--- a +++ b/data/text/Latarsha_DuBuque_7532e039-f228-a1d1-51fa-0758e86b3191.txt @@ -0,0 +1,99 @@ +Latarsha DuBuque +================ +Race: Other +Ethnicity: Non-Hispanic +Gender: F +Age: 16 +Birth Date: 2006-02-27 +Marital Status: S +-------------------------------------------------------------------------------- +ALLERGIES: +No Known Allergies +-------------------------------------------------------------------------------- +MEDICATIONS: + 2021-02-21[STOPPED] : Natazia 28 Day Pack +-------------------------------------------------------------------------------- +CONDITIONS: +-------------------------------------------------------------------------------- +CARE PLANS: +-------------------------------------------------------------------------------- +REPORTS: + 2022-04-11 : Complete blood count (hemogram) panel - Blood by Automated count + - Leukocytes [#/volume] in Blood by Automated count 10.1 10*3/uL + - Erythrocytes [#/volume] in Blood by Automated count 4.3 10*6/uL + - Hemoglobin [Mass/volume] in Blood 13.1 g/dL + - Hematocrit [Volume Fraction] of Blood by Automated count 36.6 % + - MCV [Entitic volume] by Automated count 80.4 fL + - MCH [Entitic mass] by Automated count 30.4 pg + - MCHC [Mass/volume] by Automated count 33.2 g/dL + - Erythrocyte distribution width [Entitic volume] by Automated count 40.4 fL + - Platelets [#/volume] in Blood by Automated count 378.8 10*3/uL + - Platelet distribution width [Entitic volume] in Blood by Automated count 351.6 fL + - Platelet mean volume [Entitic volume] in Blood by Automated count 10.9 fL + 2021-04-05 : Patient Health Questionnaire-9: Modified for Teens [Reported.PHQ.Teen] + - Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen] 2.0 {score} +-------------------------------------------------------------------------------- +OBSERVATIONS: + 2022-04-11 : Tobacco smoking status Never smoked tobacco (finding) + 2022-04-11 : Platelet mean volume [Entitic volume] in Blood by Automated count 10.9 fL + 2022-04-11 : Platelet distribution width [Entitic volume] in Blood by Automated count 351.6 fL + 2022-04-11 : Platelets [#/volume] in Blood by Automated count 378.8 10*3/uL + 2022-04-11 : Erythrocyte distribution width [Entitic volume] by Automated count 40.4 fL + 2022-04-11 : MCHC [Mass/volume] by Automated count 33.2 g/dL + 2022-04-11 : MCH [Entitic mass] by Automated count 30.4 pg + 2022-04-11 : MCV [Entitic volume] by Automated count 80.4 fL + 2022-04-11 : Hematocrit [Volume Fraction] of Blood by Automated count 36.6 % + 2022-04-11 : Hemoglobin [Mass/volume] in Blood 13.1 g/dL + 2022-04-11 : Erythrocytes [#/volume] in Blood by Automated count 4.3 10*6/uL + 2022-04-11 : Leukocytes [#/volume] in Blood by Automated count 10.1 10*3/uL + 2022-04-11 : Respiratory rate 12.0 /min + 2022-04-11 : Heart rate 97.0 /min + 2022-04-11 : Blood Pressure + - Diastolic Blood Pressure 83.0 mm[Hg] + - Systolic Blood Pressure 107.0 mm[Hg] + 2022-04-11 : Body mass index (BMI) [Percentile] Per age and gender 43.0 % + 2022-04-11 : Body Mass Index 20.0 kg/m2 + 2022-04-11 : Body Weight 52.2 kg + 2022-04-11 : Pain severity - 0-10 verbal numeric rating [Score] - Reported 2.0 {score} + 2022-04-11 : Body Height 161.6 cm + 2021-04-05 : Patient Health Questionnaire-9: Modified for Teens total score [Reported.PHQ.Teen] 2.0 {score} + 2021-04-05 : Tobacco smoking status Never smoked tobacco (finding) + 2021-04-05 : Respiratory rate 15.0 /min + 2021-04-05 : Heart rate 76.0 /min + 2021-04-05 : Blood Pressure + - Diastolic Blood Pressure 85.0 mm[Hg] + - Systolic Blood Pressure 104.0 mm[Hg] + 2021-04-05 : Body mass index (BMI) [Percentile] Per age and gender 45.6 % + 2021-04-05 : Body Mass Index 19.7 kg/m2 + 2021-04-05 : Body Weight 50.9 kg + 2021-04-05 : Pain severity - 0-10 verbal numeric rating [Score] - Reported 2.0 {score} + 2021-04-05 : Body Height 161.0 cm +-------------------------------------------------------------------------------- +PROCEDURES: + 2022-04-11 : Anticipatory guidance (procedure) + 2022-04-11 : Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure) + 2022-04-11 : Medication Reconciliation (procedure) + 2022-04-11 : Assessment of substance use (procedure) + 2021-04-05 : Anticipatory guidance (procedure) + 2021-04-05 : Assessment using Car, Relax, Alone, Forget, Friends, Trouble Screening Test (procedure) + 2021-04-05 : Assessment of substance use (procedure) + 2021-04-05 : Depression screening using Patient Health Questionnaire Nine Item score (procedure) + 2021-04-05 : Medication Reconciliation (procedure) + 2021-04-05 : Depression screening (procedure) +-------------------------------------------------------------------------------- +IMMUNIZATIONS: + 2022-04-11 : meningococcal MCV4P + 2022-04-11 : Influenza, seasonal, injectable, preservative free + 2021-06-14 : SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose + 2021-05-24 : SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose + 2021-04-05 : Influenza, seasonal, injectable, preservative free +-------------------------------------------------------------------------------- +ENCOUNTERS: +2022-04-11 (Dr. Natividad Davis) : Encounter at HILLTOWN COMMUNITY HEALTH CENTERS INC +2021-06-14 (Dr. Saundra Kuphal) : Encounter at COOLEY DICKINSON HOSPITAL INC +2021-05-24 (Dr. Saundra Kuphal) : Encounter at COOLEY DICKINSON HOSPITAL INC +2021-04-05 (Dr. Natividad Davis) : Encounter at HILLTOWN COMMUNITY HEALTH CENTERS INC +2021-02-21 (Dr. Saundra Kuphal) : Encounter at COOLEY DICKINSON HOSPITAL INC +-------------------------------------------------------------------------------- +IMAGING STUDIES: +--------------------------------------------------------------------------------