MU2 Export Summary 1234 Test Covington GA 300147 US Data 6 Export6 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 Karen Kidder, M.D.
Reason for Referral Not available.
Allergies and Adverse Reactions
Name Reaction Notes
penicillin G benzathine hives
hives
Plan of Treatment Not available.
Medications
Expired
Name Start Date Expiration Date SIG Comments
Proventil HFA Inhalation HFA Aerosol Inhaler 90 mcg/actuation 1/21/2013 2/20/2013 inhale 2 puffs by inhalation route 4 times a day for 30 days prn wheezing
Tamiflu Oral Capsule 30 mg 1/21/2013 1/31/2013 take 1 capsule by oral route 2 times a day for 10 days until gone
inhale 2 puffs by inhalation route 4 times a day for 30 days prn wheezing Proventil HFA Expired - take 1 capsule by oral route 2 times a day for 10 days until gone Tamiflu Expired -
History Of Immunizations
Name Date Admin Mfg Name Mfg Code Trade Name Lot# Route Inj Vis Given Vis Pub CVX
MMR 3/12/2011 Acambis, Inc ACA MMR II ABN 9876 Intramuscular Left Vastus Lateralis 1/21/2013 3/3/2009 03
ABN 9876 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States
Problem List
Description Status Onset
Asthma Active 03/12/2011
Flu like illness Active
Asthma Active Flu like illness 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(%)
4/15/2010 9:38:00 AM 90 mmHg 60 mmHg 125 lbs 60 in 24.4121 kg/m² 1.5493 m² 97.4 %
3/12/2011 9:45:00 AM 89 mmHg 62 mmHg 145 lbs 62 in 26.5206 kg/m² 1.6962 m² 97.9 %
1/21/2013 10:12:00 AM 130 mmHg 86 mmHg 162 lbs 64 in 27.807 kg/m² 1.8216 m² 97.2 %
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 Never
Tobacco
History of Procedures
Date Ordered Description Order Status Result Status
3/12/2011 12:00 AM Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use Reviewed
Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
Results Summary
Data and Description Results
1/21/2013 10:16 AM Hgb Bld-mCnc 13.50 g/dL Hct Fr Bld Auto 46.50 % 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