| ID | Last Name | First Name | M.I. | Age | Home Address | City | State | Home Ph | Cell Ph | Em. Contact Name | Em. Contact Relation | Em. Ph | Em. Cell | Primary Doctor | Primary Dr. Phone | Specialist Dr 1 | Specialty 1 | Specialist 1 Ph | Specialist Dr 2 | Speciality 2 | Specialist 2 Ph | Specialist Dr 3 | Speciality 3 | Specialist 3 Ph | Medical Ins Co | Medical Ins ID | Ins Group Number | Hospital/Group | Condition Approx Date | Condition Approx Date | Recent Surgery | Recent Surgery | Recent Surgery | Allergy | Allergy | Allergy | Diseases Treated | Diseases Treated | Diseases Treated | Diseases Treated | Medication | Medication | Medication | Medication | Medication | Medication | Recent Immunizations | Timestamp |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Mazurek | John | C | 62 | 431 Ravine Drive | Winthrop Harbor | IL | 847-746-2477 | 847-804-2477 | Laura Mazurek | Wife | 847-746-2477 | 847-804-2478 | Dr. J Brown | 847-555-7878 | Dr. S. Hadddad | Foot | 847-555-9999 | Dr. Van Stamos | Hip | 847-876-4531 | Dr. George Holt | Back | 847-326-9812 | Humana | 457937452894 | H003627 | Evanston Northwestern Health | Pulmonary Embolism 12/07 | Pulmonary Embolism 12/04 | Bunion Surgery 12/07 | Hip Replacement 7/05 | Asprin | Hay fever | High Blood Pressure | Warfarin / 4 MG | Atenolol / 50 MG | Mavik / 2MG | Folbic Tablet | Flu Shot 10/07 | 4/28/2008 9:02:08 AM | |||||||
| 13 | oliveira | raul | a | 40 | 6441 algerian dr | parkton nc | AL | 910 624 4243 | daniella oliveira | 910 624 1805 | 910 624 4243 | Dr.none | Dr.benson | phycihsrtay | Dr.blue | phycologist | Dr. | evergreen behaviral | bipolar schzofrenia ptsd | lithium seroqel zoloft zanax stelazine carbamazepine | 8/4/2008 1:56:54 PM | |||||||||||||||||||||||||||
| 14 | CUMMINGS | KATHRYN | 52 | 5038 FOREST ROAD | ELM CITY | NC | 252-292-7411 | CUMMINGS MIKE | SPOUSE | 252-292-7411 | Dr. | Dr. VANDENBOSCH | ORTHO SURGEON | 252-243-9629 | Dr. | Dr. | JAN 9 2007 ARTHOSCOPE KNEE | 8/15/2008 11:23:12 PM | ||||||||||||||||||||||||||||||
| 15 | rowe | cheryl | a | 30 | 126-p avenida majorca | laguna hills | CA | colleen gackowski | mother | 9492334096 | Dr. | Dr. | Dr. | Dr. | 9/22/2008 4:08:56 AM | |||||||||||||||||||||||||||||||||
| 11 | Mazurek | John | C | 62 | 431 Ravine Drive | Winthrop harbor | IL | 847-746-2477 | 847-804-2477 | Laura Mazurek | Wife | 847-746-2477 | 847-804-2478 | Dr.Johathan Brown | 847-945-4575 | Dr. Steven Haddad | Foot Surgeon | Dr.Van Stamos | Hip Surgeon | Dr. | Humana | H40093729-01 | 60282001A2129 | Evanston Northwestern Hospital | DVT - Dec- 2007 | Pulmonary Embolism - Jan 2008 | Bunion Surgery - Rt. Ft. - Dr. Haddad - Orthopedic - Ill Bone and Joint 12-07 | Hip Replacement - Rt. HIP - Dr. Stamos - Orthopedic - Ill Bone and Joint 7-04 | Bunion Surgery - Lf. Ft. - Dr. Bucciero - Podiatrist - 11-00 | Asprin (marginal) | DVT & Pulmonary Embolism 12-2003 | DVT & Pulmonary Embolism 12-2007 | High Blood Pressure under control with Atenolol 10 years | Atenolol 50mg, Daily | Warfarin 4/2mg alternate, Daily | Mavik 2mg, Daily | Flu Shot 10-2007 | 8/3/2008 7:10:35 AM | ||||||||||