--------------- MY HEALTHEVET PERSONAL INFORMATION REPORT --------------- *************CONFIDENTIAL************* Produced by the VA Blue Button (v12.10) 05 Nov 2014 @ 0827 This summary is a copy of information from your My HealtheVet Personal Health Record. Your summary may include: - information that you entered (self reported) - information from your VA health record - your military service information from the department of defense (DoD). ***Note: Your health care team may not have all of the information from your Personal Health Record unless you share it with them. Contact your health care team if you have questions about your health information.*** Key: Double dashes (--) mean there is no information to display. Name: MHVTESTVETERAN, ONE A Date of Birth: 01 Mar 1948 ------------------------ DOWNLOAD REQUEST SUMMARY ----------------------- System Request Date/Time: 05 Nov 2014 @ 0827 File Name: mhv_MHVTESTVETERAN_20141105_0827.txt Date Range Selected: 05 Nov 2009 to 05 Nov 2014 Data Types Selected: My HealtheVet Account Summary Self Reported Demographics VA Demographics Self Reported Health Care Providers Self Reported Treatment Facilities Self Reported Health Insurance VA Wellness Reminders VA Appointments (Future) VA Appointments (Limited to past 2 years) VA Allergies Self Reported Allergies VA Medication History Self Reported Medications and Supplements VA Problem List VA Admissions and Discharges VA Notes Self Reported Medical Events VA Immunizations Self Reported Immunizations VA Laboratory Results: Chemistry/Hematology/Microbiology VA Pathology Reports: Surgical Pathology/Cytology/Electron Microscopy Self Reported Labs and Tests VA Vitals and Readings Self Reported Vitals and Readings VA Radiology Reports VA Electrocardiogram (EKG) Reports Self Reported Family Health History Self Reported Military Health History Self Reported Activity Journal Self Reported Food Journal DoD Military Service Information Self Reported My Goals Current Self Reported My Goals Completed --------------------- 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 -------------------- ------ PORTLAND, OREGON VA MEDICAL CENTER na AUSTIN PSIM na SPOKANE VAMC na SURGERY QUALITY WORKFLOW MGMT na VA SOUTHERN OREGON REHABILITATION CENTER na ENROLLMENT SYSTEM REENGINEERING na AUSTIN MHV na ---------------------- SELF REPORTED DEMOGRAPHICS ----------------------- Source: Self-Entered Your self-entered information saved in My HealtheVet is not shared with other sources. First Name: ONE Middle Initial: A 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 or Destination Address: 123 Anywhere Road Mailing or Destination Address2: Apt. 123 Mailing or Destination City: Anywhere Mailing or Destination State: DC Mailing or Destination Country: United States Mailing or Destination Province: Mailing or Destination Zip/Postal Code: 00000 Home Phone Number: 000-555-2123 Work Phone Number: 000-555-4100 Pager Number: 000-555-2020 Cell Phone Number: 000-555-0303 FAX Number: 000-555-4110 Email Address: mhvveteran@emailaddress.com Preferred Method of Contact: Email EMERGENCY CONTACTS Contact First Name: Two Contact Last Name: MHVVeteran Relationship: Home Phone Number: 000-555-2121 Work Phone Number: 000-555-1000 Extension: Cell Phone Number: 000-555-1855 Address Line 1: 123 Anywhere Road Address Line 2: Apt 123 City: Anywhere State: DC Country: United States Province: Zip/Post Code: 00000 Email Address: mhvveterantwo@emailaddress.com Contact First Name: Three Contact Last Name: MHVVeteran Relationship: Home Phone Number: 000-555-2339 Work Phone Number: 000-555-5000 Extension: Cell Phone Number: 000-555-1458 Address Line 1: 123 Anwhere Road Address Line 2: Apt 123 City: Anywhere State: DC Country: United States Province: Zip/Post Code: 00000 Email Address: mhvveteranthree@emailaddress.com ---------------------------- VA DEMOGRAPHICS ---------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: VA Treating Facility Your information in My HealtheVet is not transferred to your VA Health Record. Also, VA Demographic information is not updated between VA treating facilities. If you have any questions or updates, please contact your VA health care team. ========================================================================= VA Treating Facility: VA SOUTHERN OREGON REHABILITATION CENTER CLINICS ------------------------------------------------------------------------- First Name: ONE Middle Name: A Last Name: MHVTESTVETERAN Religion: -- Ethnicity: -- Date of Birth: 01 Mar 1948 Place of Birth: WASHINGTON, DISTRICT OF COLUMBIA Age: 66 Gender: Male Marital Status: DIVORCED ------------------------------------------------------------------------- PERMANENT ADDRESS AND CONTACT INFORMATION Street Address: 123 ANYWHERE RD Street Address 2: APT 123 Work Phone Number: -- City: WASHINGTON State: DISTRICT OF COLUMBIA Zip Code: 00000 County: 001 Country: USA Home Phone Number: -- Work Phone Number: -- Cell Phone Number: -- Email Address: MHVVETERAN@EMAILADDRESS.COM ------------------------------------------------------------------------- ELIGIBILITY Primary Eligibility Code: -- Service Connected Percentage: 70 EMPLOYMENT Employment Status: NOT EMPLOYED Employer Name: -- ------------------------------------------------------------------------- ACTIVE INSURANCE Insurance Company: -- Effective Date: -- Expiration Date: -- Group Name: -- Group Number: -- Subscriber ID: -- Subscriber Name: -- Subscriber Relationship: -- ------------------------------------------------------------------------- PRIMARY NEXT OF KIN Name: MHVVETERAN, TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- EMERGENCY CONTACT Name: MHVVETERAN, TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- VA GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- CIVIL GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- ------------------------------------------------------------------------- ========================================================================= VA Treating Facility: SPOKANE VAMC ------------------------------------------------------------------------- First Name: ONE Middle Name: A Last Name: MHVTESTVETERAN Religion: -- Ethnicity: -- Date of Birth: 01 Mar 1948 Place of Birth: WASHINGTON, DISTRICT OF COLUMBIA Age: 66 Gender: Male Marital Status: DIVORCED ------------------------------------------------------------------------- PERMANENT ADDRESS AND CONTACT INFORMATION Street Address: 123 ANYWHERE RD Street Address 2: APT 123 Work Phone Number: -- City: WASHINGTON State: DISTRICT OF COLUMBIA Zip Code: 00000 County: 001 Country: USA Home Phone Number: -- Work Phone Number: -- Cell Phone Number: -- Email Address: MHVVETERAN@EMAILADDRESS.COM ------------------------------------------------------------------------- ELIGIBILITY Primary Eligibility Code: -- Service Connected Percentage: 70 EMPLOYMENT Employment Status: NOT EMPLOYED Employer Name: -- ------------------------------------------------------------------------- ACTIVE INSURANCE Insurance Company: -- Effective Date: -- Expiration Date: -- Group Name: -- Group Number: -- Subscriber ID: -- Subscriber Name: -- Subscriber Relationship: -- ------------------------------------------------------------------------- PRIMARY NEXT OF KIN Name: MHVVETERAN, TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- EMERGENCY CONTACT Name: MHVVETERAN, TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- VA GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- CIVIL GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- ------------------------------------------------------------------------- ========================================================================= VA Treating Facility: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- First Name: ONE Middle Name: A Last Name: MHVTESTVETERAN Religion: -- Ethnicity: -- Date of Birth: 01 Mar 1948 Place of Birth: WASHINGTON, DISTRICT OF COLUMBIA Age: 66 Gender: Male Marital Status: DIVORCED ------------------------------------------------------------------------- PERMANENT ADDRESS AND CONTACT INFORMATION Street Address: 123 ANYWHERE RD Street Address 2: APT 123 Work Phone Number: -- City: WASHINGTON State: DISTRICT OF COLUMBIA Zip Code: 00000 County: 001 Country: USA Home Phone Number: -- Work Phone Number: -- Cell Phone Number: -- Email Address: MHVVETERAN@EMAILADDRESS.COM ------------------------------------------------------------------------- ELIGIBILITY Primary Eligibility Code: -- Service Connected Percentage: 0 EMPLOYMENT Employment Status: NOT EMPLOYED Employer Name: -- ------------------------------------------------------------------------- ACTIVE INSURANCE Insurance Company: -- Effective Date: -- Expiration Date: -- Group Name: -- Group Number: -- Subscriber ID: -- Subscriber Name: -- Subscriber Relationship: -- ------------------------------------------------------------------------- PRIMARY NEXT OF KIN Name: MHVVETERAN, TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- EMERGENCY CONTACT Name: MHVVETERAN,TWO Street Address: 123 Anywhere Road City: ANYWHERE State: DC Zip Code: 00000 Home Phone Number: 000-444-1952 Work Phone Number: -- ------------------------------------------------------------------------- VA GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- CIVIL GUARDIAN Name: -- Street Address: -- City: -- State: -- Zip Code: -- Home Phone Number: -- Work Phone Number: -- ------------------------------------------------------------------------- ------------------ SELF REPORTED HEALTH CARE PROVIDERS ------------------ Source: Self-Entered Provider Name: One Provider Type of Provider: Primary Other Clinician Information: Phone Number: 000-285-2220 Ext: 1485 Email: oneprovider@institution.org Comments: Dr. Provider can be reached on the weekend if needed by leaving a message with the clinic. Provider Name: Two Provider Type of Provider: Specialist Other Clinician Information: Phone Number: 000-767-3200 Ext: 404 Email: specialist@institution.org Comments: Dr. Provider should be notified of any changes in my medical condition. Requires a referral from my health insurance company. ------------------ SELF REPORTED TREATMENT FACILITIES-------------------- Source: Self-Entered Facility Name: Anywhere VA Medical Center Facility Type: VA VA Home Facility: Yes Phone Number: 000-370-4468 Ext: Mailing Address: 123 VA Drive Mailing Address2: Suite 4 Mailing City: Anywhere Mailing State: VA Mailing Country: United States Mailing Province: Mailing Zip/Postal Code: 00000 Comments: Contact clinic when calling to make my appointments. Facility Name: Healthcare INC Facility Type: Non-VA VA Home Facility: No Phone Number: 000-555-3062 Ext: 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: 00000 Comments: Reminder to bring My HealtheVet printouts for all visits ------------------- SELF REPORTED HEALTH INSURANCE ---------------------- Source: Self-Entered Health Insurance Company: My Health Insurance Company Primary Insurance Provider: Yes ID Number: ADC-30105-1 Group Number: 23010 Insured: One MHVveteran Start Date: 01 Jan 2014 Stop Date: Pre-Approval Phone Number: 000-555-2101 Health Insurance Company Phone Number: 000-555-3100 Comments: Need to get pre-authorization for special services. Health Insurance Company: My Other Health Insurance Company Primary Insurance Provider: No ID Number: 030131-9942 Group Number: ABC123456789 Insured: One MHVveteran Start Date: 01 Jan 2014 Stop Date: Pre-Approval Phone Number: 000-555-8949 Health Insurance Company Phone Number: 000-555-1502 Comments: Dental Coverage --------------------------- VA WELLNESS REMINDERS ----------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Wellness Reminder Due Date Last Completed Location ------------------------------------------------------------------------- Influenza Vaccine DUE NOW UNKNOWN PORTLAND, OR Colon Cancer Screening 01 Oct 2022 01 Oct 2012 PORTLAND, OR Colon Cancer Screening DUE NOW UNKNOWN VA SOUTHERN Influenza Vaccine DUE NOW UNKNOWN SPOKANE VAMC Colon Cancer Screening DUE NOW UNKNOWN SPOKANE VAMC Pneumonia Vaccine -- 05 Nov 2014 PORTLAND, OR Body Mass Index more than 25 DUE NOW UNKNOWN PORTLAND, OR Pneumonia Vaccine DUE NOW UNKNOWN SPOKANE VAMC Control of Your Cholesterol DUE NOW UNKNOWN PORTLAND, OR Pneumonia Vaccine DUE NOW UNKNOWN VA SOUTHERN Influenza Vaccine DUE NOW UNKNOWN VA SOUTHERN 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: 05 Nov 2014 @ 0813 Sort By: Date (Descending) All future VA Appointments are shown below. Past VA Appointments are limited to two years from the date of your download request. To cancel, change or request an appointment with your VA health care team, please contact your local VA facility. PAST APPOINTMENTS: -------------------- Date/Time: 08 Oct 2014 @ 1330 Location: PORTLAND Status: CANCELLED Clinic: GEN SURG HERNIA-4A103 Phone Number: 5456 Date/Time: 08 Sep 2014 @ 1215 Location: PORTLAND Status: CANCELLED Clinic: DEMENTIA NEW-BLDG 104 Phone Number: 50820 Date/Time: 29 Jul 2014 @ 0900 Location: PORTLAND Status: APPOINTMENT NOT KEPT Clinic: MH1,D P2 Bldg 104 Phone Number: 5-5187 Date/Time: 09 Dec 2013 @ 0800 Location: PORTLAND Status: APPOINTMENT NOT KEPT Clinic: MH1,D P2 Bldg 104 Phone Number: 5-5187 Date/Time: 05 Aug 2013 @ 0800 Location: BEND Status: CANCELLED Clinic: DEMENTIA BEND CVT Phone Number: 5-1440 Date/Time: 08 Jul 2013 @ 0800 Location: PORTLAND Status: APPOINTMENT NOT KEPT Clinic: MH1,D P2 Bldg 104 Phone Number: 5-5187 Date/Time: 16 May 2013 @ 0800 Location: PORTLAND Status: CANCELLED Clinic: MH1I DOUGLAS,D P2 Bldg 104 Phone Number: 5-5187 Date/Time: 07 Jan 2013 @ 0800 Location: PORTLAND Status: APPOINTMENT NOT KEPT Clinic: MH1,D P2 Bldg 104 Phone Number: 5-5187 ----------------------------- VA ALLERGIES ------------------------------ Source: VA Last Updated: 05 Nov 2014 @ 0812 Remember to share all information about your allergies with your health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. Allergy Name: IMIPRAMINE Location: PORTLAND, OREGON VA MEDICAL CENTER Date Entered: 07 Dec 2012 Reaction: ANAPHYLAXIS Allergy Type: DRUG VA Drug Class: TRICYCLIC ANTIDEPRESSANTS Observed/Historical: OBSERVED Comments: severe 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: 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: 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: -- 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: 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 Remember to share all information about your allergies with your health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. Allergy information. -------------------------- SELF REPORTED ALLERGIES -------------------- 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 Allergy Name: Diovan Date: 07 Jan 2013 Severity: Mild Diagnosed: No Reaction: Dry cough Comments: I called my provider and told him the reaction I had. He is calling in a new Rx for my HTN -------------------------- VA MEDICATION HISTORY ---------------------- Source: VA Last Updated: 28 Oct 2014 @ 1026 Sorted By: Last Filled On (Descending) Remember to share all information about your medications or updates with your VA health care team. Also, check information in your VA Allergies and your Self Reported Allergies. This may let you know if you had a reaction to a medication you received. If you have any questions about your information please visit the FAQs or contact your VA health care team. Medication: ASPIRIN 81MG EC TAB Instructions: TAKE ONE TABLET BY MOUTH EVERY DAY Status: Active Refills Remaining: 3 Last Filled On: 14 Oct 2014 Initially Ordered On: 14 Oct 2014 Quantity: 30 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11936697 Medication: ASPIRIN 325MG EC TAB Instructions: TAKE ONE TABLET BY MOUTH EVERY DAY Status: Active Refills Remaining: 11 Last Filled On: 24 Sep 2014 Initially Ordered On: 25 Aug 2014 Quantity: 1 Days Supply: 1 Pharmacy: PORTLAND PHARMACY Prescription Number: 11925371 Medication: AMLODIPINE BESYLATE 5MG TAB Instructions: TAKE ONE-HALF TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE Status: Expired Refills Remaining: 2 Last Filled On: 01 Mar 2013 Initially Ordered On: 10 Dec 2012 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11532047 Medication: DONEPEZIL HCL 5MG TAB Instructions: TAKE ONE TABLET BY MOUTH EVERY MORNING Status: Expired Refills Remaining: 10 Last Filled On: 16 Feb 2013 Initially Ordered On: 10 Dec 2012 Quantity: 30 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11532048 Medication: HCTZ 25/TRIAMTERENE 37.5MG TAB Instructions: TAKE ONE-HALF TABLET (12.5/18.75 MG) BY MOUTH EVERY DAY Status: Expired Refills Remaining: 3 Last Filled On: 11 Dec 2012 Initially Ordered On: 10 Dec 2012 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11532051 Medication: FLUOXETINE HCL 10MG CAP Instructions: TAKE ONE CAPSULE BY MOUTH EVERY MORNING Status: Expired Refills Remaining: 3 Last Filled On: 11 Dec 2012 Initially Ordered On: 10 Dec 2012 Quantity: 90 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11532050 Medication: AMLODIPINE BESYLATE 10MG TAB Instructions: TAKE ONE-HALF TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE -- AVOID GRAPEFRUIT JUICE -- Status: Discontinued Refills Remaining: 3 Last Filled On: 15 Jul 2012 Initially Ordered On: 15 Jul 2012 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181487A Medication: COLON ELECTROLYTE LAVAGE PWD FOR SOLN Instructions: MIX 1 GALLON IN WATER AND DRINK AS DIRECTED FOR 1 DAY DISSOLVE 1 BOTTLE Status: Discontinued Refills Remaining: 0 Last Filled On: 15 Jul 2012 Initially Ordered On: 13 Jul 2012 Quantity: 1 Days Supply: 2 Pharmacy: PORTLAND PHARMACY Prescription Number: 11461309 Medication: ACCU-CHEK AVIVA (GLUCOSE) TEST STRIP #50 Instructions: USE 1 STRIP FOR BLOOD GLUCOSE TESTING AS DIRECTED Status: Discontinued Refills Remaining: 2 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 200 Days Supply: 50 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181484A Medication: SODIUM CHLORIDE 0.65% SOLN NASAL Instructions: SPRAY 2 SPRAYS MOUTH MINUTE FOR 30 DAYS Status: Discontinued Refills Remaining: 3 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 10 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181532A 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: Discontinued Refills Remaining: 2 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181502A Medication: NAPROXEN 500MG TAB Instructions: TAKE ONE TABLET BY MOUTH TWICE A DAY -- TAKE WITH FOOD IF GI Status: Discontinued Refills Remaining: 3 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 60 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181531A Medication: METFORMIN HCL 1000MG TAB Instructions: TAKE ONE TABLET BY MOUTH TWICE DAILY WITH MEALS FOR DIABETES. Status: Discontinued Refills Remaining: 2 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 180 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181499A Medication: LISINOPRIL 10MG TAB Instructions: TAKE ONE TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE Status: Discontinued Refills Remaining: 3 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 30 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181497A 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: Discontinued Refills Remaining: 2 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 3 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181494A Medication: INSULIN NPH HUMAN 100 UNIT/ML NOVOLIN N Instructions: INJECT 16 UNITS SUBCUTANEOUSLY EVERY MORNING AND INJECT 18 UNITS AT BEDTIME EACH VIAL EXPIRES 30 DAYS AFTER FIRST OPENING. Status: Discontinued Refills Remaining: 1 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 3 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181492A Medication: IBUPROFEN 600MG TAB Instructions: TAKE ONE TABLET BY MOUTH FOUR TIMES DAILY WITH MEALS AS NEEDED FOR PAIN Status: Discontinued Refills Remaining: 3 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 240 Days Supply: 60 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181491A Medication: DEXAMETHASONE 4MG TAB Instructions: TAKE TWO TABLETS BY MOUTH HOUR FOR 2 DAYS -- TAKE WITH FOOD -- Status: Discontinued Refills Remaining: 2 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 96 Days Supply: 30 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181530A 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: Discontinued Refills Remaining: 1 Last Filled On: 09 Jul 2012 Initially Ordered On: 06 Jul 2012 Quantity: 10 Days Supply: 45 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181529A Medication: AMLODIPINE BESYLATE 10MG TAB Instructions: TAKE ONE-HALF TABLET BY MOUTH EVERY DAY FOR BLOOD PRESSURE -- AVOID GRAPEFRUIT JUICE -- Status: Expired Refills Remaining: 2 Last Filled On: 17 May 2012 Initially Ordered On: 03 Jun 2011 Quantity: 45 Days Supply: 90 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181487 Medication: IBUPROFEN 600MG TAB Instructions: TAKE ONE TABLET BY MOUTH FOUR TIMES DAILY WITH MEALS AS NEEDED FOR PAIN Status: Expired Refills Remaining: 2 Last Filled On: 17 Feb 2012 Initially Ordered On: 03 Jun 2011 Quantity: 240 Days Supply: 60 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181491 Medication: ACCU-CHEK AVIVA (GLUCOSE) TEST STRIP #50 Instructions: USE 1 STRIP FOR BLOOD GLUCOSE TESTING AS DIRECTED Status: Expired Refills Remaining: 1 Last Filled On: 05 Dec 2011 Initially Ordered On: 03 Jun 2011 Quantity: 200 Days Supply: 50 Pharmacy: PORTLAND PHARMACY Prescription Number: 11181484 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: Expired 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: 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: Expired 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: 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 Medication: METFORMIN HCL 1000MG TAB Instructions: TAKE ONE TABLET BY MOUTH TWICE DAILY WITH MEALS FOR DIABETES. Status: Expired 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: 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: 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: 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: 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: 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: Expired 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: COLONIC LAVAGE SOLUTION (4 LITER) Instructions: MIX 1 GALLON IN WATER AND DRINK AS DIRECTED FOR 1 DAY DISSOLVE 1 BOTTLE Status: Expired 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 ----------------- SELF REPORTED MEDICATIONS AND SUPPLEMENTS ------------- Source: Self-Entered Remember to share all information about your medications or updates with your health care team. Category: OTC Drug Name: Cough Medicine Prescription Number: Strength: 1000mg Dose: 2 TBS Frequency: morning and night Start Date: 01 Feb 2010 Stop Date: 21 Feb 2010 Pharmacy Name: My Local Drugstore Pharmacy Phone: 000-010-0000 Reason for taking: Cough was keeping me up at night Comments: Cleared up after a few weeks Category: Supplement Drug Name: Multi-vitamin Prescription Number: Strength: 100% RDA Dose: 1 tablet daily Frequency: morning Start Date: 18 Mar 2010 Stop Date: Pharmacy Name: My Local Drugstore Pharmacy Phone: 000-010-0000 Reason for taking: To stay healthy Comments: Feeling more energetic since I started taking vitamin ---------------------------- VA PROBLEM LIST ---------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Date/Time Entered (Descending) then alphabetically by Problem Your VA Problem List contains active health problems your VA providers are helping you to manage. This information is available 3 calendar days after it has been entered. It may not contain active problems managed by non-VA health care providers. If you have any questions about your information, visit the FAQs or contact your VA health care team. Problem: Posttraumatic Stress Disorder (ICD-9-CM 309.81) Date/Time Entered: 11 Feb 2013 @ 1200 Location: PORTLAND, OREGON VA MEDICAL CENTER Status: ACTIVE Provider: PROVIDER, ONE Comments: AWAITING A COMP AND PEN EXAM comment #1 Comment #2 comment #3 Problem: MILD COGNITIVE IMPAIRMENT (ICD-9-CM 799.9) Date/Time Entered: 16 Jan 2013 @ 1200 Location: PORTLAND, OREGON VA MEDICAL CENTER Status: ACTIVE Provider: PROVIDER, ONE Comments: this is only a test INDEPENDENT IN ADLs AND IADLs Problem: Diabetes with neurological Manifestations, type i [Juvenile type], not stated as (ICD-9-CM 250.61) Date/Time Entered: 07 Dec 2012 @ 1200 Location: PORTLAND, OREGON VA MEDICAL CENTER Status: ACTIVE Provider: PROVIDER, ONE Comments: -- Problem: Hyperlipidemia (ICD-9-CM 272.4) Date/Time Entered: 07 Dec 2012 @ 1200 Location: PORTLAND, OREGON VA MEDICAL CENTER Status: ACTIVE Provider: PROVIDER, ONE Comments: -- Problem: TRAUMATIC BRAIN INJURY (ICD-9-CM 799.9) Date/Time Entered: 07 Dec 2012 @ 1200 Location: PORTLAND, OREGON VA MEDICAL CENTER Status: ACTIVE Provider: PROVIDER, ONE Comments: -- --------------------- VA ADMISSIONS AND DISCHARGES ---------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Admission Date/Time (Descending) Discharge summaries are available 3 calendar days after they are completed. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= Admission Date: 10 Dec 2012 @ 0935 Location: PORTLAND, OREGON VA MEDICAL CENTER Admitting Physician: PROVIDER, ONE Discharge Date: 11 Dec 2012 @ 1134 Discharge Physician: PROVIDER, ONE ----------------------------------------------------------------------------- DISCHARGE SUMMARY LOCAL TITLE: Discharge Summary STANDARD TITLE: DISCHARGE SUMMARY DICT DATE: DEC 10, 2012@10:40 ENTRY DATE: DEC 10, 2012@10:41:06 DICTATED BY: PROVIDER, ONE ATTENDING: PROVIDER, ONE URGENCY: routine STATUS: COMPLETED THIS IS ONLY A TEST ATTENDING PHYSICIAN: PRIMARY CARE PROVIDER AND FACILIITY: PRINCIPAL DIAGNOSIS: OTHER DIAGNOSES TREATED OR IMPACTING TREATMENT THIS ADMISSION: PROCEDURES PERFORMED AT THIS HOSPITAL DURING CURRENT ADMISSION: SUMMARY: (ABBREVIATED HPI, PE, AND PERTINENT LABS) HOSPITAL COURSE: FUNCTIONAL STATUS: (MAY INCLUDE ACTIVITY LEVEL, WORK RESTRICTIONS, OR DIET) DISCHARGE MEDICATIONS: (INDICATE ADDITIONS OR CHANGES WITH AN ASTERISK) MEDICATIONS THAT HAVE BEEN DISCONTINUED: CLINICAL ISSUES REQUIRING FOLLOW UP DURING PC PHONE APT: 1. 2. 3. ADDITIONAL FOLLOW UP APPOINTMENTS: SPECIALTY EXPECTED DATE SCHEDULED(Y/N) POINT OF CONTACT 1. 2. 3. FOLLOW UP LABS INCLUDING PATHOLOGY & MICROBIOLOGY: TEST ORDERED(Y/N) EXPECTED DATE IF NOT ORDERED 1. 2. 3. FOLLOW UP IMAGING AND PROCEDURES: PROCEDURE ORDERED(Y/N) EXPECTED DATE IF NOT ORDERED 1. 2. 3. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 12/10/2012 16:15 for TWO PROVIDER MD INTERNAL MEDICINE RESIDENT ------------------------------- VA NOTES -------------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Date/Time (Descending) VA Notes from January 1, 2013 forward are available 3 calendar days after they have been completed and signed by all required members of your VA health care team. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= Date/Time: 23 Jul 2014 @ 0932 Note Title: AUDIOLOGY - GENERAL Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 23 Jul 2014 @ 0933 ------------------------------------------------------------------------- LOCAL TITLE: AUDIOLOGY - GENERAL STANDARD TITLE: AUDIOLOGY NOTE DATE OF NOTE: JUL 23, 2014@09:32 ENTRY DATE: JUL 23, 2014@09:32:57 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED THIS IS ONLY A TEST. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 07/23/2014 09:33 ------------------------------------------------------------------------- ========================================================================= Date/Time: 25 Jan 2013 @ 0701 Note Title: CARDIOLOGY - FOLLOW-UP Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 25 Jan 2013 @ 0707 ------------------------------------------------------------------------- LOCAL TITLE: CARDIOLOGY - FOLLOW-UP STANDARD TITLE: CARDIOLOGY OUTPATIENT NOTE DATE OF NOTE: JAN 25, 2013@07:01 ENTRY DATE: JAN 25, 2013@07:02:25 AUTHOR: PROVIDER, TWO EXP COSIGNER: PROVIDER, ONE URGENCY: STATUS: COMPLETED Mr. ONE A MHVTESTVETERAN is a 64 yo M with a PMHx as below who presents in routine follow-up. Past Cardiology History:Patient family history of cardiac stess and disease (uncle and older brother) all with diabetes. SUBJECTIVE: OBJECTIVE: Active Medications: 1) Amlodipine besylate 5mg tab take one-half tablet by mouth every day for blood pressure 2) Donepezil hcl 5mg tab take one tablet by mouth every morning 3) Fluoxetine hcl 10mg cap take one capsule by mouth every morning 4) Hctz 25/triamterene 37.5mg tab take one-half tablet (12.5/18.75 mg) by mouth every day active non-va medications status ========================================================================= 1) Non-va fish oil cap/tab 1 cap/tab mouth every day 2) Non-va ginkgo biloba small amount mouth every day 3) Non-va kava cap/tab 1 cap/tab mouth every day 4) Non-va lisinopril 5mg tab 2.5mg mouth every day 8 total medications) Physical Exam: Vitals: 98.5 F [36.9 C] (12/10/2012 09:24) 190/70 (01/07/2013 15:27) 88 (12/10/2012 09:24) No assessments on file. BSA : 2.569 sq. meters on 12/10/2012 09:24 BODY MASS INDEX DEC 10, 2012@09:24:38 46.7 GEN - NECK - CV - PULM - EXT - Lab Studies: Mixed dates for most recent tests of this panel No CBC in last year 145 H : 102 : 25 H / \ N/A / MCV: N/A ------ : ------ : ------ 150 H N/A ----- N/A SEGS: N/A 6.5 H*: 25 : 1.2 \ / N/A \ BANDS: N/A ASSESSMENT/PLAN: Mr. ONE A MHVTESTVETERAN is a 64 yo M with a PMHx as above who presents in routine follow-up. IMPRESSION: 1. 2. 3. 4. PLAN:Order a series of test to include a stress test and a series of cardiac lab panels. Will also review patient's current medication history and revise accordingly. FELLOW SUPERVISION: Staffed with Dr. Provider who agrees with my assessment and plan. /es/ TWO PROVIDER, MD Chief of Clinical Appl Coord Signed: 01/25/2013 07:07 /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Cosigned: 02/11/2013 07:55 ------------------------------------------------------------------------- ========================================================================= Date/Time: 25 Jan 2013 @ 0655 Note Title: INPAT - MED - MS - PROGRESS Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, TWO Co-signed By: PROVIDER, TWO Date/Time Signed: 25 Jan 2013 @ 0700 ------------------------------------------------------------------------- LOCAL TITLE: INPAT - MED - MS - PROGRESS STANDARD TITLE: STUDENT INPATIENT NOTE DATE OF NOTE: JAN 25, 2013@06:55 ENTRY DATE: JAN 25, 2013@06:56:26 AUTHOR: PROVIDER, TWO EXP COSIGNER: PROVIDER, ONE URGENCY: STATUS: COMPLETED *** INPAT - MED - MS - PROGRESS Has ADDENDA *** Patient presented and discussed at multi-disciplinary rounds today: Yes during patient interview< ia sked Mr. MHV if his family had a history of cardiac issues and diabetes, he replied that yes there was a history of both with his uncle and older brother. This new line of questioning was in response to a comment he made earlier to his RN. Plan to follow up with Dr. Provider, the resident which is providing care for Mr. MHV. The patient was staffed with Dr. Provider who agrees with my assessment and plan. /es/ TWO PROVIDER Chief of Clinical Appl Coord Signed: 01/25/2013 07:00 /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Cosigned: 02/11/2013 07:55 01/25/2013 ADDENDUM STATUS: COMPLETED this is only a test of making an addendum /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/25/2013 11:48 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1437 Note Title: PHYSICAL THERAPY - INPATIENT NOTE Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1438 ------------------------------------------------------------------------- LOCAL TITLE: PHYSICAL THERAPY - INPATIENT NOTE STANDARD TITLE: PHYSICAL THERAPY INPATIENT NOTE DATE OF NOTE: JAN 24, 2013@14:37 ENTRY DATE: JAN 24, 2013@14:38 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED S: Pain level: Pain location: O: A: (progress toward goals) P: THIS IS ONLY A TEST /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:38 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1436 Note Title: INPAT - CT SURG - ADMIT Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1437 ------------------------------------------------------------------------- LOCAL TITLE: INPAT - CT SURG - ADMIT STANDARD TITLE: THORACIC SURGERY INPATIENT NOTE DATE OF NOTE: JAN 24, 2013@14:36 ENTRY DATE: JAN 24, 2013@14:37:02 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED I have seen and discussed the patient with my supervising practitioner, Dr. Two Provider, and Dr. Three Provider who is in agreement with the assesment and plan. Patient Name: MHVTESTVETERAN,ONE A S: THIS IS ONLY A TEST O: POD# s/p: No vitals data available in last 24 hours. I/O: Last CHEM 7 After 0500 JAN 24, 2013: N/A : N/A : N/A / ------ : ------ : ------ N/A N/A : N/A : N/A \ Last CBC w/Diff After 0500 JAN 24, 2013: \ N/A / MCV N/A N/A -------- N/A SEGS N/A / N/A \ BANDS N/A Active Medications: Neuro: AAO Pulm: CTAB CV: NRRR Abd: soft, NT, +BS Ext: Incision intact No hematoma A: P: /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:37 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1435 Note Title: SPECIALTY CLINIC PROGRESS NOTE Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1435 ------------------------------------------------------------------------- LOCAL TITLE: SPECIALTY CLINIC PROGRESS NOTE STANDARD TITLE: NURSING NOTE DATE OF NOTE: JAN 24, 2013@14:35 ENTRY DATE: JAN 24, 2013@14:35:11 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED This is only a test. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:35 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1433 Note Title: DAILY PERIPHERAL LINE - MAINTENANCE Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1434 ------------------------------------------------------------------------- LOCAL TITLE: DAILY PERIPHERAL LINE - MAINTENANCE STANDARD TITLE: TEAM NOTE DATE OF NOTE: JAN 24, 2013@14:33 ENTRY DATE: JAN 24, 2013@14:33:56 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED *** DAILY PERIPHERAL LINE - MAINTENANCE Has ADDENDA *** Maintenance done: Jan 25,2013@07:00 IV Type:Peripheral Location: Right hand Site flushed with Saline Patent Dressing: Dry and Intact Phlebitis (REQUIRED): 0 = No symptoms. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:34 01/25/2013 ADDENDUM STATUS: COMPLETED Appearance/Behavior: This is a well developed and well nourished Caucasian MALE seated in no apparent distress. Thought Processing: Speech is regular rate and rhythm, normal volume with no thought disorder. Thought Content: Patient thoughts marked by no evidence of psychotic symptoms, no evidence of SI or HI. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/25/2013 11:48 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1431 Note Title: GEN SURG - ATTENDING Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1432 ------------------------------------------------------------------------- LOCAL TITLE: GEN SURG - ATTENDING STANDARD TITLE: SURGERY ATTENDING NOTE DATE OF NOTE: JAN 24, 2013@14:31 ENTRY DATE: JAN 24, 2013@14:32:05 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED *** GEN SURG - ATTENDING Has ADDENDA *** THIS IS ONLY A TEST /es/ PROVIDER ONE MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:32 01/25/2013 ADDENDUM STATUS: COMPLETED ID: ONE A MHVTESTVETERAN is a 64 y/o WHITEMALE who is referred for Dementia Clinic Evaluation. Source: CC:" " HPI: Past Medical History: Previous Cognitive Testing: DEMENTIA EVALUATIONS DEM: SLUMS SCORE 12/10/2012 28 Medications: Active Medications: 1) Amlodipine besylate 5mg tab take one-half tablet by mouth every day for blood pressure 2) Donepezil hcl 5mg tab take one tablet by mouth every morning 3) Fluoxetine hcl 10mg cap take one capsule by mouth every morning 4) Hctz 25/triamterene 37.5mg tab take one-half tablet (12.5/18.75 mg) by mouth every day active non-va medications status ========================================================================= 1) Non-va fish oil cap/tab 1 cap/tab mouth every day 2) Non-va ginkgo biloba small amount mouth every day 3) Non-va kava cap/tab 1 cap/tab mouth every day 4) Non-va lisinopril 5mg tab 2.5mg mouth every day 8 total medications) METHOCARBAMOL, TERAZOSIN, BACTRIM, TRAMADOL, TRIMETHOPRIM, IMIPRAMINE Habits: Family History: Social History: REVIEW OF SYSTEMS Mood: Sleep: Energy: Appetite: Concentration: Obsessive Thoughts: Compulsions: Hallucinations: Delusions: Anxiety: ST LOUIS MENTAL STATUS EXAMINATION ACTIVITIES OF DAILY LIVING SCORE INSTRUMENTAL ACTIVITIES OF DAILY LIVING SCORE NEUROBEHAVIORAL COGNITIVE STATUS EXAM Level of Consciousness: Orientation: /12 Attention: ()Passed Screen or /8 Language Comprehension: ()Passed Screen or /6 Language Repetition: ()Passed Screen or /12 Naming: ()Passed Screen or /8 Construction: ()Passed Screen or /6 Memory: /12 Calculation: ()Passed Screen or /4 Similarities: ()Passed Screen or /8 Judgment: ()Passed Screen or /6 NEUROLOGICAL EXAM Station and Gait: Cranial Nerves: Motor Exam: Sensory Exam: Reflexes: Coordination: MENTAL STATUS EXAM Appearance/Behavior Thought Processing Thought Content Mood/Affect Sensorium/Intellect Insight/Judgment IMAGING STUDIES LABORATORY STUDIES DIAGNOSTIC FORMULATION DSM IV DIAGNOSIS Axis I Axis II Axis III Axis IV Axis V TREATMENT PLAN /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/25/2013 11:47 ------------------------------------------------------------------------- ========================================================================= Date/Time: 24 Jan 2013 @ 1430 Note Title: PDHC - NEW PCP Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 24 Jan 2013 @ 1431 ------------------------------------------------------------------------- LOCAL TITLE: PDHC - NEW PCP STANDARD TITLE: OEF/OIF NOTE DATE OF NOTE: JAN 24, 2013@14:30 ENTRY DATE: JAN 24, 2013@14:31:16 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED *** PDHC - NEW PCP Has ADDENDA *** This is only a test. /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/24/2013 14:31 01/25/2013 ADDENDUM STATUS: COMPLETED this is only a test /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/25/2013 11:47 ------------------------------------------------------------------------- ========================================================================= Date/Time: 08 Jan 2013 @ 1145 Note Title: 10-10M Location: VA SOUTHERN OREGON REHABILITATION CENTER CLINICS Signed By: PROVIDER, THREE Co-signed By: PROVIDER, THREE Date/Time Signed: 08 Jan 2013 @ 1146 ------------------------------------------------------------------------- LOCAL TITLE: 10-10M STANDARD TITLE: PHYSICIAN NOTE DATE OF NOTE: JAN 08, 2013@11:45 ENTRY DATE: JAN 08, 2013@11:45:58 AUTHOR: PROVIDER, THREE EXP COSIGNER: URGENCY: STATUS: COMPLETED Testing for national and VISN for Open Notes project /es/ THREE PROVIDER MD PACT Signed: 01/08/2013 11:46 ------------------------------------------------------------------------- ========================================================================= Date/Time: 07 Jan 2013 @ 1428 Note Title: SECURE MESSAGING Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 07 Jan 2013 @ 1429 ------------------------------------------------------------------------- LOCAL TITLE: SECURE MESSAGING STANDARD TITLE: MHV DIALOG NOTE DATE OF NOTE: JAN 07, 2013@14:28 ENTRY DATE: JAN 07, 2013@14:28:52 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED *** SECURE MESSAGING Has ADDENDA *** THIS IS A TEST /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/07/2013 14:29 01/07/2013 ADDENDUM STATUS: COMPLETED CLINICAL REMINDER ACTIVITY *Annual OTC/Non-VA Med Review: Reviewed medication list with patient. New OTC/Non-VA medications to be added to list. DM NEPHROPATHY SCREENING: Angiotensin II receptor blocker therapy is contraindicated. Comment: test patient Eval of Positive Depression Screen: Rescreen with PHQ-2 if most recent previous screen is > 1 day old. A PHQ-2 screen was performed. The score was 0 which is a negative screen for depression. 1. Little interest or pleasure in doing things Not at all 2. Feeling down, depressed, or hopeless Not at all Are you feeling hopeless about the present or future? NO Have you had thoughts recently about taking your life? NO ASSESSMENT: Suicide risk screen is negative. PROVIDER EVALUATION The results of the PHQ depression screen have been reviewed. I have personally evaluated the patient including inquiry about feelings of hopelessness, suicidal thoughts, suicide plan if thoughts are present, and prior suicide attempts. Based on the evaluation, the following disposition plan will be implemented: No mental health condition requiring further intervention. Comment: test patient *Influenza Reminder: Patient was given influenza vaccination today for flu prevention. Influenza Dose: 0.5 ml Route/Site: IM Left Deltoid Lot Number: 1225 1P Exp. Date: May 31, 2013 (Manufacturer: Novartis) Given by: Staff Nurse Patient was given a copy of 2012-2013 Vaccine Information Statement for Influenza and verbalized an understanding of the document. Patient has been advised of possible side effects (rash, hives, nausea, difficulty breathing, redness, unusual pain, fever) and given the following instructions: *Notify the nurse immediately if any side effects are experienced. *If any urgent or emergent problems are experienced after leaving the clinical area report to the nearest emergency room or call 911. *Nurse/MA BP>=140/90: Repeat BP: 190/70 *Diabetes Foot Exam: Diabetic Visual Foot Exam: Visual foot exam is normal. Pedal Pulse Foot Exam: Pedal pulse foot exam is normal. Sensory Foot Exam by Monofilament: Monofilament sensory foot exam is normal. *Vitals: Pain: 3 What does your pain level need to be for you to experience rest and comfort: Elevated Pain Score: Latest pain score reported by patient: 8 (12/10/2012 09:24). *Diabetes-Retinal Exam: Retinal exam done within the past year at an outside location. Retinal exam done within the past year at an outside location. Result: No Retinopathy Verify month and year: January 2, 2013 Results: outside hospital CHF ACE/ARB Review: Medications reviewed for ACE inhibitor/Angiotensin II receptor blocker therapy. Current medications include ACE inhibitor/Angiotensin receptor blocker therapy. Diabetes or CVD Elevated LDL: No lipid treatment change is needed based on patient's current status. Comment: test patient Eval Positive AUDIT-C Screen: SCREEN FOR ALCOHOL (AUDIT-C) An alcohol screening test (AUDIT-C) was negative (score=0). 1. How often did you have a drink containing alcohol in the past year? Never 2. How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? Response not required due to responses to other questions. 3. How often did you have six or more drinks on one occasion in the past year? Response not required due to responses to other questions. The patient reports drinking below the recommended limits. The patient was advised to continue to drink within recommended limits, which were reviewed with patient. The medical risks of alcohol and the risks of drinking over the safe limits were reviewed. This issue will be addressed at the next yearly screening. HTN/DM BP>140/90: Repeat BP: 190/70 The patient's blood pressure is usually adequately controlled. No medication changes are indicated at this time. Comment: test patient Based on the patient's comorbidities and condition, no education to improve BP control is warranted at this time. Comment: test patient Evaluation of + Depression Screen: Are you feeling hopeless about the present or future? NO Have you had thoughts recently about taking your life? NO ASSESSMENT: Suicide risk screen is negative. PROVIDER EVALUATION The results of the PHQ depression screen have been reviewed. I have personally evaluated the patient including inquiry about feelings of hopelessness, suicidal thoughts, suicide plan if thoughts are present, and prior suicide attempts. Based on the evaluation, the following disposition plan will be implemented: No mental health condition requiring further intervention. Comment: test patient Evaluation of + PTSD Screen: Are you feeling hopeless about the present or future? NO Have you had thoughts recently about taking your life? NO ASSESSMENT: Suicide risk screen is negative. PROVIDER EVALUATION: The results of the PTSD screen have been reviewed. I have personally evaluated the patient including inquiry about feelings of hopelessness, suicidal thoughts, suicide plan if thoughts are present, and prior suicide attempts. Based on the evaluation, the following disposition plan will be implemented: No mental health condition requiring further intervention. Comment: test patient /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/07/2013 15:31 ------------------------------------------------------------------------- ========================================================================= Date/Time: 07 Jan 2013 @ 1427 Note Title: MHD - INDIVIDUAL NOTE Location: PORTLAND, OREGON VA MEDICAL CENTER Signed By: PROVIDER, ONE Co-signed By: PROVIDER, ONE Date/Time Signed: 07 Jan 2013 @ 1428 ------------------------------------------------------------------------- LOCAL TITLE: MHD - INDIVIDUAL NOTE STANDARD TITLE: MENTAL HEALTH OUTPATIENT NOTE DATE OF NOTE: JAN 07, 2013@14:27 ENTRY DATE: JAN 07, 2013@14:28:02 AUTHOR: PROVIDER, ONE EXP COSIGNER: URGENCY: STATUS: COMPLETED THIS IS A TEST. THIS IS ONLY A TEST /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Signed: 01/07/2013 14:28 /es/ ONE PROVIDER MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST Cosigned: 05/03/2013 09:43 for ------------------------------------------------------------------------- --------------------- SELF REPORTED MEDICAL EVENTS ---------------------- Source: Self-Entered Medical Event: Broken right arm Start Date: 04 Jan 2010 Stop Date: 17 Feb 2010 Response: Placed in cast from my hand to my elbow Comments: Went to community hospital emergency room since I was on vacation. Followed up with my VA doctor when I returned home. Medical Event: Rebroke R Arm Start Date: 07 Jan 2013 Stop Date: Response: Slipped and fell on ice. Placed in cast from my hand to my elbow Comments: Need to F/U with VA PCP ----------------------------- VA IMMUNIZATIONS -------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Your VA Immunizations list may not be complete. If you have any questions about your information, visit the FAQs or contact your VA health care team. ========================================================================= This section shows your five most recent immunization records. Sorted By: Date Received(Descending) Immunization Date Received ------------------------------------------------------------------------- INFLUENZA-H1N1-09, NOVEL (PANDEMIC) 07 Dec 2012 @ 1155 TETANUS DIPTHERIA (TD-ADULT) 07 Dec 2012 @ 1155 INFLUENZA-H1N1-09, NOVEL (PANDEMIC) 01 Oct 2012 @ 1200 PNEUMOCOCCAL 06 Mar 2011 @ 0900 PNEUMOVAX POLYSACCHARIDE PPSV23 06 Mar 2011 @ 0900 ========================================================================= This section shows all of the immunizations listed in your VA health record, grouped by immunization. Sorted By: Immunization Name, then Date (Descending) ------------------------------------------------------------------------- Immunization: INFLUENZA-H1N1-09, NOVEL (PANDEMIC) Date Received: 07 Dec 2012 @ 1155 Location: PORTLAND (OR) VAMC Reaction:* None Reported Comments: Novartis;#10127605;Feb 2010 Immunization: INFLUENZA-H1N1-09, NOVEL (PANDEMIC) Date Received: 01 Oct 2012 @ 1200 Location: PORTLAND (OR) VAMC Reaction:* None Reported Comments: -- ------------------------------------------------------------------------- Immunization: PNEUMOCOCCAL Date Received: 06 Mar 2011 @ 0900 Location: PORTLAND (OR) VAMC Reaction:* None Reported Comments: Inj type: IM, Site:Lt Deltoid ------------------------------------------------------------------------- Immunization: PNEUMOVAX POLYSACCHARIDE PPSV23 Date Received: 06 Mar 2011 @ 0900 Location: PORTLAND (OR) VAMC Reaction:* None Reported Comments: Inj type: IM, Site:Lt Deltoid ------------------------------------------------------------------------- Immunization: TETANUS DIPTHERIA (TD-ADULT) Date Received: 07 Dec 2012 @ 1155 Location: PORTLAND (OR) VAMC Reaction:* None Reported Comments: 1234567 ======================================================================== Reaction Key: * = Check information in your VA Allergies and Adverse Reactions as well as your Self Reported Allergies. This may let you know if you had a reaction to an immunization you received. -------------------- SELF REPORTED IMMUNIZATIONS ------------------------ Source: Self-Entered Immunization: Tetanus Other: Booster Method: Injection Date Received: 07 Jan 2013 Reactions: --------------------------------- Comments: Stepped on a board with rusty nails in it. Nail just broke the skin 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: 05 Nov 2014 @ 0813 Sorted By: Date Specimen Collected (Descending) Lab Test(Alphabetical Order), then Time Specimen Collected VA Laboratory Results are available 3 calendar days after they have been verified. For some tests, results slightly outside the reference range are not unusual. In addition, not all results are clinically significant. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= Lab Test: Potassium Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 17 Jan 2013 @ 1341 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: POTASSIUM Result: 6.5 Critical High 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: GRAM STAIN - MISC............. Lab Type: Microbiology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: LUNG Collection Sample: SPUTUM, EXPECTORATED Date/Time Collected: 12 Dec 2012 @ 1200 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Date/Time Completed: 07 Jan 2013 @ 1200 ------------------------------------------------------------------------- GRAM STAIN: POSITIVE CULTURE RESULTS: STAPHYLOCOCCUS AUREUS - Quantity: 250 Comment: TEST ANTIBIOTIC SUSCEPTIBILITY TEST RESULTS: STAPHYLOCOCCUS AUREUS : CEFAZOLIN..................... S CIPROFLOXACIN................. S DOXYCYCLINE................... S LINEZOLID..................... S MOXIFLOXACIN.................. S OXACILLIN..................... S PENICILLIN.................... R PIPERACILLIN/TAZOBAC.......... S TRIMETH/SULFA................. S CLINDAMYCIN................... S ERYTHROMYCIN.................. S VANCOMYCIN.................... S Bacteriology Remark(s): TEST ----------------------------------------------------------------------------- Result Key: SUSC = Susceptibility Result S = Susceptible INTP = Interpretation I = Intermediate MIC = Minimum Inhibitory Concentration R = Resistant ========================================================================= Lab Test: Glycohemoglobin A(1) C Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Whole blood Date/Time Collected: 12 Dec 2012 @ 0811 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL Result: 8.5 High Units: % Reference Range: (3.4-6.1) Interpretation: *** If Diabetic, recommended HgA1C should be <7% *** Hemoglobin A1c values reported after 1-1-95 are standardized in accordance with recommendations of the Diabetes Control and Complications Trial(DCCT). Based on these recommendations, a upward shift in reported results will be noted. A table depicting this shift is available in Chemistry on request. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Cell Count Body Fluid Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Cerebral spinal fluid Date/Time Collected: 12 Dec 2012 @ 0810 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: APPEARANCE BODY FLUID Result: CLEAR Units: -- Reference Range: Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: COLOR Result: YELLOW Units: -- Reference Range: Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: ERYTHROCYTES Result: 10 High Units: #/cumm Reference Range: (0-0) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: LEUKOCYTES Result: 250 High Units: #/cumm Reference Range: (0-6) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: TUBE NUMBER Result: 1 Units: -- Reference Range: Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: XANTHOCHROMIA, CSF Result: NEG Units: -- Reference Range: Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Albumin/Creat Ratio Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Urine Date/Time Collected: 12 Dec 2012 @ 0810 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: ALBUMIN Result: 25 High Units: MG/DL Reference Range: (0-2) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: ALBUMIN/CREATININE Result: 20 Units: mg/g Reference Range: (<30) Interpretation: Reference range change per ADA Guidelines. Normal <30 mg/g Microalbuminuria 30 - 299 mg/g Clinical Albuminuria >300 mg/g Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: CREATININE Result: 1.2 Units: mg/dL Reference Range: Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Lipid Panel Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0809 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: CHOLESTEROL Result: 165 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 97239-2964 Status: Final ---------------------- Test Name: CHOLESTEROL.IN HDL Result: 45 Units: mg/dL Reference Range: (32-78) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: CHOLESTEROL.IN LDL Result: 120 Units: MG/DL Reference Range: (43-161) Interpretation: ***If pt age < 75, recommended LDL-C < 100 mg/dl in diabetes and ischemic heart disease*** ACCORDING TO THE "NATIONAL CHOLESTEROL EDUCATION PROGRAM" LEVELS OF RISK ARE DEFINED AS FOLLOWS: LOW RISK: <130 MG/DL BORDERLINE HIGH RISK: 130-159 MG/DL HIGH RISK: >=160 MG/DL NOTE THAT NONFASTING RESULTS ARE SLIGHTLY LOWER THAN FASTING RESULTS. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: TRIGLYCERIDE Result: 99 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: VDRL Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Cerebral spinal fluid Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: REAGIN AB Result: NEG Units: -- Reference Range: (SEE INTERPRETATION) Interpretation: NORMAL REFERENCE RANGE = NONREACTIVE Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: HIV Ab Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Serum Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: HIV 1+2 AB Result: NEG Units: -- Reference Range: Interpretation: Interpretation of serologic results should be made in a clinical context including post-test counseling regarding HIV risk. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Carbon Dioxide Content Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Chloride Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: CHLORIDE Result: 102 Units: mmol/L Reference Range: (95-108) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Creatinine Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: CREATININE Result: 1.3 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Creatinine eGFR Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: GLOMERULAR FILTRATION RATE.PREDICTED Result: 56 Low Units: -- Reference Range: (>60) Interpretation: 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Gen Chem Specimen Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: ANION GAP Result: 19 Units: mmol/L Reference Range: (10-22) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Glucose Quant Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Lipid Panel Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: CHOLESTEROL Result: 150 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 97239-2964 Status: Final ---------------------- Test Name: CHOLESTEROL.IN HDL Result: 23 Low Units: mg/dL Reference Range: (32-78) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: CHOLESTEROL.IN LDL Result: 23 Low Units: MG/DL Reference Range: (43-161) Interpretation: ***If pt age < 75, recommended LDL-C < 100 mg/dl in diabetes and ischemic heart disease*** ACCORDING TO THE "NATIONAL CHOLESTEROL EDUCATION PROGRAM" LEVELS OF RISK ARE DEFINED AS FOLLOWS: LOW RISK: <130 MG/DL BORDERLINE HIGH RISK: 130-159 MG/DL HIGH RISK: >=160 MG/DL NOTE THAT NONFASTING RESULTS ARE SLIGHTLY LOWER THAN FASTING RESULTS. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ---------------------- Test Name: TRIGLYCERIDE Result: 46 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Potassium Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: POTASSIUM Result: 3.5 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 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Sodium Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: SODIUM Result: 145 High Units: mmol/L Reference Range: (131-142) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Thyroid Stimulating Hormone Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: THYROTROPIN Result: 29 High Units: uIU/mL Reference Range: (0.27-4.20) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Transferase Aspartate SGOT Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: ASPARTATE AMINOTRANSFERASE Result: 12 Low Units: IU/L Reference Range: (14-44) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Urea Nitrogen Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 12 Dec 2012 @ 0808 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: UREA NITROGEN Result: 25 High Units: mg/dL Reference Range: (7-23) Interpretation: -- Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: Glycohemoglobin A(1) C Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Whole blood Date/Time Collected: 12 Dec 2012 @ 0806 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: HEMOGLOBIN A1C/HEMOGLOBIN.TOTAL Result: 7.4 High Units: % Reference Range: (3.4-6.1) Interpretation: *** If Diabetic, recommended HgA1C should be <7% *** Hemoglobin A1c values reported after 1-1-95 are standardized in accordance with recommendations of the Diabetes Control and Complications Trial(DCCT). Based on these recommendations, a upward shift in reported results will be noted. A table depicting this shift is available in Chemistry on request. Performing Location: PORTLAND, OREGON VA MEDICAL CENTER 3710 SW US VETERANS HOSPTL RD , PORTLAND, OR 97239-2964 Status: Final ------------------------------------------------------------------------- Comments: TEST ========================================================================= Lab Test: INR Lab Type: Chemistry/Hematology Ordering Provider: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- Test Name: COAGULATION TISSUE FACTOR INDUCED.INR Result: 0.7 Low Units: -- Reference Range: (0.90-1.20) Interpretation: 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. Therapeutic ranges may differ with individual clinical circumstances. 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Whole blood Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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: PROVIDER, ONE Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Specimen: Plasma Date/Time Collected: 03 Jun 2011 @ 1024 Collected Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------------------------------------------------------------- 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]. ========================================================================= ------------------------- VA PATHOLOGY REPORTS -------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Date Obtained (Descending), Type of Report VA Pathology Reports are available 14 calendar days after they have been completed. Some studies done at a non-VA facility may not be available or they may not necessarily include an interpretation. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= Type of Report: Surgical Pathology Specimen: SKIN Date Obtained: 28 Mar 2013 Performing Location: PORTLAND, OREGON VA MEDICAL CENTERPO BOX 1034, PORTLAND 97207 Date Completed: 28 Mar 2013 ------------------------------------------------------------------------- SURGICAL PATHOLOGY REPORT Date Spec taken: Mar 28, 2013 08:18 Pathologist: THREE PROVIDER Date Spec rec'd: Mar 28, 2013 08:18 Resident: Date completed: Mar 28, 2013 Accession #: SP 13 99997 Submitted by: PROVIDER, ONE Practitioner:ONE PROVIDER MD ------------------------------------------------------------------------------- Specimen: SKIN GROSS DESCRIPTION: HEALTHY SKIN, NO ANOMALIES MICROSCOPIC EXAM: (Date Spec taken: Mar 28, 2013 08:18) LOOKS HEALTHY TO ME ========================================================================= Type of Report: Cytology Specimen: nose DESCRIPTION: tissue is from nose Date Obtained: 09 Jan 2013 Performing Location: PORTLAND, OREGON VA MEDICAL CENTERPO BOX 1034, PORTLAND 97207 Date Completed: 09 Jan 2013 ------------------------------------------------------------------------- CYTOLOGY REPORT Date Spec taken: Jan 09, 2013 08:51 Pathologist:THREE PROVIDER MD Date Spec rec'd: Jan 09, 2013 08:51 Tech: ONE TECH Date completed: Jan 09, 2013 Accession #: CY 13 9998 Submitted by: Tech, One Practitioner: ONE PROVIDER MD ------------------------------------------------------------------------------- Specimen: nose DESCRIPTION: tissue is from nose MICROSCOPIC EXAM (Date Spec taken: Jan 09, 2013 08:51) tissue looks normal ========================================================================= Type of Report: Surgical Pathology Specimen: NOSE Date Obtained: 28 Dec 2012 Performing Location: PORTLAND, OREGON VA MEDICAL CENTERPO BOX 1034, PORTLAND 97207 Date Completed: 28 Dec 2012 ------------------------------------------------------------------------- SURGICAL PATHOLOGY REPORT Date Spec taken: Dec 28, 2012 07:24 Pathologist:THREE PROVIDER Date Spec rec'd: Dec 28, 2012 07:24 Resident: Date completed: Dec 28, 2012 Accession #: SP 12 99998 Submitted by: PROVIDER, ONE Practitioner:ONE PROVIDER MD ------------------------------------------------------------------------------- Specimen: NOSE Brief Clinical History: NO CLINICAL HISTORY Operative Findings: THIS IS A TEST...NO FINDINGS. Postoperative Diagnosis: STILL NO FINDINGS GROSS DESCRIPTION: *+* MODIFIED REPORT *+* (Last modified: Mar 27, 2013 08:27 typed by PROVIDER, THREE) gross examination normal MICROSCOPIC EXAM: (Date Spec taken: Dec 28, 2012 07:24) *+* MODIFIED REPORT *+* (Last modified: Mar 27, 2013 08:28 typed by PROVIDER, THREE) large pores under microscopic exam ========================================================================= -------------------- SELF REPORTED LABS AND TESTS ----------------------- Source: Self-Entered Test Name: Blood Test Date: 06 Jun 2010 Location performed: Community Center Provider: Red Cross Blood Drive Results: Was not able to donate blood because iron was low Comments: Will ask doctor at next visit Test Name: Colonoscopy Date: 01 Jul 2010 Location performed: VAMC Provider: Provider One Results: No new polyps Comments: Keep high fiber diet Test Name: CBC Date: 08 Jan 2013 Location performed: Non VA Location Provider: Dr. Smith Results: GLUCOSE 144 K 4.1 CO2 26.9 CA 9.3 AST 31 ALT 35 ALK 86 Comments: This is an old lab test. I wanted the report in my record ------------------------ VA VITALS AND READINGS ------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 VA Vitals and Readings displays your vital signs and other health readings. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= This section shows your most recent record for each vital sign and health reading. Vital Sign or Health Reading Measurement Date/Time Collected ------------------------------------------------------------------------- Blood Pressure 190/70 mm[Hg] 07 Jan 2013 @ 1527 Pulse Rate 88 /min 10 Dec 2012 @ 0924 Respiration 16 /min 10 Dec 2012 @ 0924 Temperature 98.5 F 10 Dec 2012 @ 0924 Pain Level 3 07 Jan 2013 @ 1527 Height 70 in 10 Dec 2012 @ 0924 Weight 325 lb 10 Dec 2012 @ 0924 ========================================================================= This section shows all of the vital signs and health readings listed in your VA health record based on the dates you selected when you requested your VA Blue Button. They are grouped by the type of vital sign or health reading. Sorted By: Type of Vital Sign or Health Reading, then Date/Time (Descending) ----------------------------------------------------------- Vital Sign: Blood Pressure Measurement: 190/70 mm[Hg] Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Jan 2013 @ 1527 Vital Sign: Blood Pressure Measurement: 200/120 mm[Hg] Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Blood Pressure Measurement: 190/120 mm[Hg] Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Dec 2012 @ 1201 Vital Sign: Blood Pressure Measurement: 150/70 mm[Hg] Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 Vital Sign: Blood Pressure Measurement: 155/92 mm[Hg] Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 06 Jun 2011 @ 1247 ----------------------------------------------------------- Vital Sign: Temperature Measurement: 98.5 F Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Temperature Measurement: 101.3 F Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 ----------------------------------------------------------- Vital Sign: Circumference/Girth Measurement: 50 in Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 ----------------------------------------------------------- Vital Sign: Height Measurement: 70 in Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Height Measurement: 70 in Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Dec 2012 @ 1201 Vital Sign: Height Measurement: 70 in Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 Vital Sign: Height Measurement: 64 in Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 06 Jun 2011 @ 1237 ----------------------------------------------------------- Vital Sign: Pain Level Measurement: 3 Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Jan 2013 @ 1527 Vital Sign: Pain Level Measurement: 8 Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Pain Level Measurement: 7 Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Dec 2012 @ 1201 Vital Sign: Pain Level Measurement: 6 Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 Vital Sign: Pain Level Measurement: 1 Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 06 Jun 2011 @ 1247 ----------------------------------------------------------- Vital Sign: Pulse Oximetry Measurement: 98 % Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 ----------------------------------------------------------- Vital Sign: Pulse Rate Measurement: 88 /min Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Pulse Rate Measurement: 120 /min Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 ----------------------------------------------------------- Vital Sign: Respiration Measurement: 16 /min Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Respiration Measurement: 20 /min Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 ----------------------------------------------------------- Vital Sign: Weight Measurement: 325 lb Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 10 Dec 2012 @ 0924 Vital Sign: Weight Measurement: 350 lb Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 07 Dec 2012 @ 1201 Vital Sign: Weight Measurement: 310 lb Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 11 Nov 2012 @ 0900 Vital Sign: Weight Measurement: 301 lb Comments: -- Location: PORTLAND, OREGON VA MEDICAL CENTER Date/Time Collected: 06 Jun 2011 @ 1237 -------------------- SELF REPORTED VITALS AND READINGS ------------------ Source: Self-Entered Remember to share your self entered information with your VA health care team. =========================================================================== 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 =========================================================================== Measurement Type: Blood pressure Date: 06 Jan 2013 Time: 1940 Systolic: 126 Diastolic: 82 Comments: Did not sleep well last night. Took a long nap this afternoon =========================================================================== Measurement Type: Blood pressure Date: 07 Jan 2013 Time: 2359 Systolic: 132 Diastolic: 76 Comments: Feeling fine =========================================================================== Measurement Type: Heart rate Date: 02 Jun 2010 Time: 1720 Heart Rate: 160 Comments: Started taking Beta-Blockers after visit with physician =========================================================================== Measurement Type: Heart rate Date: 06 Jan 2013 Time: 1900 Heart Rate: 86 Comments: Feel Fine =========================================================================== Measurement Type: Heart rate Date: 07 Jan 2013 Time: 2359 Heart Rate: 77 Comments: Feel OK =========================================================================== Measurement Type: Body weight Date: 02 Apr 2010 Time: 1720 Body Weight: 246 Measure: Pounds Comments: Talk to provider about weight management program at next visit =========================================================================== Measurement Type: Body weight Date: 02 May 2010 Time: 1720 Body Weight: 244 Measure: Pounds Comments: Lost a few pounds and feel better. Walking daily =========================================================================== Measurement Type: Body weight Date: 02 Jun 2010 Time: 1720 Body Weight: 242 Measure: Pounds Comments: still walking when I have time off from work =========================================================================== Measurement Type: Body weight Date: 06 Jan 2013 Time: 1900 Body Weight: 244 Measure: Pounds Comments: I can feel all those Christmas cookies I ate =========================================================================== Measurement Type: Body weight Date: 07 Jan 2013 Time: 2359 Body Weight: 242 Measure: Pounds Comments: Took a long walk with the dog today =========================================================================== Measurement Type: Body temperature Date: 02 Mar 2010 Time: 1720 Body temperature: 98.5 Measure: Fahrenheit Method: Mouth Comments: I wasn't feeling well but temperature is normal =========================================================================== Measurement Type: Body temperature Date: 06 Jan 2013 Time: 1900 Body temperature: 98.3 Measure: Fahrenheit Method: Mouth Comments: Not sure if this ear themo is working or if I am doing something work... =========================================================================== Measurement Type: Body temperature Date: 07 Jan 2013 Time: 2359 Body temperature: 98.1 Measure: Fahrenheit Method: Mouth Comments: Feel Fine =========================================================================== Measurement Type: Pain Date: 02 Jan 2010 Time: 1720 Pain Level: 7 Comments: Lower back pain - took 1 Ibuprofen with food for pain =========================================================================== Measurement Type: Pain Date: 06 Jan 2013 Time: 1900 Pain Level: 4 Comments: Feet are sore from the long walk I took with the Dog today =========================================================================== Measurement Type: Pain Date: 07 Jan 2013 Time: 2359 Pain Level: 3 Comments: General aches =========================================================================== Measurement Type: Blood sugar Date: 02 Jan 2010 Time: 1720 Method: Sterile Lancet Blood sugar count: 166 Comments: BS taken before meal =========================================================================== Measurement Type: Blood sugar Date: 06 Jan 2013 Time: 1900 Method: Sterile Lancet Blood sugar count: 174 Comments: I just ate. Need to leave the ice cream alone =========================================================================== Measurement Type: Blood sugar Date: 07 Jan 2013 Time: 2359 Method: Sterile Lancet Blood sugar count: 141 Comments: Feeling good! =========================================================================== Measurement Type: INR Date: 08 Jan 2013 Time: 2359 INR value: .8 Target range: No Target Location: Non VA Provider Provider: Dr. Smith Comments: PT Only 9.6 PTT only 13.3 -------------------------- VA RADIOLOGY REPORTS ------------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Date/Time Exam Performed (Descending) VA Radiology Reports are available 3 calendar days after they have been completed. Some studies done at a non-VA facility may not be available or they may not necessarily include an interpretation. If you have any questions about your information please visit the FAQs or contact the provider who ordered the study or your primary care provider. ========================================================================= Procedure/Test Name: CT HEAD OR BRAIN W/O CONTRAST Date/Time Exam Performed: 10 Dec 2012 @ 1018 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Requesting Provider: PROVIDER, ONE Reasons for Study: THIS IS ONLY A TEST Clinical History: THIS IS ONLY A TEST Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Radiologist: RADIOLOGIST, ONE -------------------------------------------------------------------------- RADIOLOGY REPORT Report: Impression: Test patient; no report necessary for dictation; ADMIN complete. Primary Diagnostic Code: ========================================================================= Procedure/Test Name: BONE DENSITY (DPX), AXIAL SKELETON, HIPS/PELVIS/SPINE Date/Time Exam Performed: 10 Dec 2012 @ 1017 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Requesting Provider: PROVIDER, ONE Reasons for Study: THIS IS ONLY A TEST Clinical History: THIS IS ONLY A TEST Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Radiologist: RADIOLOGIST, ONE -------------------------------------------------------------------------- RADIOLOGY REPORT Report: Impression: Test patient; no report necessary for dictation; ADMIN complete. Primary Diagnostic Code: ========================================================================= Procedure/Test Name: *BONE IMAGING, WHOLE BODY Date/Time Exam Performed: 10 Dec 2012 @ 1016 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Requesting Provider: PROVIDER, ONE Reasons for Study: THIS IS ONLY A TEST Clinical History: THIS IS ONLY A TEST Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Radiologist: RADIOLOGIST, ONE -------------------------------------------------------------------------- RADIOLOGY REPORT Report: Impression: Test patient; no report necessary for dictation; ADMIN complete. Primary Diagnostic Code: ========================================================================= Procedure/Test Name: CHEST 2 VIEWS PA&LAT Date/Time Exam Performed: 10 Dec 2012 @ 1014 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Requesting Provider: PROVIDER, ONE Reasons for Study: THIS IS ONLY A TEST Clinical History: r/o pneumonia Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Radiologist: RADIOLOGIST, ONE -------------------------------------------------------------------------- RADIOLOGY REPORT Report: Test report for Dr. Provider Impression: Test for Dr. Provider Primary Diagnostic Code: ========================================================================= Procedure/Test Name: ULTRASOUND ABDOMEN COMPLETE Date/Time Exam Performed: 10 Dec 2012 @ 1013 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER Requesting Provider: PROVIDER, ONE Reasons for Study: THIS IS ONLY A TEST Clinical History: THIS IS ONLY A TEST Performing Location: PORTLAND, OREGON VA MEDICAL CENTER PO BOX 1034, PORTLAND 97207 Radiologist: RADIOLOGIST, ONE -------------------------------------------------------------------------- RADIOLOGY REPORT Report: Impression: Test patient; no report necessary for dictation; ADMIN complete. Primary Diagnostic Code: ========================================================================= ------------------ VA ELECTROCARDIOGRAM (EKG) REPORTS ------------------- Source: VA Last Updated: 05 Nov 2014 @ 0813 Sorted By: Date/Time Exam Performed (Descending) Your EKG list may not be complete. Some studies done at a non-VA facility may not be available. If you have any questions about your information please visit the FAQs or contact your VA health care team. ========================================================================= Procedure/Test Name: Electrocardiogram (EKG) Date/Time Exam Performed: 10 Dec 2012 @ 1200 Ordering Location: PORTLAND, OREGON VA MEDICAL CENTER ------------------ SELF REPORTED 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 ------------------ SELF REPORTED MILITARY HEALTH HISTORY ---------------- Source: Self-Entered Event Title: Overseas Deployment Event Date: 07 Apr 2002 Service Branch: Army Rank: COL 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 -------------------- SELF REPORTED ACTIVITY JOURNAL --------------------- Source: Self-Entered ========================================================================= Date: 28 Aug 2012 Day of Week: Tuesday Comments: Started my new exercise program today ------------------------------------------------------------------------- Activity: Walked for 30 minutes Type: Aerobic/cardio Distance/Duration: 1 Measure: mile(s) Intensity: Moderate impact Time of Day: Morning ------------------------------------------------------------------------- Activity: Swam 20 laps Type: Aerobic/cardio Distance/Duration: 45 Measure: lap(s) Intensity: High impact Time of Day: Afternoon ------------------------------------------------------------------------- Activity: Lifted weights Type: Weights Distance/Duration: 15 Measure: pound(s) Intensity: Low impact Number of Sets: 2 Number of Reps: 10 Time of Day: Afternoon ------------------------------------------------------------------------- Activity: Yoga Type: Other Distance/Duration: 30 Measure: min(s) Intensity: Low impact Time of Day: Evening ========================================================================= Date: 27 Aug 2012 Day of Week: Monday Comments: I need to get back in shape ------------------------------------------------------------------------- Activity: Stretching Type: Other Distance/Duration: 1 Measure: hour(s) Intensity: Low impact Time of Day: Afternoon ----------------------- SELF REPORTED FOOD JOURNAL ---------------------- Source: Self-Entered ========================================================================= Date: 02 Jan 2013 Day of Week: Wednesday ------------------------------------------------------------------------- Water consumed (number of 8oz glasses): 4 ------------------------------------------------------------------------- Breakfast Food/Beverage Item: 3 eggs/cheese Quantity: 1 Serving Size: X-Large Method of Preparation: Fresh Food/Beverage Item: OJ Quantity: 1 Serving Size: 8 Method of Preparation: Fresh Food/Beverage Item: glasses of whole milk Quantity: 1 Serving Size: 8 Method of Preparation: Fresh ------------------------------------------------------------------------- Dinner Food/Beverage Item: Hot Dogs Quantity: 2 Serving Size: Large Method of Preparation: Boiled Food/Beverage Item: French Fries Quantity: 1 Serving Size: Large Method of Preparation: Fried ------------------------------------------------------------------------- Lunch Food/Beverage Item: Taco X 3 Quantity: 3 Serving Size: Large Method of Preparation: Fast Food Food/Beverage Item: Root Beers Quantity: 2 Serving Size: 8 Method of Preparation: Fresh ------------------------------------------------------------------------- Snack Food/Beverage Item: Strawberry Shake Quantity: 1 Serving Size: 8 Method of Preparation: Frozen ------------------------------------------------------------------------- Comments: Added Lemon ========================================================================= Date: 01 Jan 2013 Day of Week: Tuesday ------------------------------------------------------------------------- Water consumed (number of 8oz glasses): 2 ------------------------------------------------------------------------- Breakfast Food/Beverage Item: 3 glasses of whole milk Quantity: 3 Serving Size: Large Method of Preparation: Fresh Food/Beverage Item: Cheerios 1 large bowl Quantity: 1 Serving Size: Large Method of Preparation: Fresh ------------------------------------------------------------------------- Dinner Food/Beverage Item: Pizza medium cheese Quantity: 1 Serving Size: Small Method of Preparation: Baked ------------------------------------------------------------------------- Lunch Food/Beverage Item: Greek Salad Quantity: 1 Serving Size: 16 Method of Preparation: Fresh Food/Beverage Item: Root Beers Quantity: 2 Serving Size: 8 Method of Preparation: Fresh ------------------------------------------------------------------------- Snack Food/Beverage Item: Ice Cream Quantity: 1 Serving Size: 4 Method of Preparation: Frozen ------------------------------------------------------------------------- Comments: Ice Water ========================================================================= Date: 31 Dec 2012 Day of Week: Monday ------------------------------------------------------------------------- Water consumed (number of 8oz glasses): 0 ------------------------------------------------------------------------- Breakfast Food/Beverage Item: Orange Quantity: 1 Serving Size: Large Method of Preparation: Fresh Food/Beverage Item: Hamburger Quantity: .25 Serving Size: Large Method of Preparation: Fast Food Food/Beverage Item: Banana Quantity: 1 Serving Size: Large Method of Preparation: Fresh Food/Beverage Item: Apple Quantity: 1 Serving Size: Large Method of Preparation: Fresh ------------------------------------------------------------------------- Dinner Food/Beverage Item: French Fries Quantity: 1 Serving Size: X-Large Method of Preparation: Fast Food Food/Beverage Item: Coke Quantity: 1 Serving Size: 16 Method of Preparation: Other ------------------------------------------------------------------------- Lunch Food/Beverage Item: Coke Quantity: 1 Serving Size: 16 Method of Preparation: Other Food/Beverage Item: Chicken Sandwich Quantity: Serving Size: Method of Preparation: Fast Food Food/Beverage Item: French Fries Quantity: 1 Serving Size: X-Large Method of Preparation: Fast Food ------------------------------------------------------------------------- Comments: -------------------- DoD Military Service Information ------------------- Source: DoD Last Updated: 17 Jan 2013 @ 1527 NOTES: 1) This report may not show your complete DoD Military Service Information. For more information go to the FAQ tab. Data prior to establishment of DEERS and full service reporting (c. 1980) may not appear. 2) It is normal for the begin/end dates in DoD records, adjusted by the Personnel Center after separation, to vary slightly from the DD-214. 3) No peacetime deployments will be displayed. For Gulf War I, only one period will be displayed even if you deployed more than once. No conflict prior to Gulf War I will be displayed. Kosovo, Bosnia, and Southern Watch data is incomplete and may not display. 4) For Guard/Reserve, periods of active duty may not display. No periods of Active duty service less than 30 days will display. -- Regular Active Service Service Begin Date End Date Character of Service Rank - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army 06/11/2005 03/26/2007 Honorable COL Army 02/22/2009 02/21/2010 Honorable COL Army 04/10/2010 04/08/2011 Honorable COL -- Reserve/Guard Association Periods Service Begin Date End Date Character of Service Rank - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army Guard 01/11/1987 08/24/1993 Unknown Army Reserve 08/25/1993 10/25/2004 Unknown COL Army Reserve 03/27/2007 10/31/2008 Unknown COL -- Reserve/Guard Activation Periods Service Begin Date End Date Activated Under (Title 10, 32, etc.) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army Reserve 11/10/2001 11/09/2002 Army Reserve 04/14/2003 10/13/2004 Army Reserve 10/24/2004 10/25/2004 Army Reserve 03/27/2007 10/24/2007 Army Reserve 02/04/2008 10/31/2008 -- Deployment Periods Service Begin Date End Date Conflict Location - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army Reserve 03/01/2004 03/31/2004 OEF/OIF Unknown Army 01/01/2007 03/26/2007 OEF/OIF Iraq -- DoD MOS/Occupation Codes -- Note: Both Service and DoD Generic codes may not be present in all records Service Begin Date Enl/Off Type Svc Occ Code DoD Occ Code - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army Reserve 01/16/1975 Officer Primary 35D00 3A Army Reserve 01/16/1975 Officer Duty 35B00 3A Army Reserve 03/31/2002 Officer Primary 35D 3A Army Reserve 03/31/2002 Officer Duty 35D 3A Army Reserve 06/30/2002 Officer Duty 00A 9E Army Reserve 11/30/2002 Officer Duty 01A 9E Army Reserve 10/31/2003 Officer Duty 35D 3A Army 06/11/2005 Officer Primary 35D5K 3A Army 05/31/2006 Officer Duty 35D 3A Army Reserve 03/27/2007 Officer Primary 35D5K 3A Army Reserve 06/27/2007 Officer Duty 35D5K 3A Army 02/22/2009 Officer Primary 35D5K 3A Army 02/22/2009 Officer Secondary 66HD5 6E18 Army 02/22/2009 Officer Duty 35D00 3A -- Military/Combat Pay Details Service Begin Date End Date Military Pay Type Location - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army Reserve 03/01/2004 03/31/2004 02 Army 01/01/2007 01 Iraq Army 01/01/2007 02 -- Separation Pay Details Service Begin Date End Date Separation Pay Type - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- Retirement Periods Service Begin Date End Date Retirement Type Rank - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army 11/01/2008 02/21/2009 F COL Army 02/22/2010 04/09/2010 F COL Army 04/09/2011 F COL -- DoD Retirement Pay Service Begin Date End Date Dsblty % Pay Stat Term Rsn Stop Pay Rsn - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Army 10/31/2008 11/30/2008 00 1 C Z Army 12/01/2008 00 1 W Z Army 03/01/2010 07/31/2010 00 1 C Z Army 08/01/2010 00 5 W B Army 05/01/2011 05/31/2011 00 1 C Z Army 06/01/2011 11/30/2011 00 1 C Z Army 12/01/2011 00 1 W Z Translations of Codes Used in this Section: Service Occupation Codes 00A Officer Duties Unassigned 01A Officer Officer Generalist 35D Officer All Source Intelligence 35D Officer (obsolete) Air Traffic Control Equipment Repairer 35D Officer (obsolete) Meteorological Equipment Repairman DoD Occupation Codes 3A Officer Intelligence, General 9E Officer Other Military Pay Type Code 01 Combat Zone Tax Exclusion (CZTE) 02 Hostile Fire/Imminent Danger 03 Hazardous Duty incentive Separation Pay Type Code 01 Separation Pay 02 Readjustment Pay 03 Non-Disability Severance Pay 04 Disability Severance Pay 05 Discharge Gratuity 06 Death Gratuity 07 Special Separation Benefit 08 Voluntary Separation Incentive Pay 09 Voluntary Separation Pay (VSP) Retirement Type Code A Mandatory B Voluntary C Fleet Reserve D Temporary Disability Retirement List E Permanent Disability Retirement List F Title III G Special Act H Philippine Scouts Retired Pay Status Code 1 Receiving retired pay 2 Eligible, not receiving pay 3 Eligible, not receiving direct SBP remittance 4 Terminated 5 Suspended Retired Pay Termination Reason Code C Pay condition terminated S Pay terminated for the reason reported in the Stop Payment Reason Code W Not terminated Stop Payment Reason Code A Member died B Recalled to Active Duty C Removed from TDRL, returned to Active Duty D Removed from TDRL, returned to Civilian E Pay suspended, failure to report for TDRL physical F Civil Service retirement waiver G VA compensation waiver H Dual compensation, pay cap offset J Refused retired pay K Pay suspended, whereabouts unknown L Suspected death M Pay suspended, miscellaneous Z Not applicable -------------------- SELF REPORTED MY GOALS: CURRENT GOALS --------------- Source: Self-Entered Sorted By: Priority, then by Goal Start Date (Descending) Remember to share your self-entered information with your VA health care team. This section contains all of your My Goals: Current Goals information regardless of the date range selected when you requested your VA Blue Button. ========================================================================== ALL CURRENT GOALS - SUMMARY LIST (BY PRIORITY) -------------------------------------------------------------------------- Goals Most Important to Me My Goal: Lose Weight Description: Lose 20 lbs Goal Start Date: 09 Apr 2013 My Goal: Be Debt Free Description: I want to get out of debt. Goal Start Date: 01 Jan 2013 -------------------------------------------------------------------------- Goals Second Most Important to Me None Entered -------------------------------------------------------------------------- My Other Goals My Goal: Have More Fun Description: I want to have more things to do and be more social. Goal Start Date: 10 Apr 2013 My Goal: Dating Description: I want to be in a relationship. The first thing I need to do is start dating. I am lonely and would like to find someone to be with. Goal Start Date: 10 Apr 2013 ========================================================================== ALL CURRENT GOALS - DETAILED INFORMATION -------------------------------------------------------------------------- MY GOAL: LOSE WEIGHT Description: Lose 20 lbs Type: Health Priority: Goals Most Important to Me Goal Start Date: 09 Apr 2013 Goal End Date: None Entered Completion: No End Date (Ongoing) Strengths: Determination Enjoy doing outdoor activities. I want to be healthy. Obstacles: Always want dessert after dinner. I eat when I am bored. --------------------------------------------- Task: Prepare healthy snack. Task Description: Each night to satisfy the want for a dessert, I will prepare and eat some fresh fruit. Task Completion: No End Date (Ongoing) Task Start Date: 09 Apr 2013 Task End Date: None Entered Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: Not Finished Yet --------------------------------------------- Task: Things to do when I am bored. Task Description: I will make a list of items that I can do so when I am bored. Call a friend, go for a walk, do a puzzle. Task Completion: Has An End Date Task Start Date: 09 Apr 2013 Task End Date: 31 May 2013 Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: Not Finished Yet Rewards: None Entered -------------------------------------------------------------------------- MY GOAL: BE DEBT FREE Description: I want to get out of debt. Type: Finance Priority: Goals Most Important to Me Goal Start Date: 01 Jan 2013 Goal End Date: 31 Aug 2013 Completion: Has An End Date Strengths: I can follow a plan. I have support from people that care about me. Obstacles: I do not know where my money goes each month. I do not know how to get rid of my debt. --------------------------------------------- Task: Find the bill that has the highest interest rate. Task Description: I will look for the monthly bill with the highest interest rate. I will work toward paying off this bill first. Task Completion: Has An End Date Task Start Date: 01 Jan 2013 Task End Date: 15 Jan 2013 Task Repeats: Every other week Date Task Finished: 10 Apr 2013 --------------------------------------------- Task: Get information on how to get rid of debt. Task Description: I will find information about how to get rid of my debt from the Internet, local library, or a VA Social Worker. I will find information about making a monthly budget. Task Completion: Has An End Date Task Start Date: 01 Jan 2013 Task End Date: 14 Feb 2013 Task Repeats: Every other week Date Task Finished: 10 Apr 2013 --------------------------------------------- Task: Keep all receipts for 1 month. Task Description: I will find a place like a folder or shoe box to keep my receipts for things I buy for 1 month. This includes anything that I paid cash for such as eating out for lunch. Task Completion: Has An End Date Task Start Date: 01 Jan 2013 Task End Date: 31 Jan 2013 Task Repeats: Twice a day Date Task Finished: 10 Apr 2013 --------------------------------------------- Task: Make a list of all my monthly bills. Task Description: I will make a list of all of my monthly bills like rent, car payment, and credit cards. I need to know how much I owe each month. Task Completion: Has An End Date Task Start Date: 01 Jan 2013 Task End Date: 31 Aug 2013 Task Repeats: Yearly Date Task Finished: Not Finished Yet Rewards: Go on a weekend getaway. -------------------------------------------------------------------------- MY GOAL: HAVE MORE FUN Description: I want to have more things to do and be more social. Type: Leisure Activity Priority: Other Goals Goal Start Date: 10 Apr 2013 Goal End Date: None Entered Completion: No End Date (Ongoing) Strengths: I am loyal and care about others. I am a good listener. Obstacles: I would rather be alone than with other people. --------------------------------------------- Task: Pick an activity to do with another person. Task Description: I will use what I learned to ask someone to join me. I will ask someone to do one of the activities from my list with me. I will practice doing this several times and with different people. Task Completion: No End Date (Ongoing) Task Start Date: 24 Apr 2013 Task End Date: None Entered Task Repeats: Every other week Date Task Finished: Not Finished Yet --------------------------------------------- Task: Make a list of activities and places I like. Task Description: I will list activities I might enjoy doing with others. This may include walking, bike riding, shopping, volunteer work, hobbies, going to the beach, mountains or the dog park. Task Completion: Has An End Date Task Start Date: 17 Apr 2013 Task End Date: 19 Apr 2013 Task Repeats: Twice a day Date Task Finished: Not Finished Yet Rewards: Buy something that will help me with the activity I enjoy doing. For example, a new soccer ball. -------------------------------------------------------------------------- MY GOAL: DATING Description: I want to be in a relationship. The first thing I need to do is start dating. I am lonely and would like to find someone to be with. Type: Relationships Priority: Other Goals Goal Start Date: 10 Apr 2013 Goal End Date: None Entered Completion: No End Date (Ongoing) Strengths: I am kind to others. I am a good listener. I am loyal to people close to me. Obstacles: I worry what people think about me. I do not know where or how to meet someone to date. --------------------------------------------- Task: Find places to meet people who like what I like. Task Description: I will use my list to find groups, clubs, or classes that focus on the things I like to do. For example: a book club, a bicycle riding group, or a local cooking class. Task Completion: No End Date (Ongoing) Task Start Date: 13 Apr 2013 Task End Date: None Entered Task Repeats: Every other week Date Task Finished: Not Finished Yet --------------------------------------------- Task: Help for feeling nervous around others. Task Description: I will work with my health care team to help me feel less nervous around other people. Task Completion: No End Date (Ongoing) Task Start Date: 10 Apr 2013 Task End Date: None Entered Task Repeats: Every other week Date Task Finished: Not Finished Yet --------------------------------------------- Task: Make a list of things I like to do. Task Description: I will write down things that I like to do. For example, I like to read, ride my bike, and cook. I will use this list to find people who like what I like. Task Completion: Has An End Date Task Start Date: 10 Apr 2013 Task End Date: 12 Apr 2013 Task Repeats: Twice a day Date Task Finished: Not Finished Yet Rewards: Talk to my friend about my dating plans. ---------------- SELF REPORTED MY GOALS: COMPLETED GOALS -------------- Source: Self-Entered Sorted By: Date Goal Completed (Descending) Remember to share your self-entered information with your VA health care team. This section contains your My Goals: Completed Goals information included in the date range selected when you requested your VA Blue Button. ========================================================================== COMPLETED GOALS - SUMMARY LIST (BY DATE GOAL COMPLETED) -------------------------------------------------------------------------- My Goal: Run a 1/2 marathon Description: I would like to run in the Surf-city half marathon. Date Goal Completed: 10 Apr 2013 My Goal: Find a Place to Live Description: I will move out of my current living situation and find another place to live. Date Goal Completed: 10 Apr 2013 My Goal: Go to School Description: I want to get a better job and need to get training. I want to go to college or a trade school. Date Goal Completed: 10 Apr 2013 ========================================================================== COMPLETED GOALS - DETAILED INFORMATION (BY DATE GOAL COMPLETED) -------------------------------------------------------------------------- MY GOAL: RUN A 1/2 MARATHON Description: I would like to run in the Surf-city half marathon. Type: Health Priority: Goals Most Important to Me Goal Start Date: 01 Dec 2012 Goal End Date: 15 Feb 2013 Completion: Has An End Date Date Goal Completed: 10 Apr 2013 Strengths: None Entered Obstacles: Finding enough time to get my training in. -------------------------------------------------- Task: Go for a 5 mile run. Task Description: None Entered Task Completion: No End Date (Ongoing) Task Start Date: 01 Dec 2012 Task End Date: None Entered Task Repeats: Every Tuesday, Thursday Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Reserve every Saturday for long runs. Task Description: None Entered Task Completion: Has An End Date Task Start Date: 01 Dec 2012 Task End Date: 15 Feb 2013 Task Repeats: Every other week Date Task Finished: 10 Apr 2013 Rewards: Make the race a weekend trip. -------------------------------------------------------------------------- MY GOAL: FIND A PLACE TO LIVE Description: I will move out of my current living situation and find another place to live. Type: Living Situation Priority: Goals Second Most Important to Me Goal Start Date: 03 Mar 2013 Goal End Date: 01 Apr 2013 Completion: Has An End Date Date Goal Completed: 10 Apr 2013 Strengths: None Entered Obstacles: Fear of living alone. I am not sure how to get a place to live. I am not sure how much I can afford. -------------------------------------------------- Task: How much rent can I pay. Task Description: I will review my income and see how much money I have for rent. Task Completion: Has An End Date Task Start Date: 10 Mar 2013 Task End Date: 15 Mar 2013 Task Repeats: Twice a day Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Talk with people I know who have lived alone. Task Description: I will talk with people who live alone to find out how they do it. Task Completion: No End Date (Ongoing) Task Start Date: 03 Mar 2013 Task End Date: None Entered Task Repeats: Every other week Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Rental Listings Task Description: I will get rental listings from newspapers, rental agencies, or online postings. I will get help from my local Veteran service officer or social services agency. Task Completion: No End Date (Ongoing) Task Start Date: 03 Mar 2013 Task End Date: None Entered Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Search for a rental. Task Description: I will call the number in the listings to set up visits. Task Completion: No End Date (Ongoing) Task Start Date: 03 Mar 2013 Task End Date: None Entered Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Remind myself of other things that I have done well on my own. Task Description: I will list things that I have done well in my life. When I am feeling alone I will read over my list. Task Completion: No End Date (Ongoing) Task Start Date: 03 Mar 2013 Task End Date: None Entered Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: 10 Apr 2013 -------------------------------------------------- Task: Fill out rental applications. Task Description: I will search online or go to rental agencies to pick up rental applications for the place I want to live. I will submit applications online or in person. Task Completion: No End Date (Ongoing) Task Start Date: 03 Mar 2013 Task End Date: None Entered Task Repeats: Every Monday, Wednesday, Friday Date Task Finished: 10 Apr 2013 Rewards: Invite a friend over. Get something for my new home. -------------------------------------------------------------------------- MY GOAL: GO TO SCHOOL Description: I want to get a better job and need to get training. I want to go to college or a trade school. Type: Learning Priority: Goals Second Most Important to Me Goal Start Date: 01 Feb 2013 Goal End Date: 01 Apr 2013 Completion: Has An End Date Date Goal Completed: 10 Apr 2013 Strengths: None Entered Obstacles: I do not know what school or program I want to attend. I do not know what is available or what I am eligible for. -------------------------------------------------- Task: Research places to go to school. Task Description: I will meet with a career counselor at my local community college or a Veteran's service officer at my local county or VA office. I will meet with a person at my local trade school. I can also search online for distance learning schools. Task Completion: Has An End Date Task Start Date: 01 Feb 2013 Task End Date: 01 Mar 2013 Task Repeats: Every other week Date Task Finished: 10 Apr 2013 Rewards: Go out to dinner with family and friends to celebrate. Share my decision with friends and people that are important to me. ----------- END OF MY HEALTHEVET PERSONAL INFORMATION REPORT ----------