MU2 Export Summary GA US Maria Hernandez 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 James Getwell M.D. Patricia Primary
Reason for Referral
Reason for Referral Plan Date Provider
Pulmonary Functional test George Lung, 987 Anymed Way, , Portland, OR, 97005, 555-555-1049
Allergies and Adverse Reactions
Name Reaction Notes
penicillin G benzathine Hives Active
codeine sulfate Swelling Active
aspirin Anaphaylaxis active
Hives Swelling Anaphaylaxis
Plan of Treatment
Planned Activity Comments Planned Date Planned Time Plan/Goal
Pulmonary Functional test
Smoking Cessation Plan 9/25/2012 12:00 AM Resources and instructions provided during visit
Smoking Cessation: Goal 9/25/2012 12:00 AM Quit smoking
Weight Loss Plan 9/25/2012 12:00 AM Resources and instructions provided during visit.
Weight Loss: Goal 9/25/2012 12:00 AM BMI < 25
Preventative Health Plan 9/25/2012 12:00 AM Annual pap smear, mammogram, annual breast exam.
Chest X-Ray, PA and Lateral Views 1/24/2013 12:00 AM
Pulmonary Functional test Smoking Cessation Plan Smoking Cessation: Goal Weight Loss Plan Weight Loss: Goal Preventative Health Plan Chest X-Ray, PA and Lateral Views
Medications
Expired
Name Start Date Expiration Date SIG Comments
metoprolol tartrate Oral Tablet 25 mg 1/1/2013 1/31/2013 take 1 tablet (25 mg) by oral route once daily for 30 days
Proventil HFA Inhalation HFA Aerosol Inhaler 90 mcg/actuation 1/1/2013 1/31/2013 inhale 2 puffs by inhalation route every 4 hours as needed for 30 days
azithromycin Oral Tablet 500 mg 1/24/2013 2/23/2013 take 1 tablet by oral route daily for 30 days , then 250 mg once daily for the next 4 days
take 1 tablet (25 mg) by oral route once daily for 30 days metoprolol tartrate Expired - inhale 2 puffs by inhalation route every 4 hours as needed for 30 days Proventil HFA Expired - take 1 tablet by oral route daily for 30 days , then 250 mg once daily for the next 4 days azithromycin Expired -
History Of Immunizations
Name Date Admin Mfg Name Mfg Code Trade Name Lot# Route Inj Vis Given Vis Pub CVX
Influenza Adult 9/25/2012 Abbott Laboratories AB Fluzone v45353534 Intramuscular Left Arm 1/14/2013 9/3/1980 88
v45353534 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States
Problem List
Description Status Onset
Acute Pharyngitis Resolved 10/28/2011
Essential Hypertension Active 09/25/2012
Pneumonia Active 01/24/2013
Asthma Active 1/1/2013
Acute Pharyngitis Resolved Essential Hypertension Active Pneumonia Active Asthma 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(%)
10/28/2011 5:11:00 PM 114 mmHg 76 mmHg 150 lbs 64 in 25.7472 kg/m² 1.7528 m²
9/25/2012 5:18:00 PM 155 mmHg 94 mmHg 155 lbs 64 in 26.6054 kg/m² 1.7818 m²
1/24/2013 12:36:00 PM 120 mmHg 80 mmHg 162 lbs 64 in 27.807 kg/m² 1.8216 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 start 2012
Tobacco
History of Procedures
Date Ordered Description Order Status Result Status
9/25/2012 12:00 AM Influenza virus vaccine Reviewed
1/24/2013 12:00 AM Chest X-Ray, PA and Lateral Views Ordered
Influenza virus vaccine Chest X-Ray, PA and Lateral Views
Results Summary
Data and Description Results
1/24/2013 12:35 PM Hgb Bld-mCnc 13.50 g/dL Hct Fr Bld Auto 42.0 % WBC # Bld Auto 6.0 x10E3/uL Platelet # Bld Auto 265.0 x10E3/uL
13.5 - 18 41 - 53 4.3 - 10.8 150 - 400
Functional Status Assessment
Functional Condition Type
No Impairment Cognitive
No Impairment