John Doe

Health Report

Clinical Summary

April 1st, 1989 - November 20, 2012

Created on

November 20, 2012 at 3:24pm

About You

Personal Details

Name

John Doe

Address

123 Anywhere Road
Apartment 123
Anywhere,DC 00001

Phone

(000)-010-0101

Birth Date

March 1st, 1965

Sex

Male

Marital Status

Married

Religion 

Christian

Ethnicity

Hispanic

Language Spoken

English, Spanish

Guardian/Emergency Contact

Jean Doe (Spouse)

Address

1234 Elm Ave
San Gabriel, CA 91775

Phone

(310)-111-2222

Allergies

Peanuts

Reaction Severity Comments
Anaphylactic shock Severe Avoid peanuts and peanut based foods. Foods cooked with peanut oil also cause the reaction

Pollen

Reaction Severity Comments
Watery eyes, itchy nose Mild Took an over the counter antihistamine

Dogs/Pets

Reaction Severity Comments
Sneezing and runny nose Moderate Has been to a friends house who has pets (cat).

TRAMADOL

Reaction Severity Comments
URINARY RETENTION Moderate gradually worsening difficulty emptying bladder -- might try tramadol again cautiously because pt. reported pain releif

METHOCARBAMOL

Reaction Severity Comments
CONFUSION, DROWSINESS Moderate Drowsiness and hallucinations while on methocarbamol plus carbamazepine and other sedatives.

Immunizations

October 7th, 2012

Pneumococcal polysaccharide

Type Dose Quantity Instructions/Comments
Intramuscular injection 0.5 mL Soreness and swelling in injection site
September 1st, 2009

Meningococcal Conjugate

Type Dose Quantity Instructions/Comments
Intramuscular injection 0.5 mL Brief fainting spells
Aug 10th, 2006

Hepatitis B

Type Dose Quantity Instructions/Comments
Intramuscular injection 0.5 mL Soreness at the injection site
July 11th, 1990

Rabies

Type Dose Quantity Instructions/Comments
Intramuscular injection 1.0 mL Soreness and redness at the injection site

Medications

Aspirin EC

Active
June 15, 2010
NickName Type Prescribed By Prescription No Directions
Heart Hlth RX Medication Dr. Reggie Miller 010101B Daily 1 tablet (81mg)

Ginkgo biloba

Active
March 11th, 2008
NickName Type Prescribed By Prescription No Directions
Improve concentration Herbal ---- 020121X 2 capsule, daily with breakfast

Multi-vitamin

Active
Sept 22, 2003
NickName Type Prescribed By Prescription No Directions
Stay Hlthy Supplement Dr. Reggie Miller 020121X 1 tablet daily.

Cough Medicine

NOT Active
Feb 15, 2005
April 10, 2007
NickName Type Prescribed By Prescription No Directions
Cough Medicine OTC Dr. Reggie Miller 020121X 2 TBS morning and night (2000mg daily)

Medical Conditions (Problem List)

Arthritic Degeneration

Active
Condition Name Date Observation
Arthritic Degeneration (Left Hip) October 2009-Present Details here.

Lung Cancer

Active
Condition Name Date Observation
Lung Cancer (Left Lung) May 2004-Present Details here.

Depression

Active
Condition Name Date Observation
Depression 2001-Present Details here.

Asthma

Active
Condition Name Date Observation
Asthma 1989-Present Details here.

Carpal Tunnel Syndrome

Inactive
Condition Name Date Observation
Carpal Tunnel Syndrome (RSD) 2002-2003 Details here.

Care Team

Care Team

3

Daphne Miller, MD

Primary Care

Ashby Medical Center

415.642.0331

John Miller, MD

Cardiologist

Ashby Medical Center

415.642.0332

David Johnson, MD

Neurologist

Ashby Medical Center

415.642.0333

Doctor Visits

June 1st, 2012

Dr. Daphne Miller

Office Visit
Purpose

Annual Physical Exam

Provider

Dr. Daphne Miller

Location

Ashby Medical Center

April 15th, 2005

Dr. John Miller

Ashby Medical Center
Purpose

Alopecia

Provider

Dr. John Miller

Location

Ashby Medical Center

Lab Results

June 22nd, 2012

Lipid Panel

Component Your Result Standard Range Units

Cholesterol

230

< 200

mg/dl

HDL

30

> 40

mg/dl

June 22nd, 2006

Lipid Panel

Component Your Result Standard Range Units

Cholesterol

170

< 200

mg/dl

HDL

44

> 40

mg/dl

Procedures Done

March 22nd, 2011

ACL Surgery

Name of Org

Dr. David Johnson

Phone

(403) 298-4619

Address

Ashby Medical Center
486 Mendicino Avenue
San Mateo, CA 94287

July 16th, 2004

Nephrolithotripsy

Name of Org

Dr. John Miller

Phone

(403) 298-4619

Address

Ashby Medical Center
486 Mendicino Avenue
San Mateo, CA 94287

Upcoming Activities

MRI

June 15, 2012
Activity Name Type Instructions
Brain MRI Procedure Make sure braces are off.

Needle Biopsy

Nov 21, 2008
Activity Name Type Instructions
Needle Biopsy Procedure Bring someone with you to drive you back home.

Stress Test

May 13, 2003
NickName Type Directions
Stress Test Test Come in relaxed dress, to run for 1 Mile on treadmill.