coverage type | Policy ID | Covered party ID | Policy Holder |
---|---|---|---|---|
Good Health Insurance | Extended healthcare / Family | Contract Number | 1138345 | Patient's Mother |
Planned Care | Start Date | Patient Provider Rating | Provider Provider Rating | Provider | Patient Support/Caregiver |
---|---|---|---|---|---|
Procedure: Colonoscopy | June 15, 2013 | 1st, Medium | 3rd, Medium | Caregiver: Mother | |
Medication: Heparin 0.25 ml pre-filled syringe | July 12, 2013 | First, Medium | Third, Medium | Caregiver: Mother |
Procedure | Date |
---|---|
Colonic polypectomy | 1998 |
Result Type | Result Value | Relevant Reference Range | Interpretation | Date |
---|---|---|---|---|
Hemoglobin | 13.2 g/dL | Normal range for women is 12.0 to 15.5 grams per deciliter | Normal | 03/19/2008 |
Leukocytes | 6.7 10*9/L | Normal white blood cell count range 3.5-10.5 billion cells/L | Normal | 03/19/2008 |
Platelets | 123 10*9/L | Normal white blood cell count range 3.5-10.5 billion cells/L | Low | 03/19/2008 |
Hematocrit | 35.3 % | Normal hematocrit range for female: 34.9-44.5 percent | Normal | 03/19/2008 |
Erythrocytes | 4.21 10*12/L | Normal red blood cell count range 3.90-5.03 trillion cells/L | Normal | 03/19/2008 |
Urea nitrogen, Serum | Pending | Pending | Pending | March 20, 2008 |
Social History Observation | Description | Dates Observed |
---|---|---|
Current Smoking Status | Former smoker | September 10, 2012 |
Tobacco Use | Moderate cigarette smoker, 10-19/day | February, 2009 - February, 2011 |
Alcoholic drinks per day | 12 | Since February, 2012 |
Date / Time: | Sept 10, 2012 | Sept 1, 2011 |
---|---|---|
Height | 177 cm | 177 cm |
Weight | 86 kg | 88 kg |
Blood Pressure | 132/88 | 128/80 |