# 170.315_b1_toc_amb_ccd_r21_sample2 test data

Patient | Thomas Manfred, jr
Date of birth | July 1, 1980
Sex | Male
Race |
Ethnicity |
Contact info | Primary Home: 1002 Amber Dr Beaverton, OR 97006, US Tel: +1(555)-113-1234
Patient IDs | 112233334 2.16.840.1.113883.4.1

Document Id | TT102 2.16.840.1.113883.19.5.99999.1
Document Created: | July 22, 2015

Care provision | Annual 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

Author | Amb EMR v1.0
Contact info | 2472 Rocky place Beaverton, OR 97006, US Tel: +1(555)-555-1002

Encounter Id | 9937012 2.16.840.1.113883.19
Encounter Date | From July 22, 2015, 14:00, EST to July 22, 2015, 14:30, EST

Personal relationship | Mr. Richard Manfred
Contact info | Primary Home: 1002 Amber Dr Beaverton, OR 97006, US Tel: +1(555)-114-1544
Personal relationship | Ms Lisa Manfred
Contact info | Primary Home: 1002 Amber Dr Beaverton, OR 97006, US Tel: +1(555)-114-1544

Entered by | Tracy Davis
Contact info | 2472 Rocky place Beaverton, OR 97006, US Tel: +1(555)-555-1002

Signed | Dr Albert Davis at July 22, 2015
Contact info | 2472 Rocky place Beaverton, OR 97006, US Tel: +1(555)-555-1002

Informant | Albert Davis
Contact info | 2472 Rocky place Beaverton, OR 97006, US Tel: +1(555)-555-1002
Informant | Lisa Manfred

Information recipient: | Dr Albert Davis

Legal authenticator | Dr Albert Davis signed at July 22, 2015
Contact info | 2472 Rocky place Beaverton, OR 97006, US Tel: +1(555)-555-1002

Document maintained by | Neighborhood 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
- MEDICATIONS
- PROBLEMS
- ENCOUNTERS
- IMMUNIZATIONS
- VITAL SIGNS
- SOCIAL HISTORY
- PROCEDURES
- MEDICAL EQUIPMENT
- RESULTS
- FUNCTIONAL STATUS
- ASSESSMENTS
- TREATMENT PLAN
- Goals Section
- Health Concerns
- MENTAL STATUS

### 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