------------------ MY HEALTHEVET PERSONAL HEALTH INFORMATION ------------ *************CONFIDENTIAL************* Produced by the Blue Button (v11.3.1) 11 Jul 2011 @ 0555 This summary is a copy of information from your My HealtheVet Personal Health Record. Your summary contains information that you entered and may also include a copy of some of the information in your VA medical record as it becomes available in My HealtheVet. Please let your health care team know if you have questions about your health information. Name: MHVTESTVETERAN, ONE Date of Birth: 01 Mar 1948 ------------------------ DOWNLOAD REQUEST SUMMARY ----------------------- System Request Date/Time: 11 Jul 2011 @ 0555 User Request Type: Download only my selected data from My HealtheVet File Name: mhv_MHVTESTVETERAN_20110711.txt Date Range Selected: 11 Jun 2010 to 11 Jul 2011 Data Types Selected: My HealtheVet Account Summary Demographics Health Care Providers Treatment Facilities Health Insurance VA Wellness Reminders VA Appointments (Future) VA Appointments (Limited to past 2 years) VA Medication History Medications and Supplements VA Allergies Allergies/Adverse Reactions Medical Events Immunizations VA Laboratory Results Labs and Tests Vitals and Readings Family Health History Military Health History --------------------- MY HEALTHEVET ACCOUNT SUMMARY --------------------- Source: VA Authentication Status: Authenticated Authentication Date: 18 May 2011 Authentication Facility ID: 648 Authentication Facility Name: PORTLAND, OREGON VA MEDICAL CENTER VA Treating Facility Type ---------------------------- ----------- AUSTIN MHV OTHER AUSTIN PSIM OTHER PORTLAND, OREGON VA MEDICAL CENTER VAMC ----------------------------- DEMOGRAPHICS ---------------------------- Source: Self-Entered First Name: ONE Middle Initial: Last Name: MHVTESTVETERAN Suffix: Alias: MHVVET Relationship to VA: Patient, Veteran Gender: Male Blood Type: AB+ Organ Donor: Yes Date of Birth: 01 Mar 1948 Marital Status: Married Current Occupation: Truck Driver Mailing Address: 123 Anywhere Road Mailing Address2: Apt. 123 Mailing City: Anywhere Mailing State: DC Mailing Country: United States Mailing Province: Mailing Zip/Postal Code: 00001 Alternate Address: Alternate Address2: Alternate City: Alternate State: Alternate Country: Alternate Province: Alternate Zip/Postal Code: Home Phone Number: 000-020-0202 Work Phone Number: 000-040-0404 Pager Number: Cell Phone Number: 000-030-0303 FAX Number: 000-050-0505 Email Address: mhvveteran@emailaddress.com Preferred Method of Contact: Email EMERGENCY CONTACTS Contact First Name: Two Contact Last Name: MHVVeteran Relationship: Home Phone Number: 000-010-0001 Work Phone Number: Extension: Cell Phone Number: Address Line 1: 123 Anywhere Road Address Line 2: City: Anywhere State: DC Country: United States Province: Zip/Post Code: 000001 Email Address: Contact First Name: Three Contact Last Name: MHVVeteran Relationship: Home Phone Number: 000-010-0101 Work Phone Number: 000-080-0808 Extension: Cell Phone Number: 000-090-0909 Address Line 1: 123 Anywhere Road Address Line 2: City: State: DC Country: United States Province: Zip/Post Code: 00001 Email Address: ------------------------- HEALTH CARE PROVIDERS ------------------------- Source: Self-Entered Provider Name: John Doe Type of Provider: Primary Other Clinician Information: Phone Number: 000-000-0000 Ext: 1234 Email: provider@institution.org Comments: Dr. Doe can be reached on the weekend if needed by leaving a message with the clinic. Provider Name: Jane Smith Type of Provider: Specialist Other Clinician Information: Phone Number: 000-000-0001 Ext: 1234 Email: specialist@institution.org Comments: Dr. Smith should be notified of any changes in my medical condition. Requires a referral from my health insurance company. ------------------------- TREATMENT FACILITIES -------------------------- Source: Self-Entered Facility Name: Anywhere VA Medical Center Facility Type: VA VA Home Facility: Yes Phone Number: 000-000-0001 Ext: 1234 Mailing Address: 123 VA Drive Mailing Address2: Suite 4 Mailing City: Anywhere Mailing State: DC Mailing Country: United States Mailing Province: Mailing Zip/Postal Code: 00001 Comments: Contact clinic when calling to make my appointments. Facility Name: Health Care Inc. Facility Type: Non-VA VA Home Facility: No Phone Number: 000-000-0002 Ext: 5678 Mailing Address: 123 Anywhere Road Mailing Address2: B-Wing Mailing City: Anywhere Mailing State: DC Mailing Country: United States Mailing Province: Mailing Zip/Postal Code: 00001 Comments: Reminder to bring My HealtheVet printouts for all visits --------------------------- HEALTH INSURANCE ---------------------------- Source: Self-Entered Health Insurance Company: My Health Insurance Company Primary Insurance Provider: Yes ID Number: 0001234 Group Number: 0000000 Insured: One MHVveteran Start Date: 01 Jan 2009 Stop Date: Pre-Approval Phone Number: 000-000-0003 Health Insurance Company Phone Number: 000-000-0004 Comments: Need to get pre-authorization for special services. Health Insurance Company: My Other Health Insurance Company Primary Insurance Provider: No ID Number: 000567891010 Group Number: ABC123456789 Insured: One MHVveteran Start Date: 01 Jan 2009 Stop Date: Pre-Approval Phone Number: 000-000-0005 Health Insurance Company Phone Number: 000-000-0005 Comments: Coverage only for vision and dental. ---------------------------- VA WELLNESS REMINDERS ------------------------- Source: VA Last Updated: 11 Jul 2011 @ 0523 Wellness Reminder Due Date Last Completed Location ---------------------------------------------------------------------------- Control of Your Cholesterol DUE NOW UNKNOWN PORTLAND, OR Influenza Vaccine DUE NOW UNKNOWN PORTLAND, OR Pneumonia Vaccine 06 Mar 2011 PORTLAND, OR Body Mass Index more than 25 DUE NOW UNKNOWN PORTLAND, OR Colon Cancer Screening DUE NOW UNKNOWN PORTLAND, OR Learn more about these Wellness Reminders by visiting My HealtheVet. Please contact your health care team with any questions about your VA Wellness Reminders. --------------------------- VA APPOINTMENTS ----------------------------- Source: VA Last Updated: 11 Jul 2011 @ 0523 VA Past Appointments are limited to two years from the date of your download request. PAST APPOINTMENTS: -------------------- Date/Time: 15 Mar 2011 @ 1000 Location: PORTLAND Status: NOT APPLICABLE Clinic: 111A TEST NOTE LOCATION Phone Number: 000-000-0001 Note: This appointment has pre-appointment activity scheduled: Lab: 15 Mar 2011 @ 0930 Date/Time: 06 Mar 2011 @ 1000 Location: PORTLAND Status: NOT APPLICABLE Clinic: 111A TEST NOTE LOCATION Phone Number: 000-000-0001 Note: This appointment has pre-appointment activity scheduled: Lab: 06 Mar 2011 @ 0900 EKG: 06 Mar 2011 @ 0930 Date/Time: 03 Jan 2011 @ 1300 Location: PORTLAND Status: NOT APPLICABLE Clinic: 111A TEST NOTE LOCATION Phone Number: 000-000-0001 Date/Time: 30 Aug 2010 @ 1400 Location: PORTLAND Status: NOT APPLICABLE Clinic: 111A TEST NOTE LOCATION Phone Number: 000-000-0001 -------------------------- VA MEDICATION HISTORY ---------------------- Source: VA Last Updated: 07 Jun 2011 @ 1445 Medication: ACCU-CHEK AVIVA (GLUCOSE) TEST STRIP #50 Instructions: USE 1 STRIP FOR BLOOD GLUCOSE TESTING AS DIRECTED Status: Active Refills Remaining: 2 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 200 Days Supply: 50 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181484 Medication: AMLODIPINE BESYLATE 10MG TAB Instructions: TAKE ONE-HALF TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE -- AVOID GRAPEFRUIT JUICE -- Status: Active Refills Remaining: 3 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181487 Medication: COLONIC LAVAGE SOLUTION (4 LITER) Instructions: MIX 1 GALLON IN WATER AND DRINK AS DIRECTED FOR 1 DAY DISSOLVE 1 BOTTLE Status: Active Refills Remaining: 0 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 1 Days Supply: 2 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181488 Medication: IBUPROFEN 600MG TAB Instructions: TAKE ONE TABLET BY MOUTH FOUR TIMES DAILY WITH MEALS AS NEEDED FOR PAIN Status: Active Refills Remaining: 3 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 240 Days Supply: 60 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181491 Medication: INSULIN NOVOLIN NPH 100U/ML INJ 10ML VL Instructions: INJECT 16 UNITS SUBCUTANEOUSLY EVERY MORNING AND INJECT 18 UNITS AT BEDTIME EACH VIAL EXPIRES 30 DAYS AFTER FIRST OPENING. Status: Active Refills Remaining: 1 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 3 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181492 Medication: INSULIN,GLARGINE 100U/ML INJ 10ML VIAL Instructions: INJECT 25 UNITS SUBCUTANEOUSLY AT BEDTIME * DO NOT MIX OTHER INSULINS IN SAME SYRINGE AS GLARGINE. DISCARD VIAL 28 DAYS AFTER OPENING. EACH VIAL EXPIRES 28 DAYS AFTER FIRST OPENING. Status: Active Refills Remaining: 2 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 3 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181494 Medication: METFORMIN HCL 1000MG TAB Instructions: TAKE ONE TABLET BY MOUTH TWICE DAILY WITH MEALS FOR DIABETES. Status: Active Refills Remaining: 2 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 180 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181499 Medication: SIMVASTATIN 40MG TAB Instructions: TAKE ONE-HALF TABLET BY MOUTH AT BEDTIME TO LOWER YOUR CHOLESTEROL. AVOID CONSUMING GRAPEFRUIT PRODUCTS. CALL YOUR PROVIDER IF YOU HAVE UNEXPLAINED MUSCLE PAIN, TENDERNESS OR WEAKNESS. Status: Active Refills Remaining: 2 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Jun 2011 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181502 Medication: LISINOPRIL 10MG TAB Instructions: TAKE ONE TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE Status: Expired Refills Remaining: 3 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Dec 2010 Quantity: 30 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181497 Medication: BACITRACIN OINTMENT 1 OZ Instructions: APPLY SMALL AMOUNT TOPICALLY TO AFFECTED AREA TWICE A DAY TO THREE TIMES A DAY FOR 30 DAYS Status: Expired Refills Remaining: 1 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Dec 2010 Quantity: 10 Days Supply: 45 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181529 Medication: DEXAMETHASONE 4MG TAB Instructions: TAKE TWO TABLETS BY MOUTH HOUR FOR 2 DAYS -- TAKE WITH FOOD -- Status: Expired Refills Remaining: 2 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Dec 2010 Quantity: 96 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181530 Medication: NAPROXEN 500MG TAB Instructions: TAKE ONE TABLET BY MOUTH TWICE A DAY -- TAKE WITH FOOD IF GI Status: Expired Refills Remaining: 3 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Dec 2010 Quantity: 60 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181531 Medication: SODIUM CHLORIDE 0.65% SOLN NASAL Instructions: SPRAY 2 SPRAYS MOUTH MINUTE FOR 30 DAYS Status: Expired Refills Remaining: 3 Last Filled On: 03 Jun 2011 Initially Ordered On: 03 Dec 2010 Quantity: 10 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181532 ---------------------------- VA ALLERGIES ------------------------- Source: VA Last Updated: 11 Jul 2011 @ 0523 Allergy Name: TRAMADOL Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 03 Jun 2011 Reaction: RETENTION OF URINE Allergy Type: DRUG VA Drug Class: NON-OPIOID ANALGESICS Observed/Historical: HISTORICAL Comments: gradually worsening difficulty emptying bladder -- might try tramadol again cautiously because pt. reported pain relief Allergy Name: TRIMETHOPRIM Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 03 Jun 2011 Reaction: Allergy Type: DRUG VA Drug Class: ANTI-INFECTIVES,OTHER Observed/Historical: HISTORICAL Comments: the reaction to this allergy was MILD (NO SQUELAE) Allergy Name: METHOCARBAMOL Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 03 Jun 2011 Reaction: DELIRIUM, DROWSY Allergy Type: DRUG VA Drug Class: SKELETAL MUSCLE RELAXANTS Observed/Historical: OBSERVED Comments: Drowsiness and hallucinations while on methocarbamol plus carbamazepine and other sedatives Allergy Name: BACTRIM Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 03 Jun 2011 Reaction: Allergy Type: DRUG VA Drug Class: SULFONAMIDE/RELATED ANTIMICROBIALS Observed/Historical: HISTORICAL Comments: Causes Swelling of the Extremities Allergy Name: TERAZOSIN Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 03 Jun 2011 Reaction: DIZZINESS Allergy Type: DRUG VA Drug Class: ALPHA BLOCKERS/RELATED Observed/Historical: HISTORICAL Comments: Please contact your health care team with any questions about your VA Allergy information. -------------------------- ALLERGIES/ADVERSE REACTIONS --------------------- Source: Self-Entered Allergy Name: Pollen Date: 18 Mar 2011 Severity: Mild Diagnosed: Yes Reaction: Watery eyes, itchy nose Comments: Took an over the counter antihistamine ----------------------------- IMMUNIZATIONS --------------------------------- Source: Self-Entered Immunization: Tetanus Other: Method: Injection Date Received: 18 Jul 2010 Reactions: --------------------------------- Pain Comments: stepped on a rusty nail -------------------------- VA LABORATORY RESULTS ---------------------------- Source: VA Last Updated: 11 Jul 2011 @ 0523 Sorted By: Date Specimen Collected (Descending) VA Laboratory Results includes up to two years of history unless you select a different date range in your download request. ============================================================================= Lab Test: INR Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: COAGULATION TISSUE FACTOR INDUCED.INR Result: 0.7 Low Units: Reference Range: (0.90-1.20) Interpretation: Therapeutic ranges may differ with individual clinical circumstances. INR therapeutic ranges for full anticoagulation: INR for venous thromboembolism, 2.0-3.0; INR for most patients with mechanical valves, 2.5-3.5. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: PT. reported incorrectly as 9.0 by [104353-VA648]. Changed to 9.9 on Jun 06, 2011@12:08 by [87277-VA648]. ============================================================================= Lab Test: Prothrombin Time Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: COAGULATION TISSUE FACTOR INDUCED Result: 9.9 Low Units: SEC Reference Range: (11.9-14.5) Interpretation: SEE INR FOR CRITICAL VALUE CUT-OFF. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Amended ----------------------------------------------------------------------------- Comments: PT. reported incorrectly as 9.0 by [104353-VA648]. Changed to 9.9 on Jun 06, 2011@12:08 by [87277-VA648]. ============================================================================= Lab Test: Hemogram+Platelet Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Whole blood Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: ERYTHROCYTE DISTRIBUTION WIDTH Result: 10 Low Units: % Reference Range: (11.5-14.5) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN Result: 32.2 Units: pg Reference Range: (27-33) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: ERYTHROCYTE MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION Result: 33.3 Units: g/dL Reference Range: (33-37) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: ERYTHROCYTES Result: 4.44 Units: M/cmm Reference Range: (4.3-5.6) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: HEMATOCRIT Result: 47.0 Units: % Reference Range: (41-51) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: HEMOGLOBIN Result: 15.5 Units: g/dL Reference Range: (13-18) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: LEUKOCYTES Result: 20.0 High Units: K/cmm Reference Range: (4.4-10.8) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: MEAN CORPUSCULAR VOLUME Result: 90 Units: fl Reference Range: (82-98) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: PLATELET MEAN VOLUME Result: 9 Units: fl Reference Range: (7.4-10.4) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ---------------------- Test Name: PLATELETS Result: 240 Units: K/cmm Reference Range: (150-400) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: Comments about the result for this test name ============================================================================= Lab Test: Calcium Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: CALCIUM Result: 9.0 Units: mg/dL Reference Range: (8.4-10.4) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Carbon Dioxide Content Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: CARBON DIOXIDE Result: 25 Units: mmol/L Reference Range: (21-32) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Chloride Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: CHLORIDE Result: 105 Units: mmol/L Reference Range: (95-108) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Cholesterol Total Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: CHOLESTEROL Result: 152 Units: mg/dL Reference Range: (1-240) Interpretation: DESIRABLE VALUE: <200 BORDERLINE VALUE: 201-239 ELEVATED VALUE: >240 Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Creatinine Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: CREATININE Result: 1.4 Units: mg/dL Reference Range: (0.8-1.5) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Creatinine eGFR Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: GLOMERULAR FILTRATION RATE.PREDICTED Result: 51 Low Units: Reference Range: (>60) Interpretation: EGFR IS 5.9% LOWER THAN EGFR CALCULATIONS PERFORMED BEFORE 2/12/08 An eGFR <60 is abnormal. Estimated glomerular filtration rate (eGFR) results >60 are imprecise. Many variables affect the calculated result. Interpretation of eGFR results >60 must be monitored over time. Units are mL/min/1.73m^2. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Gen Chem Specimen Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: ANION GAP Result: 10.0 Units: mmol/L Reference Range: (10-22) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Glucose Quant Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: GLUCOSE Result: 150 High Units: mg/dL Reference Range: (71-109) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Amended ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Potassium Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: POTASSIUM Result: 4.5 Units: mmol/L Reference Range: (3.5-5.0) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Sodium Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: SODIUM Result: 140 Units: mmol/L Reference Range: (131-142) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Triglycerides w o extract Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: TRIGLYCERIDE Result: 250 High Units: mg/dL Reference Range: (35-160) Interpretation: DESIRABLE VALUE: <150 BORDERLINE VALUE: 150-199 ELEVATED VALUE: 200-499 Patient should be fasting at time of specimen collection for valid interpretation of triglyceride level. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Lab Test: Urea Nitrogen Lab Type: Chemistry/Hematology Ordering Provider: ZZZAATESTPHYSICIAN, EIGHTEEN Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 ----------------------------------------------------------------------------- Test Name: UREA NITROGEN Result: 12 Units: mg/dL Reference Range: (7-23) Interpretation: Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239 Status: Final ----------------------------------------------------------------------------- Comments: GLUCOSE flagged incorrectly as normal GLUCOSE reported incorrectly as 110 by [104353-VA648]. Changed to 150 on Jun 03, 2011@10:31 by [104353-VA648]. ============================================================================= Test results slightly outside the reference range are not unusual. Your provider has reviewed your test results and will contact you for any important issues. If you have further questions, please do not hesitate to contact your primary care provider. ----------------------------- LABS AND TESTS -------------------------------- Source: Self-Entered Test Name: Colonoscopy Date: 01 Jul 2010 Location performed: VAMC Provider: Provider One Results: No new polyps Comments: Keep high fiber diet ----------------------------- VITALS AND READINGS --------------------------- Source: Self-Entered =============================================================================== Measurement Type: Blood pressure Date: 02 Aug 2010 Time: 1720 Systolic: 130 Diastolic: 76 Comments: BP taken lying down =============================================================================== Measurement Type: Blood pressure Date: 02 Aug 2010 Time: 1730 Systolic: 132 Diastolic: 76 Comments: BP taken standing. PB continues at goal. Doctor says to continue BP medications as directed -------------------------- FAMILY HEALTH HISTORY ---------------------------- Source: Self-Entered Relationship: Self First Name: ONE Last Name: MHVTESTVETERAN Living or Deceased: Living Health Issues: ----------------------------- Back Pain Insomnia >1 beer/wine a day Hearing Loss Pneumonia Allergies Chicken Pox Current Smoker Diabetics Type 2 Overweight High Blood Pressure Depression High Blood Cholesterol Stomach/Bowel Other Smoking >20 Years Other Health Issues: ----------------------------- trouble sleeping Comments: I sometimes have trouble sleeping when stress is high at work Relationship: Mother First Name: Four Last Name: MHVVeteranMother Living or Deceased: Deceased Health Issues: ----------------------------- Cancer Other Diabetics Type 2 Overweight Joint Pain Stroke Other Health Issues: ----------------------------- Chronic joint pain Comments: Mother died of cancer at age 40 --------------------------- MILITARY HEALTH HISTORY ------------------------- Source: Self-Entered Event Title: Overseas Deployment Event Date: 07 Apr 2002 Service Branch: Army Rank: Captain Exposures: Yes Location of Service: Overseas Onboard Ship: No Military Occupational Specialty: Infantry Assignment: 1st Recon Exposures: In Iraq, exposed to burning chemicals Military Service Description: Unit was in charge of security -------------- END MY HEALTHEVET PERSONAL HEALTH INFORMATION ------------