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Document Id | 12345 |
Document Created: | June 15, 2016, 16:14, PST |
Care Provision | Summary of Episode for Amy Shaw |
Performer | Ronald Boone, MD |
Author | Ronald Boone, MD |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |
Encounter Id | 9937012 2.16.840.1.113883.19 |
Event Type | Summary of Episode |
Event Date | From June 15, 2016, 16:20 to June 15, 2016, 18:20 |
Encounter Location | Ambulatory Care at Community Health and Hospitals |
Responsible party | Ronald Boone, MD |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |
Assigned entity | Community Health and Hospitals
|
Emergency contact | Michael Shaw
|
Contact info | 49 Meadow St
Amherst MA 01003, US Tel: (555)555-1212 |
Care giver | Mrs. Lillian White
|
Contact info | 49 Meadow St
Amherst MA 01003, US Tel: (555)555-1215 |
Entered by | Sally Jones |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |
Signed | Ronald Boone at June 15, 2016 |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |
Informant | Henry Vincent, CPh |
Contact info | 1007 Pharmacy Drive
Portland, OR 99123, US Tel: +1(555)555-1215 |
Information recipient: | Primary Physician, MD |
Contact info | 1005 St. Clair Avenue
Amherst MA 01002, US Tel: +1(555)555-1666 |
Legal authenticator | Ronald Boone, MD signed at June 15, 2016 |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |
Document maintained by | Community Health and Hospitals |
Contact info | 1003 Healthcare Drive
Amherst MA 01002, US Tel: +1(555)555-1003 |