Good Health Health Summary 17 Daws Rd. Blue Bell MA 02368 US Mr. Adam Frankie Everyman 17 Daws Rd. Blue Bell MA 02368 US Ralph Relative MA 02368 USA Good Health Clinic 21 North Ave Burlington MA 02368 USA 21 North Ave. Burlington MA 02368 USA Henry Seven 21 North Ave. Burlington MA 02368 USA Henry Seven Rose Everyman Good Health Clinic 17 Daws Rd. Blue Bell MA 02368 USA Henry Seven Good Health Clinic Primary Care Provider Dr. Pseudo Physician-1 NIST HL7 Test Laboratory Primary Care Provider Dr. Pseudo Physician-3 HL7 Test Laboratory
Allergies, Adverse Reactions, Alerts
Substance Reaction Status
Penicillin Hives Active
Aspirin Wheezing Active
Codeine Nausea Active
Penicillin Aspirin Aspirin
Medications
Medication Directions Start Date Status Indications Fill Instructions
Proventil 0.09 MG/ACTUAT inhalant solution 2 puffs QID PRN wheezing 2011-03-01 Active Bronchitis (32398004 SNOMED CT) Generic Substitition Allowed
0.09 MG/ACTUAT inhalant solution, 2 puffs QID PRN wheezing Good Health Clinic Diethylene Glycol label in spanish
Problems Pneumonia: Resolved in March 1998 ...
Procedures
Procedure Date
Colonic polypectomy 1998
17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic 17 Daws Rd. Blue Bell MA 02368 US 17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic 17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic 17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic 17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic
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)
Liver Functions and Other Laboratory Values
ALT (SGPT) 31.0
AST (SGOT) 18.0
GGT 28.0 Alk
Phos 86.0
Total Bili 0.1
Albumin 3.2
Blood Count
White Count 7.7
Platelets 187.0
Hematocrit 23.7
Hemoglobin 8.1
ELECTROCARDIOGRAM (EKG) INFORMATION
EKG Sinus rhythm without acute changes
M 13-18 g/dl; F 12-16 g/dl
Advance Directives
Directive Description Verification Supporting Document(s)
Resuscitation status Do not resuscitate Dr. Robert Dolin, Nov 07, 1999 Advance directive
21 North Ave. Burlington MA 02368 USA Dr. Dolin Robert
Encounters
Encounter Performer Location Date
Examination Performer Name Good Health Clinic Apr 07, 2000
Checkup Examination 17 Daws Rd. Blue Bell MA 02368 US Good Health Clinic
Family history Father (deceased)
Diagnosis Age At Onset
Myocardial Infarction (cause of death) 57
Diabetes 40
Immunizations
Vaccine Date Status
Influenza virus vaccine, IM Nov 1999 Completed
Influenza virus vaccine, IM Dec 1998 Completed
Pneumococcal polysaccharide vaccine, IM Dec 1998 Completed
Tetanus and diphtheria toxoids, IM 1997 Refused
Influenza virus vaccine Possible flu-like symptoms for three days. Influenza virus vaccine Possible flu-like symptoms for three days. Influenza virus vaccine Possible flu-like symptoms for three days. Tetanus and diphtheria toxoids - preservative free Possible flu-like symptoms for three days.
Medical Equipment
Supply/Device Date Supplied
Automatic implantable cardioverter/defibrillator Nov 1999
Total hip replacement prosthesis 1998
Wheelchair 1999
Good Health Prostheses Company
Insurance Providers
Payer name Policy type / Coverage type Policy ID Covered party ID Policy Holder
Good Health Insurance Extended healthcare / Family Contract Number 1138345 Patient's Mother
17 Daws Rd. Blue Bell MA 02368 US Mr. Frank A. Everyman 17 Daws Rd. Blue Bell MA 02368 US
Plan of Care
Planned Activity Planned Date
Colonoscopy April 21, 2000
Social History
Social History Element Description Effective Dates
smoking 1 pack per day 1947 - 1972
smoking None 1973 -
Alcohol consumption None 1973 -
1 pack per day None None
Vital Signs
Date / Time: Nov 14, 1999 April 7, 2000
Height 177 cm 177 cm
Weight 86 kg 88 kg
Blood Pressure 132/86 mmHg 145/88 mmHg