Get Well Clinic: Health Summary 1357 Amber Drive Beaverton OR 97006 US Isabella Isa Jones 1357 Amber Drive Beaverton OR 97006 US Ralph Jones Beaverton OR 97006 US Get Well Clinic 1002 Healthcare Dr Portland OR 97266 US 1002 Healthcare Drive Portland OR 97266 US Mary McDonald 1002 Healthcare Drive Portland OR 97266 US Henry Seven Frank Jones Get Well Clinic 1002 Healthcare Drive Portland OR 97266 US Henry Seven Get Well Clinic 1357 Amber Drive Beaverton OR 97006 US Mr. Ralph Jones 1357 Amber Drive Beaverton OR 97006 US Mr. Frank Jones Primary Care Provider 1002 Healthcare Dr Portland OR 97266 US Dr. Henry Seven Get Well Clinic 1002 Healthcare Drive Portland OR 97266 US Dr Henry Seven Dr Henry Seven
ALLERGIES, ADVERSE REACTIONS, ALERTS
Substance Reaction Severity Status
Penicillin G benzathine Hives Moderate to severe Inactive
Codeine Shortness of Breath Moderate Active
Aspirin Hives Mild to moderate Active
ENCOUNTERS
Encounter Performer Location Date
Pnuemonia Dr Henry Seven Get Well Clinic 20120806
Outpatient Visit 1002 Healthcare Dr Portland OR 97266 US Get Well Clinic
IMMUNIZATIONS
Vaccine Date Status
Influenza virus vaccine, IM May 2012 Completed
Tetanus and diphtheria toxoids, IM Apr 2012 Completed
Influenza virus vaccine Health LS - Immuno Inc. Possible flu-like symptoms for three days. Tetanus and diphtheria toxoids - preservative free Health LS - Immuno Inc. Possible flu-like symptoms for three days.
Medications
Medication Directions Start Date Status Indications Fill Instructions
Albuterol 0.09 MG/ACTUAT inhalant solution 0.09 MG/ACTUAT inhalant solution, 2 puffs once 20120806 Active Pneumonia (233604007 SNOMED CT) Generic Substitition Allowed
0.09 MG/ACTUAT inhalant solution, 2 puffs Medication Factory Inc. Get Well Clinic Aerosol Medication Factory Inc. 1002 Healthcare Dr Portland OR 97266 US label in spanish Medication Factory Inc.
CARE PLAN
Planned Activity Planned Date
Admit Yourself to Community Health and Hospitals for Pnuemonia 20120806
Admit Yourself to Community Health and Hospitals for Pnuemonia
REASON FOR REFERRAL Recommend Admission to Community Health and Hospitals for Pnuemonia
PROBLEMS Pneumonia : Status - Active Asthma : Status - Active
PROCEDURES
Procedure Date
Chest X-Ray 2012
1002 Healthcare Dr Portland OR 97266 US Get Well Radiology 1002 Healthcare Dr Portland OR 97266 US Get Well Clinic
FUNCTIONAL STATUS
Functional Condition Effective Dates Condition Status
Dependence on cane 2008 Active
Memory impairment 2008 Active
RESULTS
LABORATORY INFORMATION
Chemistries and drug levels
HGB (M 13-18 g/dl; F 12-16 g/dl) 13.2
WBC (4.3-10.8 10+3/ul) 6.7
PLT (135-145 meq/l) 123 (L)
M 13-18 g/dl; F 12-16 g/dl
SOCIAL HISTORY
Social History Element Description Effective Dates
smoking Former Smoker (1 pack per day 20050501 to 20110227
smoking Current Everyday Smoker 2 packs per day 20110227 - today
1 pack per day
VITAL SIGNS
Date / Time: Nov 1, 2011 August 6, 2012
Height 69 inches 69 inches
Weight 189 lbs 194 lbs
Blood Pressure 132/86 mmHg 145/88 mmHg