0 5 Health Information
Resume:
Health Information Management
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Patient
Immunizations
Immunizations never marked as reviewed
Ponton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 1 Expiration date: 8/14/2021
COVID-19 (Moderna Monovalent, 12+ Years)
COVID-19 (Moderna Monovalent, 12+ Years)
Administered by: Amanda Phan, DDS Administered on: 4/3/2021 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: 807**-***-** CVX code: 207 VIS date: 12/12/20
Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 031B21A HRSA Expiration date: 9/22/2021
Administered by: Patricia Archer
COVID-19 (Moderna Monovalent, 12+ Years)
Administered by: Dina Segura, MA Administered on: 10/14/2021 Dose: 0.5 mL Site: Left deltoid Route: Intramuscular NDC: 807**-***-** CVX code: 207 VIS date: 08/27/2021
Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 035C21A Expiration date: 10/22/2021
Administered on: 3/6/2021 1419 Dose: 0.5 mL
COVID-19 (Pfizer Bivalent, 12+ Years)
Administered by: Emily Cortez Quezada,
MA
Administered on: 4/3/2023 1640 Dose: 0.3 mL
Site: Right deltoid Route: Intramuscular NDC: 59267-0304-1 CVX code: 300 VIS date: 8/31/2022
Product: Pfizer COVID Bival(12y up)(PF) Manufacturer: Pfizer, Inc Lot number: GL0446 Expiration date: 5/11/2023
Site: Right deltoid Route: Intramuscular NDC: 807**-***-** COVID-19 (Pfizer Bivalent, 12+ Years)
Administered by: Karina Tasejo Galdamez,
MA
Administered on: 8/16/2023 1424 Dose: 0.3 mL
CVX code: 207 VIS date: 12/12/20
Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 010A21A Race: White or Caucasian
Ethnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 10/14/2021
Race: White or Caucasian
Ethnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 4/3/2021
Race: White or Caucasian
Ethnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 3/6/2021
Questionnaire
Question Answer
Race: White or Caucasian
Ethnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 4/3/2023
Questionnaire
Question Answer
Questionnaire
Question Answer
Questionnaire
Question Answer
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Patient (continued)
Immunizations (continued)
Ponton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 2 Administered on: 10/1/2021 CVX code: 135
Location: PATIENT RECORD
CVX code: 300 VIS date: 4/28/2023
Influenza, Recombinant, Quadrivalent, Preservative Free Administered on: 12/14/2020 Dose: 0.5 mL Site: Right deltoid Route: C28161 CVX code: 185
Manufacturer: Sanofi Pasteur Lot number: QFAA2033 Location: KING SOOPERS - 35 Product: Pfizer COVID Bival(12y up)(PF) Manufacturer: Pfizer, Inc Lot number: GL0447 Influenza, Seasonal
Administered on: 3/7/2020 CVX code: 158
External: Patient reported Location: PATIENT RECORD Expiration date: 1/31/2024
Influenza, Seasonal
Administered by: Claudia Tweet, MA Administered on: 11/3/2021 1540 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: 492**-***-** CVX code: 158 VIS date: 08/06/2021
Product: Fluzone Quad 2021-2022 Manufacturer: Sanofi Pasteur Lot number: UJ694AA Expiration date: 6/30/2022
Influenza, Seasonal
Administered by: Karina Tasejo Galdamez,
MA
Administered on: 9/27/2023 1349 Dose: 0.5 mL
Site: Left deltoid Route: Intramuscular NDC: 492**-***-** CVX code: 158 VIS date: 08/06/2021
Product: Fluzone Quad 2023-2024 (PF) Manufacturer: Sanofi Pasteur Lot number: UT8091KA Expiration date: 6/30/2024
Site: Right deltoid
Influenza, Seasonal, Preservative Free
Administered on: 2/8/2020 Site: Left deltoid Route: C28161 CVX code: 150
Manufacturer: Sanofi Pasteur Lot number: UT6719MA Location: DTC FAMILY HEALTH AND WALK-IN
Route: Intramuscular NDC: 59267-0304-1
Influenza, High Dose
Ethnicity: Not Hispanic, Latino, or Spanish Origin Questionnaire
Question Answer
Questionnaire
Question Answer
VIS Offered Date: 9/27/2023
Patient/ Parent denies vaccine contraindications No Consented for flu vaccine Yes
Influenza Vaccine - DH Employee? (Do not edit, Billing use only)
No
VIS Offered Date: 11/3/2021
Patient/ Parent denies vaccine contraindications Yes EUA Fax Sheet Offered Date: 8/16/2023
Questionnaire
Question Answer
Race: White or Caucasian
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Patient (continued)
Immunizations (continued)
Ponton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 3 CVX code: 150
Location: PATIENT RECORD
Influenza, Seasonal, Preservative Free
PCV20 (Pneumococcal Conjugate)
Administered by: Karina Tasejo Galdamez,
MA
Administered on: 6/8/2023 1525 Dose: 0.5 mL
Site: Right deltoid Route: Intramuscular NDC: 000*-****-** CVX code: 216 VIS date: 5/12/2023
Product: Prevnar 20 (PF) Manufacturer: Pfizer, Inc Lot number: GR3621 Expiration date: 9/30/2024
Administered on: 3/15/2019 Site: Left deltoid
PPSV23 (Pneumococcal Polysaccharide)
Administered on: 2/1/2018 CVX code: 33
Location: PATIENT RECORD
Route: C28161
CVX code: 150
Tdap
Administered by: Claudia Tweet, MA Administered on: 3/18/2020 0954 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: 581**-***-** CVX code: 115 VIS date: 02/24/2015
Product: Boostrix Manufacturer: GlaxoSmithKline Lot number: HT479 Expiration date: 8/8/2021
Manufacturer: Sanofi Pasteur Lot number: UJ069AB
Tdap
Administered on: 1/1/2010 CVX code: 115
Location: PATIENT RECORD
Location: DTC FAMILY HEALTH AND
WALK-IN
Tdap
Administered on: 4/5/2011 CVX code: 115
Location: CIGNA HEALTHCARE OF COLORADO
Influenza, Seasonal, Preservative Free
Administered on: 1/1/2020
VIS Offered Date: 3/18/2020
Patient/ Parent denies vaccine contraindications Yes Questionnaire
Question Answer
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic ENCOUNTER
PATIENT
GUARANTOR
COVERAGE
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 4 Unit:
Hospital Service: No service for patient encounter. Bed: Room/bed info not found Admitting Provider: Referring Physician: Lande, Michele A Attending Provider: Adm Diagnosis:
Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
City: Denver CO 80224-3501
Primary Care Provider: Michele A Lande, NP Primary Phone: 720-***-**** EMERGENCY CONTACT
Contact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll
2. *No Contact Specified*
No Father
Guarantor: Todd Edward Ponton DOB: 7/30/1963
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
Denver,CO 80224-3501
Relation to Patient: Self Home Phone: 720-***-**** Guarantor ID: 1194232 Work Phone:
GUARANTOR EMPLOYER
Employer: Status: NOT EMPLO*
PRIMARY INSURANCE
Payor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITY
Subscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554
Pat. Rel. to Subscriber: Self
SECONDARY INSURANCE
Payor: Plan:
Group Number: Insurance Type:
Subscriber Name: Subscriber DOB:
Denver Health Medical
Center 22
Patient Class: Outpatient
MRN: 20182940
Contact Serial #: 107*******
Encounter Date/Time: 11/20/2023
Patient: Todd Edward Ponton
Hospital Account:
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Visit Information
· Follow up in about 2 weeks (around 12/4/2023) for BH Follow-up, already scheduled by front desk. Medication List
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 5 Michele A Lande, NP
Subscriber ID:
Department
Name Address Phone Fax
Wellington E. Webb Center for Primary
Care- Adult Clinic
301 W 6th Avenue
Denver CO 80204
Follow-up and Dispositions
Pat. Rel. to Subscriber:
Contact Serial # (107*******) December 3, 2023 Chart ID (No chart ID available) Provider Information
Medication List
Encounter Provider Referring Provider
Leigh M Kunkle, Psy.D.
This report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Active at the End of Visit
Instructions: Advair Diskus
omeprazole (PriLOSEC) 20mg capsule
Instructions: once daily.
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Entered by: Michele A Lande, NP Entered on: 3/18/2020 albuterol 90 mcg/actuation inhaler
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Start date: 3/12/2020
fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray Instructions: fluticasone propionate 50 mcg/actuation nasal spray,suspension PLACE ONE SPRAY IN EACH NOSTRIL EVERY DAY
Entered by: Michele A Lande, NP Entered on: 3/18/2020 fluticasone propion-salmeteroL (Advair Diskus) 500-50 mcg/dose DISKUS montelukast (Singulair) 10 mg tablet
Instructions: once daily.
Entered by: Michele A Lande, NP Entered on: 3/18/2020 calcium carbonate-vitamin D3 (Caltrate with Vitamin D3) 600 mg(1,500mg) -800 unit tablet alcohol swabs (Alcohol Prep Swabs) pads, medicated Instructions: Caltrate 600
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Medication List (continued)
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 6 Entered by: Michele A Lande, NP Entered on: 4/3/2023 Start date: 3/28/2023
Refill: 3 refills by 3/18/2021
dulaglutide (Trulicity) 0.75 mg/0.5 mL pen injector Authorized by: Michele A Lande, NP Ordered on: 5/1/2023 Start date: 5/1/2023 Quantity: 6 mL
Refill: 1 refill by 4/30/2024
gabapentin (NEURONTIN) 600 MG tablet
Instructions: Take 1 tablet (600 mg total) by mouth 3 (three) times a day. Authorized by: Michele A Lande, NP Ordered on: 6/8/2023 Start date: 6/8/2023 Quantity: 270 tablet
Refill: 2 refills by 6/7/2024
Authorized by: Michele A Lande, NP
rivaroxaban (XARELTO) 10 mg tablet
Instructions: Take 1 tablet (10 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 8/16/2023 Start date: 8/16/2023 Quantity: 90 tablet
Refill: No refills remaining
Ordered on: 3/18/2020
metFORMIN (GLUCOPHAGE) 500mg tablet
atorvastatin (LIPITOR) 40 MG tablet
Instructions: TAKE ONE TABLET BY MOUTH DAILY
Authorized by: Michele A Lande, NP Ordered on: 9/14/2023 Start date: 9/14/2023 Quantity: 90 tablet
Refill: 3 refills by 9/13/2024
lisinopriL (ZESTRIL) 40mg tablet
Instructions: Take 1 tablet (40 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 90 tablet
Refill: 2 refills by 9/26/2024
Instructions: Take 2 tablets (1,000 mg total) by mouth 2 (two) times a day. Authorized by: Michele A Lande, NP
hydrOXYzine (ATARAX) 25mg tablet
Instructions: Take 1 tablet (25 mg total) by mouth 3 (three) times a day as needed for anxiety. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 tablet
Refill: 1 refill by 9/26/2024
Ordered on: 2/27/2023
Start date: 2/27/2023
DULoxetine (CYMBALTA) 20 MG capsule
Instructions: Take 1 capsule (20 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 capsule
Refill: 1 refill by 9/26/2024
Quantity: 360 tablet
Refill: No refills remaining
acetaminophen (TYLENOL) 500 MG tablet
Start date: 3/18/2020 Quantity: 200 each
clindamycin (CLEOCIN T) 1 % external solution
Instructions: [None received]
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Medication List (continued)
Clinical Provider Notes
Integrated Behavioral Health Brief Screen
Visit Type: In Person Behavioral Health Visit
Consult Question: Individual Therapy
Todd Edward Ponton is a 60 y.o. male referred by Michele A Lande, NP to address results of a behavioral health screen. Verbal consent to treatment was obtained at check-in due to in person/video visit Identification Verified: Identification was verified at check-in due to in person / video visit Address Verified: Address was verified at check-in due to in person/video visit. ASSESSMENT:
Encounter Diagnosis
Name Primary?
•Situational anxiety Yes
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 7 Progress Notes
None
Leigh M Kunkle, Psy.D. at 11/20/2023 1600
Stopped in Visit
Instructions: Take 2 tablets (1,000 mg total) by mouth every 8 (eight) hours as needed for mild pain . Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 ibuprofen (ADVIL) 600mg tablet
Instructions: Take 1 tablet (600 mg total) by mouth every 6 (six) hours as needed for mild pain or moderate pain. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 15 tablet
Refill: No refills remaining
Start date: 11/8/2023 Quantity: 100 tablet
tamsulosin (FLOMAX) 0.4 mg capsule
Instructions: Take 1 capsule (0.4 mg total) by mouth once daily. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 30 capsule
Refill: No refills remaining
Refill: No refills remaining
phenazopyridine (PYRIDIUM) 100 MG tablet
Instructions: Take 1 tablet (100 mg total) by mouth 3 (three) times a day as needed for bladder spasms. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 9 tablet
Refill: No refills remaining
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Clinical Provider Notes (continued)
PHQ-9 and GAD-7:
EPDS Score (10+ = Positive Screen) :
Other screening tool administered: Screened for situational anxiety Treatment Goals: See Self Management Action Plan
PLAN (include follow up plan with clinic/BH provider and/or referral and coordination of care with other treatment entities):
Follow up with BHC, In-Person, in 2-3 weeks, schedule at check out SUBJECTIVE/OBJECTIVE:
HPI (review psychosocial history including substance use, family history of mental health/medical concerns, potential risks/barriers to pt engaging in treatment):
- Lots of health stressors since last visit
Reported that he had bladder tumor removed a couple of weeks ago, found it was cancerous Described plan for upcoming surgery to remove remaining tumor cells, potential need for chemo after that Expressed feeling scared, overwhelmed in receiving and processing this news about his health; finding ways to limit anxious worrying
Endorsed nervousness, feeling on-edge, anxiety with continued uncertainty about outcome of court case; next court date on Monday, will learn if plea accepted or not Noted that he has been spending time with friends/loved ones, on hobbies and starting his new business; helping keep mind on meaningful/enjoyable things
Agreeable to continued focus on behavioral activation, health management, supportive self-talk to manage numerous current stressors
Collaboration with Medical Provider: Written
Med profile reviewed: no
Intervention Provided:
I spent 14 minutes providing follow up on a behavioral health screen and engaging patient in Behavioral Health Education. Details of intervention include: Discussed situational stressors, anxious symptoms and coping. Normalized and validated fear and anxiety associated with recent bladder cancer diagnosis and subsequent surgeries, promoted emotional expression, built rapport and highlighted patients strengths and successes in support-seeking. Reinforced and encouraged continued focus on behavioral activation, engaging with social supports and future-oriented thinking.. This intervention supported patient to engage in collaborative problem solving and develop today's treatment goals. Supported patient to acquire the skills necessary to complete goals. Response to teaching: verbalize Provider masked for encounter: No.
Mandatory Disclosure/Confidentiality:
The mandatory disclosure is on file; see imaged document Patient Rights and Grievance Form:
Patient Rights and Grievance form was given to patient. Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 8 No data to display
No data to display
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/20/2023
11/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Clinical Provider Notes (continued)
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 9 Electronically signed by Leigh M Kunkle, Psy.D. at 11/21/2023 4:21 PM Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/9/2023
11/09/2023 - Infusion in Infusion Services
ENCOUNTER
PATIENT
GUARANTOR
COVERAGE
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 10 Unit:
Hospital Service: No service for patient encounter. Bed: Room/bed info not found Admitting Provider: Referring Physician: Lande, Michele A Attending Provider: Adm Diagnosis: Polycythemia [D75.1] Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
City: Denver CO 80224-3501
Primary Care Provider: Michele A Lande, NP Primary Phone: 720-***-**** EMERGENCY CONTACT
Contact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll
2. *No Contact Specified*
No Father
Guarantor: Todd Edward Ponton DOB: 7/30/1963
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
Denver,CO 80224-3501
Relation to Patient: Self Home Phone: 720-***-**** Guarantor ID: 1194232 Work Phone:
GUARANTOR EMPLOYER
Employer: Status: NOT EMPLO*
PRIMARY INSURANCE
Payor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITY
Subscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554
Pat. Rel. to Subscriber: Self
SECONDARY INSURANCE
Payor: Plan:
Group Number: Insurance Type:
Subscriber Name: Subscriber DOB:
Denver Health Medical
Center 22
Patient Class: Outpatient
MRN: 20182940
Contact Serial #: 107*******
Encounter Date/Time: 11/9/2023
Patient: Todd Edward Ponton
Hospital Account:
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/9/2023
11/09/2023 - Infusion in Infusion Services (continued) Visit Information
Medication List
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 11 Michele A Lande, NP
Subscriber ID:
Department
Name Address Phone Fax
Infusion Services 660 Bannock Street
Denver CO 80204
Pat. Rel. to Subscriber:
Contact Serial # (107*******) December 3, 2023 Chart ID (No chart ID available) Provider Information
Medication List
Referring Provider
This report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Active at the End of Visit
Instructions: Advair Diskus
omeprazole (PriLOSEC) 20mg capsule
Instructions: once daily.
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Entered by: Michele A Lande, NP Entered on: 3/18/2020 albuterol 90 mcg/actuation inhaler
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Start date: 3/12/2020
fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray Instructions: fluticasone propionate 50 mcg/actuation nasal spray,suspension PLACE ONE SPRAY IN EACH NOSTRIL EVERY DAY
Entered by: Michele A Lande, NP Entered on: 3/18/2020 fluticasone propion-salmeteroL (Advair Diskus) 500-50 mcg/dose DISKUS montelukast (Singulair) 10 mg tablet
Instructions: once daily.
Entered by: Michele A Lande, NP Entered on: 3/18/2020 calcium carbonate-vitamin D3 (Caltrate with Vitamin D3) 600 mg(1,500mg) -800 unit tablet alcohol swabs (Alcohol Prep Swabs) pads, medicated Authorized by: Michele A Lande, NP Ordered on: 3/18/2020 Start date: 3/18/2020 Quantity: 200 each
Refill: 3 refills by 3/18/2021
Instructions: Caltrate 600
Entered by: Michele A Lande, NP Entered on: 3/18/2020 Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/9/2023
11/09/2023 - Infusion in Infusion Services (continued) Medication List (continued)
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 12 Authorized by: Michele A Lande, NP Ordered on: 5/1/2023 Start date: 5/1/2023 Quantity: 6 mL
Refill: 1 refill by 4/30/2024
Authorized by: Michele A Lande, NP Ordered on: 2/27/2023 gabapentin (NEURONTIN) 600 MG tablet
Instructions: Take 1 tablet (600 mg total) by mouth 3 (three) times a day. Authorized by: Michele A Lande, NP Ordered on: 6/8/2023 Start date: 6/8/2023 Quantity: 270 tablet
Refill: 2 refills by 6/7/2024
Start date: 2/27/2023 Quantity: 360 tablet
rivaroxaban (XARELTO) 10 mg tablet
Instructions: Take 1 tablet (10 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 8/16/2023 Start date: 8/16/2023 Quantity: 90 tablet
Refill: No refills remaining
Refill: No refills remaining
atorvastatin (LIPITOR) 40 MG tablet
Instructions: TAKE ONE TABLET BY MOUTH DAILY
Authorized by: Michele A Lande, NP Ordered on: 9/14/2023 Start date: 9/14/2023 Quantity: 90 tablet
Refill: 3 refills by 9/13/2024
lisinopriL (ZESTRIL) 40mg tablet
Instructions: Take 1 tablet (40 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 90 tablet
Refill: 2 refills by 9/26/2024
metFORMIN (GLUCOPHAGE) 500mg tablet
hydrOXYzine (ATARAX) 25mg tablet
Instructions: Take 1 tablet (25 mg total) by mouth 3 (three) times a day as needed for anxiety. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 tablet
Refill: 1 refill by 9/26/2024
clindamycin (CLEOCIN T) 1 % external solution
DULoxetine (CYMBALTA) 20 MG capsule
Instructions: Take 1 capsule (20 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 capsule
Refill: 1 refill by 9/26/2024
Instructions: [None received]
acetaminophen (TYLENOL) 500 MG tablet
Instructions: Take 2 tablets (1,000 mg total) by mouth every 8 (eight) hours as needed for mild pain . Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 100 tablet
Refill: No refills remaining
Entered by: Michele A Lande, NP Entered on: 4/3/2023 Start date: 3/28/2023
Instructions: Take 2 tablets (1,000 mg total) by mouth 2 (two) times a day. dulaglutide (Trulicity) 0.75 mg/0.5 mL pen injector Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/9/2023
11/09/2023 - Infusion in Infusion Services (continued) Medication List (continued)
Labs
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 13 Lab
None
Stopped in Visit
Hematocrit [144907058] (Final result)
Electronically signed by: Angela McGee, RN on 11/09/23 1509 Status: Completed Ordering user: Angela McGee, RN 11/09/23 1509 Ordering provider: Michele A Lande, NP Authorized by: Michele A Lande, NP Ordering mode: Transcribed from paper From therapy plan: THERAPEUTIC PHLEBOTOMY Frequency: STAT 11/09/23 - Class: Clinic Collect Quantity: 1
Lab status: Final result Instance released by: Angela McGee, RN 11/9/2023 3:18 PM Diagnoses
Polycythemia [D75.1]
Instructions: Take 1 tablet (600 mg total) by mouth every 6 (six) hours as needed for mild pain or moderate pain. phenazopyridine (PYRIDIUM) 100 MG tablet
Instructions: Take 1 tablet (100 mg total) by mouth 3 (three) times a day as needed for bladder spasms. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 9 tablet
Refill: No refills remaining
Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 15 tablet
Refill: No refills remaining
Questionnaire
Question Answer
Release to patient Immediate
ibuprofen (ADVIL) 600mg tablet
Specimen Information
ID Type Source Collected By
23L-313H0130 Blood Blood Angela McGee, RN 11/09/23 1518 tamsulosin (FLOMAX) 0.4 mg capsule
Hematocrit [144907058] (Normal) Resulted: 11/09/23 1535, Result status: Final result Ordering provider: Michele A Lande, NP 11/09/23 1518 Order status: Completed Filed by: Lab, Background User 11/09/23 1535 Collected by: Angela McGee, RN 11/09/23 1518 Resulting lab: DENVER HEALTH PAVILLION L, OUTPATIENT MEDICAL CENTER
CLIA number: 06D2197244
Acknowledged by
Michele A Lande, NP on 11/13/23 0727
Karina Tasejo Galdamez, MA on 11/13/23 0941
Instructions: Take 1 capsule (0.4 mg total) by mouth once daily. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 30 capsule
Refill: No refills remaining
Hematocrit 42.7 38.0 - 52.0 % — DH OMC
Components
Component Value Reference Range Flag Lab
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Enc Date 11/9/2023
11/09/2023 - Infusion in Infusion Services (continued) Labs (continued)
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 14 Testing Performed By
Result Notes
Notify the patient labs are normal
Lab - Abbreviation Name Director Address Valid Date Range All Reviewers List
Karina Tasejo Galdamez, MA on 11/13/2023 9:41 AM
Michele A Lande, NP on 11/13/2023 7:28 AM
96 - DH OMC DENVER HEALTH
PAVILLION L,
OUTPATIENT
MEDICAL CENTER
Unknown 660 Bannock
Denver CO 80204
09/01/20 0719 - Present
Indications
Polycythemia [D75.1 (ICD-10-CM)]
Michele A Lande, NP
11/13/2023 7:28 AM MST
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Adm 11/8/2023, D/C 11/8/2023
11/08/2023 - Admission (Discharged) in Operating Room ENCOUNTER
PATIENT
GUARANTOR
COVERAGE
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 15 Unit: PAV A OR
Hospital Service: Surgery Bed: PAV A OR POOL/PAV A OR Admitting Provider: Rohan G Bhalla, MD Referring Physician: Attending Provider: Adm Diagnosis: Bladder tumor [D49.4] Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
City: Denver CO 80224-3501
Primary Care Provider: Michele A Lande, NP Primary Phone: 720-***-**** EMERGENCY CONTACT
Contact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll
2. *No Contact Specified*
No Father
Guarantor: Todd Edward Ponton DOB: 7/30/1963
Address: 7075 Leetsdale Dr Apt J12 Sex: Male
Denver,CO 80224-3501
Relation to Patient: Self Home Phone: 720-***-**** Guarantor ID: 1194232 Work Phone:
GUARANTOR EMPLOYER
Employer: Status: NOT EMPLO*
PRIMARY INSURANCE
Payor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITY
Subscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554
Pat. Rel. to Subscriber: Self
SECONDARY INSURANCE
Payor: Plan:
Group Number: Insurance Type:
Subscriber Name: Subscriber DOB:
Denver Health Medical
Center 22
Patient Class: OP Surg
MRN: 20182940
Contact Serial #: 107*******
Encounter Date/Time: 11/8/2023 0724
Patient: Todd Edward Ponton
Hospital Account:
Health Information Management
301 W. 6th Ave.
Denver CO 80204
Ponton, Todd Edward
MRN: 20182940, DOB: 7/30/1963, Sex: M
Adm 11/8/2023, D/C 11/8/2023
11/08/2023 - Admission (Discharged) in Operating Room (continued) Visit Information
Medication List
Ponton, Todd Edward (MR # 20182940) CSN:107******* Printed at 12/3/2023 10:29 PM Page 16 Admit Date/Time: 11/08/2023 7:24 AM IP Adm. Date/Time: Admission Type: Elective Point of Origin: Ambulatory Surgery Center
Admit Category:
Means of Arrival: Primary Service: Surgery Secondary Service: N/A Transfer Source: Service Area: DENVER HEALTH Unit: Operating Room Admit Provider: Rohan G Bhalla, MD Attending Provider: Rohan G Bhalla, MD Referring Provider: Subscriber ID:
Discharge Information
Date/Time: 11/08/2023 1:10 PM Disposition: Home/self Care (Routine) Destination: — Provider: Rohan G Bhalla, MD Unit: Operating Room
Pat. Rel. to Subscriber:
Contact Serial # (107*******) December 3, 2023 Chart ID (20182940-DH ENC-4) Admission Information
Medication List
Arrival Date/Time:
This report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Prior To Admission
Contact this candidate