GAUSAdamEverymanGet Well Clinic1004 Healthcare Dr. practicePortlandOR97005United States1004 Healthcare Dr. practicePortlandOR97005United StatesGet Well Clinic1004 Healthcare Dr. practicePortlandOR97005United States1004 Healthcare Dr. practicePortlandOR97005United StatesGet Well Clinic1004 Healthcare Dr. practicePortlandOR97005United StatesGet Well Clinic1004 Healthcare Dr. practicePortlandOR97005United StatesHenrySeven, M.D.

Reason for Referral	Plan Date	Provider
Pulmonary Function Testing		Penny Puffer, 1047 Healthcare Drive, , Portland, OR, 97005, 555-555-1049
test	4/2/2013	Direct Test , , , , , ,
r		14605 FirstName 14605 LastName, 28217 AddressLine1, 28217 AddressLine2, 28217 City, , 00000, 555-555-7993

Name	Reaction	Notes
codeine sulfate	swelling	active
penicillin G benzathine	hives	active
aspirin	shortness of breath	active

codeine sulfateswellingpenicillin G benzathinehivesaspirinshortness of breath

Planned Activity	Comments	Planned Date	Planned Time	Plan/Goal
Pulmonary Function Testing
test		4/2/2013	4:00 PM
r
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
Chest X-Ray, PA and Lateral Views; Body site: lower respiratory tract structure		1/24/2013	12:00 AM

Pulmonary Function TestingtestrSmoking Cessation PlanSmoking Cessation: GoalWeight Loss PlanWeight Loss: GoalChest X-Ray, PA and Lateral Views; Body site: lower respiratory tract structure

Active
Name	Start Date	Estimated Completion Date	SIG	Comments
Viagra Oral Tablet 50 mg	3/13/2013	4/12/2013	take 2 tablets (100 mg) by oral route once daily as needed approximately 1 hour before sexual activity for 30 days

Expired
Name	Start Date	Expiration Date	SIG	Comments
azithromycin Oral Tablet 500 mg	1/24/2013	2/23/2013	take 1 tablet by oral route daily for 30 days then 250 mg tablet once daily for the next 4 days
albuterol sulfate Inhalation HFA Aerosol Inhaler 90 mcg/actuation	1/1/2013	1/31/2013	inhale 2 puffs by inhalation route every 6 hours as needed for 30 days

take 1 tablet by oral route daily for 30 days then 250 mg tablet once daily for the next 4 daysazithromycinExpired - inhale 2 puffs by inhalation route every 6 hours as needed for 30 daysalbuterol sulfateExpired - take 2 tablets (100 mg) by oral route once daily as needed approximately 1 hour before sexual activity for 30 daysViagra

Name	Date Admin	Mfg Name	Mfg Code	Trade Name	Lot#	Route	Inj	Vis Given	Vis Pub	CVX
Influenza Adult	3/30/2012	Abbott Laboratories	AB	Fluzone	ADV-345	Intramuscular	Left Deltoid	12/27/2012	3/3/2010	88

ADV-3451234 testNorcrossGA30091United StatesMikeHardy1234 testNorcrossGA30091United States

Description	Status	Onset
Asthma	Active	09/25/2011
Essential Hypertension	Active	03/30/2012
Pharyngitis, Acute	Resolved	10/28/2011
Pneumonia	Active	01/24/2013
Acute Bronchitis	Active	03/07/2013
Malignant melanoma of skin; lower limb, including hip	Active	03/07/2013

AsthmaActiveEssential HypertensionActivePharyngitis, AcuteResolvedPneumoniaActiveAcute BronchitisActiveMalignant melanoma of skin; lower limb, including hipActive

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	1:41:00 PM	120 mmHg	75 mmHg				180 lbs	70 in	25.827 kg/m²	2.0081 m²
3/30/2012	2:29:00 PM	160 mmHg	98 mmHg				195 lbs	70 in	27.9793 kg/m²	2.0901 m²
1/24/2013	1:12:00 PM	120 mmHg	80 mmHg				162 lbs	70 in	23.2443 kg/m²	1.905 m²

Blood Pressure - DiastolicBlood Pressure - SystolicBody Mass IndexHeightWeightBlood Pressure - DiastolicBlood Pressure - SystolicBody Mass IndexHeightWeightBlood Pressure - DiastolicBlood Pressure - SystolicBody Mass IndexHeightWeight

Name	Status	Comments
Tobacco	Current

Tobacco

Date Ordered	Description	Order Status	Result Status
3/30/2012 12:00 AM	Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use	Reviewed
1/24/2013 12:00 AM	Chest X-Ray, PA and Lateral Views; Body site: lower respiratory tract structure	Ordered

Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular useChest X-Ray, PA and Lateral Views; Body site: lower respiratory tract structure

Data and Description	Results
1/24/2013 1:12 PM	Hgb Bld-mCnc 15.0 g/dLHct Fr Bld Auto 50.0 %WBC # Bld Auto 6.0 x10E3/uLPlatelet # Bld Auto 300.0 x10E3/uL

13.5 - 1841 - 534.3 - 10.8150 - 400

Functional Condition	Type
No Impairment	Cognitive

No Impairment

Diagnosis	Date
Asthma	01/15/2013
Essential Hypertension	12/27/2012
Pneumonia	01/24/2013