No Known Allergies
Patient | Legal: Jerry GOUGH jr Date of Birth: June 1, 1980 (35yr) Gender: Male Patient-ID: 121313344 (SSN) |
Encounter | ID: 9937012 (Examples) , Date/Time: July 22, 2015 6PM -0500 - 11PM -5000 |
Documentation Of | Care provision, Burn by Fire, Date/Time: July 22, 2015 6PM -0500 - 11PM -5000, Performer: Dr Henry SEVEN, Performer: Mary MCDONALD |
Author | Dr Henry SEVEN, Authored On: July 22, 2015 |
Procedure | Date |
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Application of Dressing for burn | July 22, 2015 |
Patient has no history of implantable devices
Date / Time: | June 22, 2015 |
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Height | 177 cm |
Weight | 88 kg |
Blood Pressure | 145/88 mm[Hg] |
Date / Time: | July 22, 2015 |
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Body Temperature | 99 degrees Fahrenheit |
Social History Observation | Description | Dates Observed |
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Current Smoking Status | Current every day | July 22, 2015 |
Birth Sex | Male | July 22, 2015 |
Planned Care | Start Date |
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Schedule an appointment with Dr Seven after 1 week for Follow up with Outpatient facility. | July 29, 2015 |
Medication: Tylenol 500mg | As needed |