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Smith, John L. -- last updated 03/30/2017



 Patient Name:  
Smith, John L.
  DOB: 
12/07/1941
  Last updated: 
03/30/2017



 


 SSN:  
123-45-6789
 

 Sex:  
M
 

 Marital:  
Married
 

 Street:  
904 Maple Ave SW
 

 City:  
Romney
 

 State:  
WV
 

 Zip:  
24746-9998
 

 Phone:  
304-555-2244
 

 Email Addr:  
jsmith433@yahoo.com
 

 Spouse/Nok:  
Kathy Smith (spouse); same addr; 304-555-2245
 

 PCP:  
David Cohen; 304 Main St, #D / Romney, WV 20036-8132; 304-555-1205
 

 


 Overview:  
-- Generally healthy senior male; blood type O+
-- migrain headaches, about once a week
-- arthritis in left elbow
-- hypertension
-- elevated cholesterol
 		

 


 Drugs Used:  
-- aspirin (2 reg), when migrains occur
-- moderate alcohol use (3 beers/week)
-- lisinopril/hctz (10/12.5mg) once/day for high BP
 		

 


 Alergies:  
-- pollen
-- bee stings
-- sulfa drugs
-- more
 ** 		

 


 Family History:  
-- Type 2 diabetes, mother and her sister
-- Multiple Myeloma, father died at age 51
 		

 


 Medicare #:  
123-45-6789-T
 

 Medicaid #:  

 

 Primary Ins:  
Aetna; PO Box 1489 / Lexington, KY 40512-4089; 1-888-555-3862
 

 Prim Policy #:  
W1086 11644-01
 

 Prim Type:  
PPO
 

 Primary Owner:  
self
 

 Employer:  
CSC; 12000 Willard Dr / Chantilly, VA 22170-2218; 703-555-3000
 

 Secondary Ins:  

 

 Sec Policy #:  

 

 






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