Sample Profile

HealthAccount User ID:
IE468135246

Last Updated:
04/17/2024  10:59 AM

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Personal Information

sample profile picture

Name:
Jamie Webber
Address:
100 East Main Road
Warwick, Rhode Island 02886
United States
DOB:
September 14, 1995
Sex:
Female
Height:
5' 5"
Weight:
120 pounds

Emergency Contact Information

Emergency Contact:
John Webber
401-555-1234
Primary Physician:
Dr. Martin
401-444-1234
Primary Dentist:
Dr. Smith
401-758-1234
Other Physician:
Dr. Luke (Diabetes Specialist)
401-824-1234

Medical Information

Blood Type:
B+
Current Meds Taken:
Aspirin
Codeine
Food/Drug Allergies:
Gluten Allergy/Penicillin

Insurance Information

Primary Insurance:
Blue Cross
Name on Policy:
Jamie Webber
ID Number:
51001-037551238-00

Addtional Information

Optical Information:
L20 R20
Immunizations:
COVID-19 - Pfizer 2 doses (8/21) Pfizer booster (03/22) Pfizer booster (10/22) Flu shot (01/24)
Current Illnesses:
Diabetes - Insulin Dependent
Past Illnesses:
COVID-19 (04/21) COVID-19 (6/22) Influenza (03/24)
Procedures:
Metal bolt in knee (12/05)
Lab Results:
None
Family History:
Father - Diabetes and Triple Bypass
Mother - Ovarian Cancer
Maternal Grandfather - Cancer (Deceased)
Living Will:
Click to view
Medical Images and Documents:
Click to view

Pharmacy Information

Pharmacy:
CVS Pharmacy
401-222-1234