Wellesley MA John D Halamka MD PPHC Dr.StevenFlier PPHC PPHC PPHC PPHC Dr.StevenRFlier PPHC

Patient requested

Payer name	Policy type	Covered party ID
Harvard Pilgrim Health Plan	Care Group Preferred	HPCG02815-00

Harvard Pilgrim Health Plan

Directive	Description	Verification	Supporting Document(s)
No advance directives

Functional Condition	Effective Dates	Condition Status
No functional status limitations

Condition	Condition Status
AV Nodal Reentry Tachycardia	Resolved
Lyme Disease	Resolved
Low HDL Cholesterol	Resolved
Corneal Abrasion	Resolved
Vegan	Active

Family member	medical history
Grandmother	survived into her 90s
Grandfather	survived into his 90s
Mother	celiac disease
Father	multiple sclerosis
Family	no colorectal cancer, prostate cancer, diabetes, hypertension

survived into her 90s survived into his 90s celiac disease multiple sclerosis no colorectal cancer, prostate cancer, diabetes, hypertension

Social History Element	Description
Tobacco use	never
Passive smoke exposure	no
Alcohol use	no
Caffeine use (drinks/day)	<1
Exercise (hours/week)	10-20
Sun exposure	rarely
Dietary restrictions	vegan

never Passive smoke exposure no no Caffeine use (drinks/day) <1 10-20 Sun exposure rarely Dietary restrictions vegan

Substance	Reaction	Status
Amoxicillin	Rash	Active

Amoxicillin

Medication	Instructions	Start Date	Status
Centrum silver tab (multiple vitamins-minerals)	1 PO qDay		Active
Vitamin D3 (cholecalciferol)	1600 units PO qDay	Oct 2007	Active

Multivitamin Centrum silver tab (multiple vitamins-minerals) Cholecalciferol Vitamin D3 (cholecalciferol)

Supply/Device	Date Supplied
No medical equipment

Vaccine	Date	Status
Hepatitis A vaccine #1	Sep 03, 2004	Completed
Hepatitis A vaccine #2	Mar 01, 2005	Completed
Tetanus vaccine	Jun 20, 2003	Completed
Pneumovax	Sep 03, 2004	Completed
Influenza	Oct 19, 2006	Completed

Hepatitis A vaccine Hepatitis A vaccine Tetanus toxoid Pneumococcal polysaccharide vaccine Pneumovax Influenza virus vaccine

Date / Time:	Oct 22, 2007	Oct 19, 2006	Sep 12, 2005	Sep 03, 2004
Height (in)
Weight (lb)	172.4	174.8	169	173
BMI	22.83	23.15	22.38	22.91
BP Systolic (mm Hg)	116	128	126	116
BP Diastolic (mm Hg)	72	81	82	70
Temperature (deg F)
Pulse rate (/min)	53	51		62
Pulse rhythm	regular	regular	regular	regular
Resp rate (/min)	14	13

regular regular regular regular

Lab results

Date / Time:	Oct 22, 2007	Oct 24, 2006	Oct 19, 2006	Sep 13, 2005	Sep 07, 2004
Hemoccult			negative
Cholesterol (mg/dL)	135	143		137	127
Triglyceride (mg/dL)	121	80		59	78
HDL (mg/dL)	40	47		43	42
LDL (mg/dL)	71	60		62	69
Homocysteine (umol/L)		9.6		9.6
CRP (mg/L)				0.6	0.6
BG Random (mg/dL)	86	88		79	88
PSA (ng/mL)		0.7		0.5	0.6
WBC (10*3/mm3)	4.4	5.1		4.2	5.0
HGB (g/dL)	13.9	13.8		14.6	13.9
HCT (%)	40.9	42		43	40
MCV (fL)	89.2	88		89	89
Platelets (10*3/mm3)	277	286		256	294
BUN (mg/dL)	12	9		13	16
Creatinine (mg/dL)	0.9	0.9		0.9	1.0
Sodium (mmol/L)	140
Potassium (mmol/L)	4.2	4.6		4.7	4.5
Calcium (mg/dL)	9.7	10.1		10.2	9.9
Uric acid (mg/dL)		6.1		6.7	7.0
SGOT (AST) (U/L)	16	16		17	15
SGPT (ALT) (U/L)	12	14		15	17
Alk Phos (U/L)	62	53		58	60
GGT (U/L)
Bili Total (mg/dL)	0.5	0.4		0.7	0.6
TSH (uIU/mL)					1.8
Vit D 25-OH, Total (ng/mL)	16 (L)		27

Procedure results

Test	Date	Description
Bone Density	Oct 22, 2007	Normal
Exercise Treadmill Test	Sep 11, 2007	No objective evidence of myocardial ischemia by EKG. No anginal symptoms. Trivial atrioventricular ectopic activity at a high workload.

Procedure	Date
VeriMed RFID microchip implantation	Dec, 2004

VeriMed RFID microchip implantation

Encounter	Location	Date

Planned Activity	Planned Date