| All Visits | Effective Date(s) | Provider | Condition Status |
|---|---|---|---|
| COMN MIGRNE WO NTRC MGRN | 12/02/2002 | David E Ford MD | Active |
| Note: Unchanged - Negative MRI of skull on 2/10/2003 | |||
| Pending Tests | Order | Diagnosis | Results Due | Ordering Provider |
|---|---|---|---|---|
| Lab | Metabolic Panel | 01/03/08 | James T Monroe MD |
| Future Tests | Order | Diagnosis | Results Due | Ordering Provider |
|---|---|---|---|---|
| Radiology - CT Scans | CT SCAN HEAD | COMN MIGRNE WO NTRC MGRN | 01/22/08 | Depak E Shah MD |
| Current Medications (continue as prescribed) | ||
|---|---|---|
| 12 Hour Decongestant 120 MG CP12 | 02/23/2010 | Diagnosis: | Migraine Headache, Unspecified |
| Past Medications on file | ||
|---|---|---|
| 2nd Skin Blister Kit MISC | 01/13/2012 | Diagnosis: | Migraine Headache, Unspecified |
| 12 Hour Nasal Relief Spray 0.05 % SOLN | 01/13/2012 | Diagnosis: | |
| Prasad Schedule 4 Drug TBDR | 02/16/2010 | Diagnosis: | |
| 2 twice a day , Test case 1 directions go here. All information existing. | |||
| 5-Hydroxy-L-Tryptophan POWD | 11/02/2009 | Diagnosis: | Migraine Headache, Unspecified |
| Ginko Biloba 1 Gram CPSP | 01/08/2008 | Diagnosis: | Migraine Headache, Unspecified |
| Take one capsule with tea twice a day by mouth. | |||
| Promethazine HCl 25 MG TABS | 01/08/2008 | Diagnosis: | NAUSEA ALONE |
| Take one tablet by mouth every four to six hours as needed. | |||
| Naproxen Sodium 550 MG TABS | 01/08/2008 | Diagnosis: | COMN MIGRNE WO NTRC MGRN |
| Take one tablet by mouth every six hours as needed. | |||
| Imitrex 25 MG TABS | 01/03/2008 - 01/08/2008 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet by mouth at onset of symptoms. Do not exceed 2 tablets daily. | |||
| Valium 5 MG TABS | 11/02/2007 - 02/01/2007 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet at bedtime. | |||
| Imitrex 25 MG TABS | 11/02/2007 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet as needed fror migraine headache. | |||
| Imitrex 25 MG TABS | 10/05/2007 - 11/02/2007 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet as directed at onset of headache. | |||
| Stress Formula Plus Iron TABS | 10/05/2007 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet once a day by mouth. | |||
| Imitrex 25 MG TABS | 09/03/2007 - 10/05/2007 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet as directed at onset of headache. | |||
| Fiorinal/Codeine #3 50-325-40-30 MG CAPS | 09/03/2007 - 10/05/2007 | Diagnosis: | Migraine Headache, Unspecified |
| 1-2 tabs every 6 hours for pain, not to exceed 6 tablets a day | |||
| Valium 5 MG TABS | 02/01/2007 - 01/08/2008 | Diagnosis: | Migraine Headache, Unspecified |
| Take 1 tablet at bedtime. | |||
| Vital Name | 11/02/2007 10:07A | 10/05/2007 10:06A | 09/03/2007 10:05A |
|---|---|---|---|
| Systolic BP-Sitting (mmHg) | 133 | 131 | 130 |
| Diastolic BP-Sitting (mmHg) | 76 | 75 | 76 |
| Pulse Rate (bpm) | 86 | 82 | 82 |
| Respiration Rate (breaths/min) | 29 | 30 | 30 |
| Temp-Oral (F) | 98.6 | 98.6 | 98.6 |
| Height (in) | 66 | 66 | 66 |
| Weight (lb) | 160 | 160 | 166 |
| Body Mass Index (kg/m2) | 25.8 | 25.8 | 26.8 |
| Body Surface Area (m2) | 1.82 | 1.82 | 1.85 |
| CBC w/ Differential & Platelet | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 01/03/2008 | Collected: 01/03/2008 Reported: 01/03/2008 |
| White Blood Cell (WBC) Count |
|
THOUS/MCL | (3.8-10.8) |
|
|
| Red Blood Cell (RBC) Count |
|
MILL/MCL | (3.80-5.10) |
|
|
| Hemoglobin |
|
G/DL | (11.7-15.5) |
|
|
| Hematocrit |
|
% | (35.0-45.0) |
|
|
| MCV |
|
FL | (.0-100.0) |
|
|
| MCH |
|
PG | (27.0-33.0) |
|
|
| MCHC |
|
G/DL | (32.0-36.0) |
|
|
| Polys |
|
% |
|
||
| Lymphs |
|
% |
|
||
| Monocytes |
|
% |
|
||
| Eos |
|
% |
|
||
| Basos |
|
% |
|
||
| Platelets |
|
THOUS/MCL | (140-400) |
|
|
| Polys (Absolute) |
|
CELLS/MCL | (1500-7800) |
|
|
| Lymphs (Absolute) |
|
CELLS/MCL | (850-3900) |
|
|
| Monocytes(Absolute) |
|
CELLS/MCL | (200-950) |
|
|
| Eos (Absolute Value) |
|
CELLS/MCL | (15-500) |
|
|
| Baso(Absolute) |
|
CELLS/MCL | (0-200) |
|
|
| RDW |
|
% | (11.0-15.0) |
|
|
| Reviewed by David E Ford MD on 01/08/2008; All test results are final unless otherwise noted. | |||||
| CBC WITH DIFFERENTIAL/PLATELET | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 11/02/2007 | Collected: 11/02/2007 Reported: 11/05/2007 |
| White Blood Cell (WBC) Count |
|
X_10-3/uL | (4.0-10.5) |
|
|
| Red Blood Cell (RBC) Count |
|
X_10-6/uL | (3.80-5.10) |
|
|
| Hemoglobin |
|
g/dL | (11.5-15.0) |
|
|
| Hematocrit |
|
% | (34.0-44.0) |
|
|
| MCV |
|
fL | (80-98) |
|
|
| MCH |
|
pg | (27.0-34.0) |
|
|
| MCHC |
|
g/dL | (32.0-36.0) |
|
|
| Polys |
|
% | (40-74) |
|
|
| Lymphs |
|
% | (14-46) |
|
|
| Monocytes |
|
% | (4-13) |
|
|
| Eos |
|
% | (0-7) |
|
|
| Basos |
|
% | (0-3) |
|
|
| Platelets |
|
X_10-3/uL | (140-415) |
|
|
| Hematology Comments: |
|
|
Status: Cannot be done | ||
| Polys (Absolute) |
|
X_10-3/uL | (1.8-7.8) |
|
|
| Lymphs (Absolute) |
|
X_10-3/uL | (0.7-4.5) |
|
|
| Monocytes(Absolute) |
|
X_10-3/uL | (0.1-1.0) |
|
|
| Eos (Absolute Value) |
|
X_10-3/uL | (0.0-0.4) |
|
|
| Baso(Absolute) |
|
X_10-3/uL | (0.0-0.2) |
|
|
| RDW |
|
% | (11.7-15.0) |
|
|
| Reviewed by David E Ford MD on 11/05/2007; All test results are final unless otherwise noted. | |||||
| HFP7+3AC | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 11/02/2007 | Collected: 11/02/2007 Reported: 11/05/2007 |
| Cholesterol, Total |
|
mg/dL | (100-199) |
|
|
| Note: Performed At: MA LABCORP MADISON 1447 YORK COURT MADISON, CA 956530000 | |||||
| Protein, Total, Serum |
|
g/dL | (6.0-8.5) |
|
|
| Albumin, Serum |
|
g/dL | (3.6-4.8) |
|
|
| Bilirubin, Total |
|
mg/dL | (0.1-1.2) |
|
|
| Alkaline Phosphatase, Serum |
|
IU/L | (25-165) |
|
|
| LDH |
|
IU/L | (100-250) |
|
|
| AST (SGOT) |
|
IU/L | (0-40) |
|
|
| Bilirubin, Direct |
|
mg/dL | (0.00-0.40) |
|
|
| ALT (SGPT) |
|
IU/L | (0-40) |
|
|
| GGT |
|
IU/L | (0-60) |
|
|
| Reviewed by David E Ford MD on 11/05/2007; All test results are final unless otherwise noted. | |||||
| THYROID PANEL WITH TSH | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 10/05/2007 | Collected: 10/05/2007 Reported: 10/08/2007 |
| Thyroxine (T4) |
|
mcg/dL | (4.5-12.0) |
|
|
| Note: ***EFFECTIVE NOVEMBER 26, 2001 The reference interval*** will be changing to: Male Female Cord Blood 6.6-17.5 6.6-17.5 1- 3 Days 11.0-21.5 11.0-21.5 1- 4 Weeks 8.2-16.6 8.2-16.6 1- 11 Months 6.4-13.9 4.9-13.7 1- 3 Years 7.0-13.1 7.1-14.1 4- 6 Years 6.1-12.6 7.2-14.0 7- 12 Years 6.7-13.4 6.1-12.1 13-15 Years 4.8-11.5 5.8-11.2 Adult 4.5-12.0 4.5-12.0 . | |||||
| T3 Uptake |
|
% | (24-39) |
|
|
| Free Thyroxine Index |
|
(1.2-4.9) |
|
||
| TSH, High Sensitivity, Serum |
|
mcIU/mL | (0.35-5.50) |
|
|
| Note: **Please Note Reference Interval Change** . | |||||
| Reviewed by David E Ford MD on 10/08/2007; All test results are final unless otherwise noted. | |||||
| Cl+K+Na | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 10/05/2007 | Collected: 10/05/2007 Reported: 10/08/2007 |
| Potassium, Serum |
|
mmol/L | (3.5-5.5) |
|
|
| Sodium, Serum |
|
mmol/L | (135-148) |
|
|
| Chloride, Serum |
|
mmol/L | (96-109) |
|
|
| Reviewed by David E Ford MD on 10/08/2007; All test results are final unless otherwise noted. | |||||
| RPR | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 10/05/2007 | Collected: 10/05/2007 Reported: 10/08/2007 |
| RPR |
|
(Non-Reactive) |
|
||
| Note: Performed At: MA LABCORP MADISON 1447 YORK COURT MADISON, CA 956530000 | |||||
| Reviewed by David E Ford MD on 10/08/2007; All test results are final unless otherwise noted. | |||||
| CBC w/ Differential & Platelet | LabCorp Madison |
|---|---|
| Ordered by David E Ford MD on 09/03/2007 | Collected: 09/03/2007 Reported: 09/03/2007 |
| White Blood Cell (WBC) Count |
|
THOUS/MCL | (3.8-10.8) |
|
|
| Red Blood Cell (RBC) Count |
|
MILL/MCL | (3.80-5.10) |
|
|
| Hemoglobin |
|
G/DL | (11.7-15.5) |
|
|
| Hematocrit |
|
% | (35.0-45.0) |
|
|
| MCV |
|
FL | (.0-100.0) |
|
|
| MCH |
|
PG | (27.0-33.0) |
|
|
| MCHC |
|
G/DL | (32.0-36.0) |
|
|
| Polys |
|
% |
|
||
| Lymphs |
|
% |
|
||
| Monocytes |
|
% |
|
||
| Eos |
|
% |
|
||
| Basos |
|
% |
|
||
| Platelets |
|
THOUS/MCL | (140-400) |
|
|
| Polys (Absolute) |
|
CELLS/MCL | (1500-7800) |
|
|
| Lymphs (Absolute) |
|
CELLS/MCL | (850-3900) |
|
|
| Monocytes(Absolute) |
|
CELLS/MCL | (200-950) |
|
|
| Eos (Absolute Value) |
|
CELLS/MCL | (15-500) |
|
|
| Baso(Absolute) |
|
CELLS/MCL | (0-200) |
|
|
| RDW |
|
% | (11.0-15.0) |
|
|
| Reviewed by David E Ford MD on 01/08/2008; All test results are final unless otherwise noted. | |||||
| Hematocrit | Madison Laboratory |
|---|---|
| Ordered by James T Monroe MD on 09/03/2007 | Collected: 09/03/2007 Reported: 09/03/2007 |
| Female |
|
(37-47) |
|
||
| Male |
|
(40-54) |
|
||
| Reviewed by James T Monroe MD on 09/03/2007; All test results are final unless otherwise noted. | |||||
| Urinalysis | Madison Laboratory |
|---|---|
| Ordered by James T Monroe MD on 09/03/2007 | Collected: 09/03/2007 Reported: 09/03/2007 |
| Appearance |
|
(Clear-Mod Cloud) |
|
||
| Bilirubin |
|
(Negative-Small) |
|
||
| Blood |
|
(Negative) |
|
||
| Color |
|
(None-Yellow) |
|
||
| Glucose |
|
(Negative-250) |
|
||
| Specific Gravity |
|
(1.000-1.010) |
|
||
| Ketone |
|
(Negative-Trace) |
|
||
| Leukocytes |
|
(Negative-Trace) |
|
||
| Nitrites |
|
(Negative) |
|
||
| pH Level |
|
(5.0-6.5) |
|
||
| Urobilinogen |
|
(Negative) |
|
||
| Reviewed by James T Monroe MD on 09/03/2007; All test results are final unless otherwise noted. | |||||
| Description | Last Updated |
|---|---|
| Wine consumption (___ glasses/day) | 01/08/2008 |
| Caffeine use | 01/08/2008 |
| Tobacco use | 01/08/2008 |
| Smoking Status Unknown |
| Procedures | CPT-4 | Diagnosis | Performing Provider | Service Location | Service Date |
|---|---|---|---|---|---|
| Hematocrit | 85014 | ROUTINE GENERAL MEDICAL EXAM | James T Monroe MD | Office - Madison Medical Center, P.A. | 09/03/2007 |
| Urinalysis | 81000 | ROUTINE GENERAL MEDICAL EXAM | James T Monroe MD | Office - Madison Medical Center, P.A. | 09/03/2007 |
| Surgical History | Last Updated |
|---|---|
| History of prior surgery [For Hx of Tx, use H prefix] | 01/08/2008 |
| Medical History | Last Updated |
|---|---|
| Reported medical history | 01/08/2008 |
| Description | Last Updated |
|---|---|
| Reported family history of cancer | 01/08/2008 |
| Family history [For FHx of Dx use Dx w/ F prefix] | 01/08/2008 |
| Vaccine | Dose # | Date | Site | Reaction(s) | Status | Source | |
|---|---|---|---|---|---|---|---|
| Influenza | 1 | 06/28/2006 | Left Arm | Active (Administered) | Madison Medical Center P. A. |
| Substance | Type | Reaction | Effective | Status |
|---|---|---|---|---|
| Ragweed | Allergy | Itchy eyes and nasal congestion | 02/04/1970 | Active |
| Latex | Allergy | Skin Rashes/Hives | 03/07/2002 | Active |
| Fiorinal/Codeine #3 | Intolerance | Nausea/Vomiting/Diarrhea | 09/05/2007 | Active |
| Note: Patient stopped taking med on day 2 | ||||
| Cheese | Allergy | Nausea/Vomiting/Diarrhea | 03/07/2002 | Active |
| Birds | Allergy | Skin Rashes/Hives, Nausea/Vomiting/Diarrhea | 11/05/2009 | Active |
| Encounter | Provider | Location | Date | Diagnosis |
|---|---|---|---|---|
| [Patient Encounter] | David E Ford MD | 01/13/2012 | ||
| [Patient Encounter] | David E Ford MD | 03/01/2010 | ||
| [Patient Encounter] | David E Ford MD | 02/23/2010 | ||
| [Patient Encounter] | David E Ford MD | 11/02/2009 | ||
| Consultation | Depak E Shah MD | Office - Madison Medical Center, P.A. | 01/08/2008 | |
| [Patient Encounter] | David E Ford MD | Office - Madison Medical Center, P.A. | 01/08/2008 | |
| New Patient Visit | Gary Madder MD | Office - Madison Medical Center, P.A. | 01/08/2008 | |
| Consultation | James T Monroe MD | Office - Madison Medical Center, P.A. | 01/03/2008 | |
| Consultation | James T Monroe MD | Office - Madison Medical Center, P.A. | 01/03/2008 | |
| Consultation | James T Monroe MD | Office - Madison Medical Center, P.A. | 11/02/2007 | |
| Re-Check | James T Monroe MD | Office - Madison Medical Center, P.A. | 10/05/2007 | |
| New Patient Evaluation | James T Monroe MD | Office - Madison Medical Center, P.A. | 09/03/2007 | |
| General Check-up | David E Ford MD | Office - Madison Medical Center, P.A. | 06/28/2006 |
| Plan Name | Member ID | Group # | Subscriber | Relationship | Effective Dates |
|---|---|---|---|---|---|
| 1 - Anaheim Managed Health | 643005639 | 048-27-9873 | Sharon A Carlson | Self | 10/03/2007 - 10/01/2008 |
| 2 - Medicare B - California | 643005639 | Sharon A Carlson | Self | 10/03/2007 - 10/01/2008 |