MU2 Export Summary 123 Anytime Test Road Wheeling IL 60090 US Another ClinicalSummary 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 and preop clearence 1/29/2013 Penny Puffer, 1047 Healthcare Drive, , Portland, OR, 97005, 555-555-1049
Allergies and Adverse Reactions
Name Reaction Notes
aspirin hives severe
Piggyback Pump Set Breaks out in pork chops usually baked
hives Breaks out in pork chops
Plan of Treatment
Planned Activity Comments Planned Date Planned Time Plan/Goal
pulmonary function and preop clearence 1/29/2013 4:00 PM
Smoking Cessation Plan 1/21/2013 4:11 PM Resources and instructions provided during visit
Blood Pressure Management Plan 1/21/2013 4:11 PM Advised patient to adopt DASH diet.
Asthma Plan 1/21/2013 4:11 PM resources/instructions provided during visit
Arthritis panel 1/21/2013 12:00 AM
pulmonary function and preop clearence Smoking Cessation Plan Blood Pressure Management Plan Asthma Plan Arthritis panel
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 at least 15 minutes before exertion for 30 days
ketorolac Injection Cartridge 30 mg/mL 4/18/2013 4/24/2013 inject 1 milliliter (30 mg) by intramuscular route every 6 hours as needed for up to 5 days total use for 6 days
inhale 2 puffs by inhalation route at least 15 minutes before exertion for 30 days Proventil HFA Expired - inject 1 milliliter (30 mg) by intramuscular route every 6 hours as needed for up to 5 days total use for 6 days ketorolac Expired -
History Of Immunizations
Name Date Admin Mfg Name Mfg Code Trade Name Lot# Route Inj Vis Given Vis Pub CVX
MMR 1/21/2013 Osaka University (Biken) JPN GARDASIL wewreq5555 Intramuscular Left Thigh 1/21/2013 1/7/1998 998
Influenza Adult 1/21/2013 Acambis, Inc ACA Fluzone r354gbdds Intravenous Right Thigh 1/21/2013 1/19/1961 88
wewreq5555 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States r354gbdds 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States
Problem List
Description Status Onset
Acute Pharyngitis Active 12/17/1996
Atrial Fibrillation Active 08/12/1998
Flu like illness Active 01/18/2013
Acute Pharyngitis Active Atrial Fibrillation 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(%)
1/21/2013 4:00:00 PM 120 mmHg 88 mmHg 149.914 lbs 30.315 in 114.691 kg/m² 1.206 m²
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
1/21/2013 12:00 AM Arthritis panel Pending
1/21/2013 12:00 AM Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) Reviewed
2/4/2013 12:00 AM Cervical biopsy/local excision of lesion Scheduled
2/4/2013 12:00 AM Nipple/areola reconstruction Scheduled
1/21/2013 12:00 AM Bone Density (Age Study) Reviewed
1/28/2013 12:00 AM Barium enema Scheduled
1/21/2013 12:00 AM Chest X-Ray, PA and Lateral Views Reviewed
1/21/2013 12:00 AM Influenza virus vaccine, split virus, preservative free, for intramuscular use Reviewed
1/21/2013 12:00 AM Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use Reviewed
Arthritis panel Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) Cervical biopsy/local excision of lesion Nipple/areola reconstruction Bone Density (Age Study) Barium enema Chest X-Ray, PA and Lateral Views Influenza virus vaccine, split virus, preservative free, for intramuscular use Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
Results Summary
Data and Description Results
1/21/2013 4:12 PM Hgb Bld-mCnc 13.40 g/dL Hct Fr Bld Auto 46.0 % WBC # Bld Auto 12.50 x10E3/uL Platelet # Bld Auto 296.0 x10E3/uL
Functional Status Assessment
Functional Condition Type
No Impairment Cognitive
Has no phyical impairment Functional
No Impairment Has no phyical impairment