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170.315_b1_toc_amb_ccd_r21_sample2 test data

PatientThomas Manfred, jr
Date of birthJuly 1, 1980
SexMale
Race
Ethnicity
Contact info Primary Home:
1002 Amber Dr
Beaverton, OR 97006, US
Tel: +1(555)-113-1234
Patient IDs112233334 2.16.840.1.113883.4.1
Document IdToC_15 2.16.840.1.113883.19.5.99999.1
Document Created:July 22, 2015
Care provisionAnnual Health Maintenance, History and Physical from July 22, 2015, 14:00, EST to July 22, 2015, 14:30, EST
Performer (primary care physician)Dr Albert Davis of Neighborhood Physicians Practice
Performer Tracy Davis
AuthorAmb EMR v1.0
Contact info2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002
Encounter Id9937012 2.16.840.1.113883.19
Encounter Date From July 22, 2015, 14:00, EST to July 22, 2015, 14:30, EST
Personal relationshipMr. Richard Manfred

Contact info Primary Home:
1002 Amber Dr
Beaverton, OR 97006, US
Tel: +1(555)-114-1544
Personal relationshipMs Lisa Manfred
Contact info Primary Home:
1002 Amber Dr
Beaverton, OR 97006, US
Tel: +1(555)-114-1544
Entered byTracy Davis
Contact info2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002
Signed Dr Albert Davis at July 22, 2015
Contact info2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002
InformantAlbert Davis
Contact info2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002
InformantLisa Manfred
Information recipient:Dr Albert Davis
Legal authenticatorThis is not intended and not fully compliant with ONC Certification Dr Albert Davis signed at July 22, 2015
Contact info2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002
Document maintained byNeighborhood Physicians Practice
Contact info Work Place:
2472 Rocky place
Beaverton, OR 97006, US
Tel: +1(555)-555-1002

Table of Contents


ALLERGIES AND ADVERSE REACTIONS

No Known Allergies

MEDICATIONS

No known Medications

PROBLEMS

No known problems

ENCOUNTERS

Encounter Location Date
Annual Health Maintenance, History and Physical Neighborhood Physicians Practice July 22, 2015 2pm EST

IMMUNIZATIONS

No known immunization history

VITAL SIGNS

Date / Time: July 22, 2015
Height 177 cm
Weight 88 kg
Blood Pressure 145/88 mm[Hg]

SOCIAL HISTORY

Social History Observation Description Dates Observed
Current Smoking Status Current every day July 22, 2015
Birth Sex Male July 22, 2015

PROCEDURES

No Procedure information

MEDICAL EQUIPMENT

Patient has no history of implantable devices

RESULTS

No Lab Test required. No Lab results.

FUNCTIONAL STATUS

No information

ASSESSMENTS

The patient was found to be healthy and advised to follow his current routine of exercise, work, sleep and quality of life.

TREATMENT PLAN

Hand-off Communication:

Planned Care Start Date
Schedule a visit for next year. July 22, 2016

Goals Section

No Goals Information

Health Concerns

No Health Concerns Information

MENTAL STATUS

No Mental Status information