PATIENT INFORMATION                                                                                                                      PT#: 00100050
Name: TEST, PATIENT DOB: 02/01/1970 Gender: Female
Address 1: 2505 S. FINLEY RD. Primary Phone: 985-647-1235 Language: English
City/State/ZIP: LOMBARD,    IL   60148 Secondary Phone:   Member No: CC000000000
Comment:  
SENSITIVITIES
# Status Code Description Reason Created Modified
1 Active ASPI ASPIRIN   01/19/2001 RRB  
2 Active BENZ BENZOYL PEROXIDE   01/19/2001 RRB  
3 Active CIME CIMETIDINE   01/19/2001 RRB  
4 Active COUM COUMARIN ANTICOAGULANTS   01/19/2001 RRB  
5 Active DISU DISULFIRAM   01/19/2001 RRB  
6 Inactive CODE CODEINE Patient called to confirm not allergic. 01/19/2001 RRB 06/23/2005 TAL
7 Inactive SULF SULFONAMIDES Entered in error. 01/19/2001 RRB 06/23/2005 TAL
HEALTH STATES
# Status Code Description Reason Created Modified
1 Active ASTH ASTHMA   01/19/2001 RRB  
2 Active ANEM ANEMIA Entered in error. 01/19/2001 RRB 06/23/2005 TAL
3    
ICD CODES
# Status Code Description Reason Created Modified
1 Active ASTH ASTHMA   01/19/2001 RRB  
             
A-Add Health State, IN#-Inactivate Health State, I-ICD Codes, S-Sensitivities, E-Exit without saving and press 'Enter'