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Demographics

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Patient Name:

John Doe

DOB:

5/25/1956

Age:

62

Gender:

Male

MRN:

98874839

   

Ethnicity:

White

   

Address:

123 Generic Street, Somewhere, MA 00000

Home Phone:

123-450-9090

Cell Phone:

111-222-3333

Email:

XXXXXXXX@email.com

   

Insurance:

BCBS New England

   

Providers:

Cardiology—Dr. Heart

 

Nephrology—Dr. Renal

 

Primary Care—Dr. Cares

 

Endocrinology—Dr. Needles

   

Pharmacy:

Generic Pharmacy, Somewhere, USA

   

Smoking History:

1 ppd in past, nonactive

Alcohol History:

1–2 beers a week

Illicit Substance Use:

Cannabis use in past, nonactive

   

PMH:

DM2

 

HTN

 

CAD

 

S/P MI (2014)

 

High cholesterol

 

OA

 

HFrEF

   

Allergies:

None

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  1/9/2019 12/28/2018 12/27/2018 12/26/2018 12/25/2018 12/24/2018 11/5/2018 8/12/2018

Sodium (135–146 mmol/L)

140

138

137

136

138

144

142

140

Potassium (3.5–5.3 mmol/L)

5.6

4.2

4.1

3.9

3.8

4.7

4.4

4.8

Chloride (98–110 mmol/L)

99

106

105

108

110

107

100

102

Carbon Dioxide (19–30 mmol/L)

24

22

20

25

27

29

26

22

Creatinine (0.70–1.25 mg/dL)

1.29

1.3

1.3

1.32

1.34

1.26

1.24

1.28

BUN (7–25 mg/dL)

26

28

30

33

36

24

25

24

Glucose (65–99 mg/dL)

146

148

137

150

142

145

134

128

Calcium (8.6–10.3 mg/dL)

       

8.8

9.3

 

9.2

AST (10–35 u/L)

         

16

 

14

ALT (9–46 u/L)

         

42

 

40

BNP (<100 pg/mL)

260

300

330

 

480

500

   

A1c %

8.60%

           

6.70%

EF %

     

25%

     

30%

Laboratory and Test Data

Vitals

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  1/10/2019 12/28/2018 12/27/2018 12/26/2018 12/25/2018 12/24/2018 11/5/2018 8/12/2018

SBP

100

112

125

132

140

148

118

122

DBP

58

64

78

84

86

90

70

74

Weight (lb)

178

177

179

182

185

194

179

176

Height (in)

71

       

71

71

71

Pulse

72

70

68

68

66

64

74

76

Respiratory Rate

18

18

16

17

18

15

20

19

Temperature (Fahrenheit)

98.6

98.4

98.7

98.6

98.8

98.5

98.6

98.7

Surgical and Procedure History

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  • Stent Placement (LAD and RCA)

  • R Knee Replacement

Jun-14

Jan-12

Medication List

  • LAST UPDATED: DECEMBER 28, 2018

  • Aspirin 81 mg Daily

  • Lisinopril 20 mg Daily

  • Toprol XL 100 mg Daily***

  • Crestor 20 mg Daily

  • Torsemide 60 mg Daily

  • Metformin 1000 mg Twice a day

  • Tylenol 500 mg 1–2 tablets Q4-6H PRN pain

  • Spironolactone 25 mg Daily

  • Amlodipine 5 mg Daily

***Note: Patient previously titrated higher on Toprol ...

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