Fletcher Abernathy
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Race: Black
Ethnicity: Non-Hispanic
Gender: M
Age: 44
Birth Date: 1978-03-19
Marital Status: M
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ALLERGIES:
No Known Allergies
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MEDICATIONS:
2022-06-01[STOPPED] : Acetaminophen 325 MG Oral Tablet for Acute bronchitis (disorder)
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CONDITIONS:
2022-06-12 - : Full-time employment (finding)
2022-06-01 - 2022-06-19 : Acute bronchitis (disorder)
2022-04-03 - : Stress (finding)
2022-04-03 - 2022-06-12 : Not in labor force (finding)
2020-12-11 - 2021-01-01 : COVID-19
2020-12-11 - 2021-01-01 : Fever (finding)
2020-12-11 - 2021-01-01 : Fatigue (finding)
2020-12-11 - 2021-01-01 : Sputum finding (finding)
2020-12-11 - 2021-01-01 : Cough (finding)
2020-03-29 - 2022-04-03 : Reports of violence in the environment (finding)
2020-03-29 - 2022-04-03 : Part-time employment (finding)
2020-03-29 - : Body mass index 30+ - obesity (finding)
2015-06-07 - 2020-03-29 : Stress (finding)
2012-06-03 - 2022-06-12 : Limited social contact (finding)
2012-06-03 - 2014-11-30 : Full-time employment (finding)
2011-08-21 - 2012-06-03 : Full-time employment (finding)
2009-05-31 - 2011-08-21 : Full-time employment (finding)
2009-05-31 - : Anemia (disorder)
2009-05-31 - : Prediabetes
2006-05-28 - 2009-05-31 : Full-time employment (finding)
2003-05-25 - 2006-05-28 : Full-time employment (finding)
1997-05-18 - : Social isolation (finding)
1997-05-18 - 2000-05-21 : Full-time employment (finding)
1996-05-12 - 2012-06-03 : Stress (finding)
1996-05-12 - 1997-05-18 : Full-time employment (finding)
1996-05-12 - : Received higher education (finding)
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CARE PLANS:
2022-06-01[CURRENT] : Respiratory therapy
Activity: Recommendation to avoid exercise
Activity: Deep breathing and coughing exercises
2020-12-11[STOPPED] : Infectious disease care plan (record artifact)
Activity: Airborne precautions (procedure)
Activity: Isolation of infected patient (procedure)
2014-11-22[STOPPED] : Respiratory therapy
Activity: Recommendation to avoid exercise
Activity: Deep breathing and coughing exercises
2011-08-15[STOPPED] : Respiratory therapy
Activity: Recommendation to avoid exercise
Activity: Deep breathing and coughing exercises
2009-05-31[CURRENT] : Diabetes self management plan
Reason: Prediabetes
Activity: Diabetic diet
Activity: Exercise therapy
1986-04-07[STOPPED] : Respiratory therapy
Activity: Recommendation to avoid exercise
Activity: Deep breathing and coughing exercises
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REPORTS:
2022-06-12 : Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]
- Total score [AUDIT-C] 2.0 {score}
2022-06-12 : Patient Health Questionnaire 2 item (PHQ-2) [Reported]
- Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] 1.0 {score}
2022-06-12 : Basic Metabolic Panel
- Glucose 73.5 mg/dL
- Urea Nitrogen 17.8 mg/dL
- Creatinine 1.3 mg/dL
- Calcium 9.3 mg/dL
- Sodium 143.8 mmol/L
- Potassium 4.0 mmol/L
- Chloride 101.4 mmol/L
- Carbon Dioxide 22.5 mmol/L
2022-04-03 : Drug Abuse Screening Test-10 [DAST-10]
- Total score [DAST-10] 1.0 {score}
2022-04-03 : Patient Health Questionnaire 2 item (PHQ-2) [Reported]
- Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] 1.0 {score}
2022-04-03 : Generalized anxiety disorder 7 item (GAD-7)
- Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] 3.0 {score}
2022-04-03 : Basic Metabolic Panel
- Glucose 64.4 mg/dL
- Urea Nitrogen 7.3 mg/dL
- Creatinine 1.3 mg/dL
- Calcium 8.5 mg/dL
- Sodium 138.5 mmol/L
- Potassium 3.9 mmol/L
- Chloride 109.1 mmol/L
- Carbon Dioxide 23.3 mmol/L
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OBSERVATIONS:
2022-06-12 : Total score [AUDIT-C] 2.0 {score}
2022-06-12 : Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] 1.0 {score}
2022-06-12 : Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
- In the past year, have you been afraid of your partner or ex-partner? No
- Do you feel physically and emotionally safe where you currently live? Yes
- Are you a refugee? No
- In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility? No
- Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you? A little bit
- How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)? 3 to 5 times a week
- Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? No
- In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? I choose not to answer this question
- During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits. 43405 /a
- What is your main insurance? Private insurance
- What is your current work situation? Full-time work
- What is the highest level of school that you have finished? More than high school
- What address do you live at? 376 Stiedemann Terrace
- Are you worried about losing your housing? No
- What is your housing situation today? I have housing
- How many family members, including yourself, do you currently live with? 2.0 {#}
- What language are you most comfortable speaking? English
- Have you been discharged from the armed forces of the United States? No
- At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income? No
- Which race(s) are you? Black/African American
- Are you Hispanic or Latino? No
2022-06-12 : Hemoglobin A1c/Hemoglobin.total in Blood 6.0 %
2022-06-12 : Tobacco smoking status Ex-smoker (finding)
2022-06-12 : Carbon Dioxide 22.5 mmol/L
2022-06-12 : Chloride 101.4 mmol/L
2022-06-12 : Potassium 4.0 mmol/L
2022-06-12 : Sodium 143.8 mmol/L
2022-06-12 : Calcium 9.3 mg/dL
2022-06-12 : Creatinine 1.3 mg/dL
2022-06-12 : Urea Nitrogen 17.8 mg/dL
2022-06-12 : Glucose 73.5 mg/dL
2022-06-12 : Respiratory rate 13.0 /min
2022-06-12 : Heart rate 69.0 /min
2022-06-12 : Blood Pressure
- Diastolic Blood Pressure 68.0 mm[Hg]
- Systolic Blood Pressure 119.0 mm[Hg]
2022-06-12 : Body Mass Index 30.3 kg/m2
2022-06-12 : Body Weight 99.8 kg
2022-06-12 : Pain severity - 0-10 verbal numeric rating [Score] - Reported 1.0 {score}
2022-06-12 : Body Height 181.4 cm
2022-04-03 : Total score [DAST-10] 1.0 {score}
2022-04-03 : Patient Health Questionnaire 2 item (PHQ-2) total score [Reported] 1.0 {score}
2022-04-03 : Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ] 3.0 {score}
2022-04-03 : Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
- In the past year, have you been afraid of your partner or ex-partner? No
- Do you feel physically and emotionally safe where you currently live? Yes
- Are you a refugee? No
- In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility? No
- Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you? Quite a bit
- How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)? 3 to 5 times a week
- Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? No
- In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? Phone
- During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits. 43405 /a
- What is your main insurance? Private insurance
- What is your current work situation? Otherwise unemployed but not seeking work
- What is the highest level of school that you have finished? More than high school
- What address do you live at? 376 Stiedemann Terrace
- Are you worried about losing your housing? No
- What is your housing situation today? I have housing
- How many family members, including yourself, do you currently live with? 2.0 {#}
- What language are you most comfortable speaking? English
- Have you been discharged from the armed forces of the United States? No
- At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income? No
- Which race(s) are you? Black/African American
- Are you Hispanic or Latino? No
2022-04-03 : Hemoglobin A1c/Hemoglobin.total in Blood 5.9 %
2022-04-03 : Tobacco smoking status Ex-smoker (finding)
2022-04-03 : Carbon Dioxide 23.3 mmol/L
2022-04-03 : Chloride 109.1 mmol/L
2022-04-03 : Potassium 3.9 mmol/L
2022-04-03 : Sodium 138.5 mmol/L
2022-04-03 : Calcium 8.5 mg/dL
2022-04-03 : Creatinine 1.3 mg/dL
2022-04-03 : Urea Nitrogen 7.3 mg/dL
2022-04-03 : Glucose 64.4 mg/dL
2022-04-03 : Respiratory rate 14.0 /min
2022-04-03 : Heart rate 65.0 /min
2022-04-03 : Blood Pressure
- Diastolic Blood Pressure 74.0 mm[Hg]
- Systolic Blood Pressure 118.0 mm[Hg]
2022-04-03 : Body Mass Index 30.3 kg/m2
2022-04-03 : Body Weight 99.8 kg
2022-04-03 : Pain severity - 0-10 verbal numeric rating [Score] - Reported 1.0 {score}
2022-04-03 : Body Height 181.4 cm
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PROCEDURES:
2022-06-12 : Assessment using Alcohol Use Disorders Identification Test - Consumption (procedure)
2022-06-12 : Assessment of substance use (procedure)
2022-06-12 : Depression screening using Patient Health Questionnaire Two-Item score (procedure)
2022-06-12 : Depression screening (procedure)
2022-06-12 : Assessment of health and social care needs (procedure)
2022-06-01 : Measurement of respiratory function (procedure) for Acute bronchitis (disorder)
2022-04-03 : Screening for drug abuse (procedure)
2022-04-03 : Assessment of substance use (procedure)
2022-04-03 : Depression screening using Patient Health Questionnaire Two-Item score (procedure)
2022-04-03 : Depression screening (procedure)
2022-04-03 : Assessment of anxiety (procedure)
2022-04-03 : Medication Reconciliation (procedure)
2022-04-03 : Assessment of health and social care needs (procedure)
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IMMUNIZATIONS:
2022-06-12 : Influenza, seasonal, injectable, preservative free
2022-04-03 : Influenza, seasonal, injectable, preservative free
2021-10-03 : SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose
2021-09-12 : SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose
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ENCOUNTERS:
2022-06-12 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
2022-06-01 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC : Encounter for Acute bronchitis (disorder)
2022-04-03 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2021-10-03 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
2021-09-12 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
2020-12-11 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC
2020-03-29 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2015-06-07 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2014-11-22 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC : Encounter for Acute bronchitis (disorder)
2012-06-03 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2011-08-15 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC : Encounter for Acute bronchitis (disorder)
2009-05-31 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC : Encounter for Anemia (disorder)
2009-05-31 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2006-05-28 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
2003-05-25 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
1997-05-18 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
1996-05-12 (Dr. Reggie Kassulke) : Encounter at NASH HEALTH CARE PRACTICES LLC
1986-04-07 (Dr. Paz Gerlach) : Encounter at UMASS MEMORIAL HEALTHALLIANCE CLINTON HOSPITAL INC : Encounter for Acute bronchitis (disorder)
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IMAGING STUDIES:
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