MU2 Export Summary 123 test Carrollton GA 30117 US Data 5 Export5 Get Well Clinic 1004 Healthcare Dr. practice Portland OR 97005 United States 1004 Healthcare Dr. practice Portland OR 97005 United States Get Well Clinic 1004 Healthcare Dr. practice Portland OR 97005 United States Get Well Clinic 1004 Healthcare Dr. practice Portland OR 97005 United States Henry Seven, M.D.
Reason for Referral
Reason for Referral Plan Date Provider
Pulmonary Function Test 1/28/2013 Penny Puffer, 1047 Healthcare Drive, , Portland, OR, 97005, 555-555-1049
Allergies and Adverse Reactions
Name Reaction Notes
penicillin G benzathine rash
aspirin hives
codeine sulfate nasea
rash hives nasea
Plan of Treatment
Planned Activity Comments Planned Date Planned Time Plan/Goal
Pulmonary Function Test 1/28/2013 4:00 PM
Smoking Cessation Plan 3/30/2012 12:00 AM Resources and instructions provided during visit
Smoking Cessation: Goal 3/30/2012 12:00 AM Quit smoking
Weight Loss Plan 3/30/2012 12:00 AM Resources and instructions provided during visit.
Weight Loss: Goal 3/30/2012 12:00 AM BMI < 25
Pulmonary Function Test Smoking Cessation Plan Smoking Cessation: Goal Weight Loss Plan Weight Loss: Goal
Medications
Expired
Name Start Date Expiration Date SIG Comments
azithromycin Oral Tablet 250 mg 1/21/2013 1/26/2013 take 2 tablets (500 mg) by oral route once daily for 1 day then 1 tablet (250 mg) by oral route once daily for 4 days
albuterol sulfate Inhalation HFA Aerosol Inhaler 90 mcg/actuation 1/21/2013 2/20/2013 inhale 1 puff by inhalation route every 6 hours for 30 days for wheezing
take 2 tablets (500 mg) by oral route once daily for 1 day then 1 tablet (250 mg) by oral route once daily for 4 days azithromycin Expired - inhale 1 puff by inhalation route every 6 hours for 30 days for wheezing albuterol sulfate Expired -
History Of Immunizations
Name Date Admin Mfg Name Mfg Code Trade Name Lot# Route Inj Vis Given Vis Pub CVX
Influenza Adult 3/30/2012 Akorn AKR Fluzone AGN 1234 Intramuscular Left Arm 1/21/2013 3/9/2005 88
AGN 1234 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States
Problem List
Description Status Onset
Asthma Active 092511
Essential hypertension Active 03/30/2012
Acute Pharyngitis Resolved 10/28/2011
Pneumonia Active 01/21/2013
Asthma Active Essential hypertension Active Acute Pharyngitis Resolved Pneumonia Active
Vital Signs
Date Time BP-Sys(mm[Hg] BP-Dia(mm[Hg]) HR(bpm) RR(rpm) Temp WT HT BMI BSA BMI Percentile O2 Sat(%)
9/25/2011 9:09:00 AM 120 mmHg 75 mmHg 180 lbs 70 in 25.827 kg/m² 2.0081 m²
3/30/2012 9:14:00 AM 160 mmHg 98 mmHg 195 lbs 70 in 27.9793 kg/m² 2.0901 m²
1/21/2013 9:28:00 AM 130 mmHg 84 mmHg 162 lbs 70 in 23.2443 kg/m² 1.905 m²
Blood Pressure - Diastolic Blood Pressure - Systolic Body Mass Index Height Weight Blood Pressure - Diastolic Blood Pressure - Systolic Body Mass Index Height Weight Blood Pressure - Diastolic Blood Pressure - Systolic Body Mass Index Height Weight
Social History
Name Status Comments
Tobacco Current
Tobacco
History of Procedures
Date Ordered Description Order Status Result Status
3/30/2012 12:00 AM Influenza virus vaccine, split virus, preservative free, for intramuscular use Reviewed
1/21/2013 12:00 AM Chest X-Ray, PA and Lateral Views Reviewed
Influenza virus vaccine, split virus, preservative free, for intramuscular use Chest X-Ray, PA and Lateral Views
Results Summary
Data and Description Results
1/21/2013 1:35 PM Hgb Bld-mCnc 13.40 g/dL Hct Fr Bld Auto 51.20 % WBC # Bld Auto 8.90 x10E3/uL Platelet # Bld Auto 246.0 x10E3/uL
Functional Status Assessment
Functional Condition Type
No Impairment Cognitive
Has no phyical impairment Functional
No Impairment Has no phyical impairment