MU2 Export Summary 123 Test Ave Norcross GA 30091 US Three 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 James Ingram, M.D. Henry Seven, M.D. Penny Puffer, M.D.
Reason for Referral
Reason for Referral Plan Date Provider
For colonscopy and hemorrhoidectomy 1/29/2013 Penny Puffer, 1047 Healthcare Drive, , Portland, OR, 97005, 555-555-1049
Allergies and Adverse Reactions
Name Reaction Notes
penicillin G benzathine rash severe reation
rash
Plan of Treatment
Planned Activity Comments Planned Date Planned Time Plan/Goal
For colonscopy and hemorrhoidectomy 1/29/2013 4:00 PM
Smoking Cessation Plan 1/22/2013 8:58 AM Resources and instructions provided during visit
Smoking Cessation: Goal 1/22/2013 8:58 AM Quit smoking
Weight Loss Plan 1/22/2013 8:58 AM Resources and instructions provided during visit.
Weight Loss: Goal 1/22/2013 8:58 AM BMI < 25
Blood Pressure Management Plan 1/22/2013 8:58 AM Advised patient to avoid supplemental salt.
Blood Pressure Management: Goal 1/22/2013 8:58 AM No longer hypertensive
Arthritis panel 1/22/2013 12:00 AM
Urinalysis (Dipstick, with microscopy) 1/22/2013 12:00 AM
Lipid panel 3/20/2013 12:00 AM
Lipid panel 3/20/2013 12:00 AM
For colonscopy and hemorrhoidectomy Smoking Cessation Plan Smoking Cessation: Goal Weight Loss Plan Weight Loss: Goal Blood Pressure Management Plan Blood Pressure Management: Goal Arthritis panel Urinalysis (Dipstick, with microscopy) Lipid panel Lipid panel
Medications
Active
Name Start Date Estimated Completion Date SIG Comments
Dilaudid Oral Tablet 2 mg take 1 tablet (2 mg) by oral route every 6 hours as needed
Demerol Injection Solution 50 mg/mL inject 1 milliliter now in offce
Expired
Name Start Date Expiration Date SIG Comments
Anusol-HC Rectal Suppository 25 mg 1/22/2013 1/29/2013 insert 1 suppository (25 mg) by rectal route 3 times per day for 7 days
Lortab Oral Tablet 10-500 mg 1/22/2013 2/1/2013 take 1 tablet by oral route every 4-6 hours as needed for pain for 10 days
take 1 tablet (2 mg) by oral route every 6 hours as needed Dilaudid inject 1 milliliter now in offce Demerol insert 1 suppository (25 mg) by rectal route 3 times per day for 7 days Anusol-HC Expired - take 1 tablet by oral route every 4-6 hours as needed for pain for 10 days Lortab Expired -
History Of Immunizations
Name Date Admin Mfg Name Mfg Code Trade Name Lot# Route Inj Vis Given Vis Pub CVX
Influenza Adult 1/22/2013 Abbott Laboratories AB Flulaval werwer444 Intramuscular Left Gluteous Medius 1/22/2013 1/18/2007 88
werwer444 1234 test Norcross GA 30091 United States Mike Hardy 1234 test Norcross GA 30091 United States
Problem List
Description Status Onset
Essential hypertension Active 11/24/1999
Coronary arteriosclerosis Active 03/14/2004
Cardiovascular Disease Active 01/22/1999
Anal Spasm Active 06/21/1964
Essential hypertension Active Coronary arteriosclerosis Active Cardiovascular Disease Active Anal Spasm 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(%)
1/22/2013 9:00:00 AM 120 mmHg 86 mmHg 88 bpm 22 rpm 37 C 145.505 lbs 48.032 in 44.3429 kg/m² 1.4956 m²
Blood Pressure - Diastolic Blood Pressure - Systolic Body Mass Index Heart Rate Height Respiratory Rate Temperature Weight
Social History
Name Status Comments
Tobacco Heavy 1 ppd for 30 years
Tobacco
History of Procedures
Date Ordered Description Order Status Result Status
1/22/2013 12:00 AM Arthritis panel Pending
1/22/2013 12:00 AM Urinalysis (Dipstick, with microscopy) Reviewed
1/22/2013 12:00 AM Breast Aspiration Reviewed
1/22/2013 12:00 AM Incision of thrombosed external hemorrhoid Reviewed
2/5/2013 12:00 AM Barium enema Scheduled
2/5/2013 12:00 AM Chest X-Ray, PA and Lateral Views Scheduled
2/5/2013 12:00 AM MRI of abdomen (with contrast) Scheduled
1/22/2013 12:00 AM Varicella-zoster immune globulin, human, for intramuscular use Ordered
1/22/2013 12:00 AM Influenza virus vaccine, split virus, preservative free, for intramuscular use Ordered
2/5/2013 12:00 AM DNA PROBE: other infectious agent Scheduled
2/5/2013 12:00 AM Obstetric panel Scheduled
2/12/2013 12:00 AM Correction of inverted nipples Pending
2/12/2013 12:00 AM Sigmoidoscopy, flexible; diagnostic Pending
3/20/2013 12:00 AM Lipid panel Ordered
3/20/2013 12:00 AM Lipid panel Ordered
Arthritis panel Urinalysis (Dipstick, with microscopy) Breast Aspiration Incision of thrombosed external hemorrhoid Barium enema Chest X-Ray, PA and Lateral Views MRI of abdomen (with contrast) Varicella-zoster immune globulin, human, for intramuscular use Influenza virus vaccine, split virus, preservative free, for intramuscular use DNA PROBE: other infectious agent Obstetric panel Correction of inverted nipples Sigmoidoscopy, flexible; diagnostic Lipid panel Lipid panel
Results Summary
Data and Description Results
1/22/2013 8:59 AM Hgb Bld-mCnc 12.60 g/dL Hct Fr Bld Auto 44.50 % WBC # Bld Auto 12.80 x10E3/uL Platelet # Bld Auto 394.0 x10E3/uL
1/22/2013 8:59 AM Cholest SerPl-mCnc 299.0 mg/dL HDLc SerPl-mCnc 18.0 mg/dL LDLc SerPl-mCnc 189.0 mg/dL PreB-LP SerPl-mCnc 35.0 mg/dL Trigl SerPl-mCnc 5000.0 mg/dL CRP SerPl High Sens-mCnc 1.80 mg/L
Functional Status Assessment
Functional Condition Type
Memory Impairment Cognitive
Has significant physical impairment Functional
Memory Impairment Has significant physical impairment