Health Summary 123 MILAN STREET DULUTH MN 55812 USA Everyman Adam Get Well Clinic 55 Center Avenue Apt 2B Phoenix AZ 85002 1004 Healthcare Dr. Portland OR 97005 USA Holly Liu 1004 Healthcare Dr. Portland OR 97005 USA Samir Khan Family Health Clinic 1004 Healthcare Dr. Portland OR 97005 USA Primary Care Provider Get Well Clinic 1004 Healthcare Dr. Portland OR 97005 Dr. Samir Khan Primary Care Provider Get Well Clinic 1004 Healthcare Dr. Portland OR 97005 RN Nancy Nightingale 1004 Healthcare Dr. Portland OR 97005 USA Samir Khan 1004 Healthcare Dr. Portland OR 97005 USA Samir Khan
Allergies, Adverse Reactions, Alerts
Allergy Substance Code CodeSystem Reaction Severity Status
Penicilin G benzathine 7982 RxNorm Hives Moderate Active
Codeine 2670 RxNorm Nausea Moderate Active
Penicilin G benzathine Codeine
Medications
Medication Medication Code Medication CodeSystem Start Date Route Dose Status Fill Instructions
albuterol 0.09 MG/ACTUAT [Proventil] 573621 RxNorm 2012-08-14 Inhalation 0.09 MG/ACTUAT INHALANT SOLUTION 2 puffs every 6 hours PRN wheezing Active Generic substitution allowed
0.09 MG/ACTUAT INHALANT SOLUTION 2 puffs every 6 hours PRN wheezing INHALANT SOLUTION
Hospital Discharge Medications
Medication Direction Start Date Status Indications Fill Instuctions
No Discharge Medication
Problems
Problem Name Code CodeSystem Start Date End Date Status
Costochondritis 64109004 SNOMED-CT 2012-08-15 Active
Asthma 195967001 SNOMED-CT 2011-09-25 Active
Laboratory Values/Results
Test Test Code Code System Actual Result Date
CO2 2028-9 LOINC 23 mmol/L 2012-08-15
23 mmol/L ; 23 mmol/L
Procedures
Procedure Name Code CodeSystem Target Site Date of Procedure
No procedure SNOMED-CT ()
Encounter Diagnosis
Code CodeSystem Description Date Finding Finding Code Status
99213 SNOMED-CT Ambulatory Visit 2012-08-15 Costochondritis 203523006 - ICD-10-CM Active
Vital Signs
Vitals Date Value
Height 2012-09-20 70 in
Weight 2012-09-20 195 lbs
Blood Pressure 2012-09-20 140/100 mmHg
BMI 2012-09-20 28
Plan of Care, Goals and Instructions
Type Planned Activity Instructions Planned DateTime Code CodeSystem
GOAL Asthma Management Resources and intructions provided during visit 406162001 SNOMED-CT
GOAL Weight Loss Diet and Exercise counseling provided during visit 289169006 SNOMED-CT
Immunizations
Vaccine Name Vaccine Code CodeSystem Date Status
Influenza virus vaccine 88 CVX 2012-08-15 Completed
Functional And Cognitive Status
Type Condition Code Code System Date Status
FUNCTIONAL No impairment 66557003 SNOMED-CT 2012-08-15 Active
COGNITIVE No impairment 66557003 SNOMED-CT 2012-08-15 Active
Social History
Element Description Description Start Date End Date Code CodeSystem
Smoking Status Never smoker 266919005 SNOMED-CT
Never smoker
Reason For Referral Pulmonary function tests, Dr. Penny Puffer, Tel: 555-555-1049, 1047 Healthcare Drive, Portland, OR 97005, Scheduled date: 2013-02-09