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    clinical logs

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    45 views601 pages

    Clinical Logs

    Uploaded by

    AlexanderWarren
    clinical logs

    Copyright:

    © All Rights Reserved
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 601

    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"

    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">

    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272/4&nbsp;is not a valid ICD code.
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon


    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Antilipids<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>

    <td bgcolor="#000000" colspan="2">


    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>

    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    700&nbsp;- CORNS/CALLOSITIES
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    496&nbsp;- CHRONIC AIRWAY OBSTRUCTION NEC
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Pulmonary - 2-agonist<BR>Pulmonary - Steroid inhalers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to podiatry
    </font>
    </td>
    </tr>
    </table>

    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">

    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>


    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    64 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    244.9&nbsp;- UNS HYPOTHYROIDISM
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="right">


    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    7</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - NSAIDS<BR>Cardiology - ACE inhibitors<BR>Endocrinology Oral glucose lowering agents<BR>Endocrinology - Thyroid<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    79 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b


    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=

    "border-style: solid; border-width: 2px">


    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    473.9&nbsp;- UNS SINUSITIS (CHRONIC)
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Antihistamines<BR>Infectious Diseases - Fluoroquinolones<BR>Miscellaneous
    - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    68 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">

    White, Non Hispanic


    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Less than shared
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>

    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    382.9&nbsp;- UNS OTITIS MEDIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Antihistamines<BR>Infectious Diseases - Penicillins<BR>Miscellaneous - Not
    covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan

    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    Nurs 6820 Practicum


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    58 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    3 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Less than shared
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    714.0&nbsp;- RHEUMATOID ARTHRITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Angiotensin II receptor blockers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Less than shared
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    722.6&nbsp;- DEGENERATION IV DISC SITE UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>


    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Neurology - Neuromuscular blockers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<

    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    041.12&nbsp;- METH RESIST STAF AUREUS NOS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Miscellaneous antibiotics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan

    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    Nurs 6820 Practicum


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    780.52&nbsp;- INSOMNIA UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Antilipids<BR>Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-010</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    20 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Shared (50-50)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    041.12&nbsp;- METH RESIST STAF AUREUS NOS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>


    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Miscellaneous antibiotics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150209-011</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Shared (50-50)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<

    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan

    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    Nurs 6820 Practicum


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    51 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    596.51&nbsp;- HYPERTONICITY BLADDER
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    496&nbsp;- CHRONIC AIRWAY OBSTRUCTION NEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Angiotensin II receptor blockers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    53 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">Social Problems Addressed:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    296.3&nbsp;- MAJOR DEPRESSIVE DISORDER RECURR
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Psychiatric - Antidepressants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information

    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>

    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    40 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    719.46&nbsp;- PAIN IN JOINT LOWER LEG
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border


    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - NSAIDS<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This


    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    x ray ordered
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>Semester:</b></font></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    27 years

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Narcotics<BR>Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    depo shot, voltarin gel
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    37 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.4&nbsp;- OTH/UNS HYPERLIPIDEMIA
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    607.84&nbsp;- IMPOTENCE ORGANIC ORIGIN
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Antilipids<BR>Urology - Erectile dysfunction medication<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information

    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>

    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    52 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    486&nbsp;- PNEUMONIA ORGANISM UNS
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.4&nbsp;- OTH/UNS HYPERLIPIDEMIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Cephalosporins<BR>Infectious Diseases - Fluoroquinolones<B
    R>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>

    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    rocephin shot
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>

    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border

    -style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    62 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    787.60&nbsp;- FULL INCONTINENCE OF FECES
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    788.30&nbsp;- URINARY INCONTINENCE UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>

    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to urology and GI
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>

    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150210-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/10/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">


    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    4 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral

    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    708.9&nbsp;- UNSPEC URTICARIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    well child check
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>

    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>

    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>

    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;


    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Shared (50-50)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Type of HP:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P

    ROB EXAM;MED DECISION LOW COMPLEX


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>

    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>

    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border

    -style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    12 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    382.9&nbsp;- UNS OTITIS MEDIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Penicillins<BR>Infectious Diseases - Miscellaneous antibio
    tics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>

    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    40 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>


    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">

    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Analgesic/Antipyretic - NSAIDS<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;

    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    55 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    041.12&nbsp;- METH RESIST STAF AUREUS NOS
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">

    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Sulfonamides<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2

    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon

    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border


    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    32 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information

    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Expanded Problem Focused


    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    244.9&nbsp;- UNS HYPOTHYROIDISM
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Endocrinology - Thyroid<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>

    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    68 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>


    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    496&nbsp;- CHRONIC AIRWAY OBSTRUCTION NEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">

    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Pulmonary - 2-agonist<BR>Pulmonary - Steroid inhalers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;

    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    28 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    780.52&nbsp;- INSOMNIA UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">


    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="


    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    lunesta
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150211-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/11/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    8 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>


    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    3 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">

    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></


    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>

    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    38 years
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    535.5&nbsp;- UNSPEC GASTRITIS/GASTRODUODENITIS
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">

    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Adrenergic blockers<BR>GI Agents - Nausea meds<BR>GI Agents - H+/K+
    ATPase enzyme inhibitors (ie omeprazole)<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>

    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;


    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    67 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physical Therapist
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    386.58&nbsp;- OTH FORMS COMBIN LABYRINTHINE DYSF
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">


    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    meclizine
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>

    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    296.3&nbsp;- MAJOR DEPRESSIVE DISORDER RECURR
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>

    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>

    <font size="2"><BR>
    Cardiology - Calcium channel blockers<BR>Endocrinology - Oral glucose lowering a
    gents<BR>Psychiatric - Antidepressants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">

    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;


    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">


    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    62 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    296.30&nbsp;- MAJ DEPRESS DIS RECURR EPI UNS
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">


    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Calcium channel blockers<BR>Psychiatric - Antidepressants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>

    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>

    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    5 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Miscellaneous antibiotics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>

    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"


    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    58 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    305.1&nbsp;- TOBACCO USE DISORDER
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon

    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>

    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>


    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    chantix
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">

    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;


    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150216-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/16/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">


    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    26 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Analgesic/Antipyretic - NSAIDS<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>

    <td width="50%"><b><font size="2">&nbsp; Case ID #:


    1532-20150217-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">

    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>

    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    257.2&nbsp;- OTH TESTICULAR HYPOFUNCTION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>

    <td width="90%" bgcolor="#FFFFFF" align="left">


    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    testosterone
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">

    <p align="right"><b><font size="2">Date of Service:


    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    44 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;

    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    257.2&nbsp;- OTH TESTICULAR HYPOFUNCTION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>

    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    testosterone
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics


    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    81 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    698.0&nbsp;- PRURITUS ANI
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    hydroxizine
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">Social Problems Addressed:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    345.9&nbsp;- EPILEPSY UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Neurology - Anticonvulsants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information

    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>

    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    31 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    528.3&nbsp;- CELLULITIS/ABSCESS ORAL SOFT TISS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border


    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Penicillins<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This


    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>Semester:</b></font></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    15 years

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    535.5&nbsp;- UNSPEC GASTRITIS/GASTRODUODENITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    28 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>


    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    78 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<

    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    278.00&nbsp;- OBESITY UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>Miscellaneous - No
    t covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>

    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan


    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    adipex
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150217-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/17/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    727.41&nbsp;- GANGLION OF JOINT
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>

    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to sx
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    76 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<


    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Observation only
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    496&nbsp;- CHRONIC AIRWAY OBSTRUCTION NEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Pulmonary - Nonsteroidal anti-inflammatory (ie Tilade)<BR>Miscellaneous - Not co
    vered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>

    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan


    ="2">
    <font size="2">
    home o2
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <b><font size="2">Preceptor: </font></b></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    33 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">

    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">

    461.0&nbsp;- ACUTE MAXILLARY SINUSITIS


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Penicillins<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">

    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    461.0&nbsp;- ACUTE MAXILLARY SINUSITIS
    </font>
    </td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Infectious Diseases - Penicillins<BR
    >
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t


    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">#1 -</font></b><font size="2">&nbsp;


    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    346.0&nbsp;- MIGRAINE W AURA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>

    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>

    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to neuro
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">

    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">

    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1 year
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    682.9&nbsp;- UNSPEC CELLULITIS/ABSCESS
    </font>
    </td>

    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Miscellaneous antibiotics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t


    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    47 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">#1 -</font></b><font size="2">&nbsp;


    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150218-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/18/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>

    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    77 years
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF">


    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>

    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=


    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    564.0&nbsp;- CONSTIPATION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    Amitiza
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">

    White, Non Hispanic


    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Moderate complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>

    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    382.9&nbsp;- UNS OTITIS MEDIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Penicillins<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t


    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">#1 -</font></b><font size="2">&nbsp;


    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>

    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Cephalosporins<BR>Infectious Diseases - Penicillins<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>

    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">

    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">

    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    278.00&nbsp;- OBESITY UNSPEC
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><


    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    Two weight loss medications.<BR><BR>Adipex and Lipovite.
    </font>
    </td>

    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    71 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b

    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Reason for Visit:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">

    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">

    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Vasodilators<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>

    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>

    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">


    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">

    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.4&nbsp;- OTH/UNS HYPERLIPIDEMIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    5</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Calcium channel blockers<BR>Endocrinology - Oral glucose lowering a
    gents<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    62 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<

    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    278.00&nbsp;- OBESITY UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan

    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    lipovite for weight loss
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    Nurs 6820 Practicum


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    63 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    346.00&nbsp;- MIGRAINE W AURA NOT INTRACT WO STATUS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    fioricet
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150223-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/23/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    67 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    511.0&nbsp;- PLEURISY WOEFFUSION/CURRENT TB
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>


    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Fluoroquinolones<BR>Miscellaneous - Not covered elsewhere<
    BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    medrol dose pack
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b

    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Type of Decision-Making:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">

    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<


    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    496&nbsp;- CHRONIC AIRWAY OBSTRUCTION NEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">

    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Pulmonary - 2-agonist<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>

    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan


    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    o2 recert
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    382.9&nbsp;- UNS OTITIS MEDIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Penicillins<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>

    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    17 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<


    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    599.0&nbsp;- URINARY TRACT INFECTION UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Macrolides<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan

    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>

    <td WIDTH="50%" bgcolor="#FFFFFF">


    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    68 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    700&nbsp;- CORNS/CALLOSITIES

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    7</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to podiatry
    </font>

    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>

    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    26 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    244.9&nbsp;- UNS HYPOTHYROIDISM
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Endocrinology - Thyroid<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>

    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">

    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>


    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    296.3&nbsp;- MAJOR DEPRESSIVE DISORDER RECURR
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>Psychiatric - Anti
    depressants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>

    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan


    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <b><font size="2">Preceptor: </font></b></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    23 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">

    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">

    041.9&nbsp;- UNS BACTERIAL INFECTION


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Sulfonamides<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">

    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    56 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    607.84&nbsp;- IMPOTENCE ORGANIC ORIGIN
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><

    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Urology - Erectile dysfunction medication<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>

    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150224-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    2/24/2015&nbsp;</font></b><font size="2"></font></b></font></fon
    t></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">


    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    36 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    257.2&nbsp;- OTH TESTICULAR HYPOFUNCTION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>

    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    testosterone
    </font>
    </td>
    </tr>
    </table>
    <P></P>

    <br clear=all style='page-break-before:always'>


    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">

    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    30 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    465.9&nbsp;- ACUTE UPPER RESP INFECTIONS UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border

    -style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >

    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    78 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>


    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Encounter #:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.4&nbsp;- OTH/UNS HYPERLIPIDEMIA
    </font>
    </td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    784.0&nbsp;- HEADACHE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    8</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    5</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Antilipids<BR>Cardiology - Diuretics<BR>Endocrinology - Oral glucos
    e lowering agents<BR>GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<
    BR>Neurology - Migraine<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan

    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">

    Nurs 6820 Practicum


    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    71 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    562.00&nbsp;- DIVERTICULOSIS SM INTESTINE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <b><font size="2"># Prescriptions currently prescribed:</font></b>


    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>

    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to gastro
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    32 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<

    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Student Participation:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>

    <td width="90%" bgcolor="#FFFFFF" align="left">


    <font size="2">
    466.0&nbsp;- ACUTE BRONCHITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">

    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">

    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    46 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>

    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>Cardiology - Calcium channel blockers<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>

    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    31 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b


    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">


    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>

    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>

    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    466.0&nbsp;- ACUTE BRONCHITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    8</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>Pul
    monary - Nonsteroidal anti-inflammatory (ie Tilade)<BR>Miscellaneous - Not cover
    ed elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    rocephin<BR>solumedrol<BR>medrol dose pack
    </font>
    </td>
    </tr>
    </table>
    <P></P>

    <br clear=all style='page-break-before:always'>


    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150302-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/2/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">

    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    133.0&nbsp;- SCABIES
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border

    -style: solid; border-width: 2px">


    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    scabies medications
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >

    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    61 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>


    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">

    <b><font size="2">Encounter #:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><

    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>Endocrinology - Oral glucose lowering agents<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>

    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">


    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    62 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    295.00&nbsp;- SCHIZOPHREN SIMPLE UNS
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;

    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - ACE inhibitors<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>

    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan


    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <b><font size="2">Preceptor: </font></b></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    51 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">

    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    1
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">

    401.9&nbsp;- UNS HYPERTENSION


    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    278.00&nbsp;- OBESITY UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    728.85&nbsp;- SPASM MUSCLE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">


    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Miscellaneous - Not covered elsewher
    e<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    Toradol<BR>Lipovite<BR>Medrol dose pack
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>

    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    722.6&nbsp;- DEGENERATION IV DISC SITE UNS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border

    -style: solid; border-width: 2px" bordercolor="#99CCFF">


    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Analgesic/Antipyretic - Narcotics<BR
    >
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This


    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>Semester:</b></font></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    13 years

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    4 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    727.43&nbsp;- GANGLION UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    refer to surgery
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    12 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    345.9&nbsp;- EPILEPSY UNSPECIFIED
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">

    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>


    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>

    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"


    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    referral to neuro
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">


    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    52 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">


    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<

    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    490&nbsp;- BRONCHITIS NOT SPECIFIED ACUTE/CHRONIC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Fluoroquinolones<BR>Miscellaneous - Not covered elsewhere<
    BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>

    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan


    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    medrol dose pack<BR>rochephin shot<BR>solu-medrol
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    27 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    784.0&nbsp;- HEADACHE
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>

    <td width="50%" bgcolor="#FFFFFF" align="right">


    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Miscellaneous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>

    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    fioricet
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150303-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/3/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">

    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<


    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>

    <td bgcolor="#FFFFFF" align="right">


    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>

    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    530.81&nbsp;- ESOPHAGEAL REFLUX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan

    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>

    <td WIDTH="50%" bgcolor="#FFFFFF">


    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    54 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female

    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    724.2&nbsp;- LUMBAGO

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Muscle relaxants<BR>Analgesic/Antipyretic - Narcotics<BR
    >
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">

    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    62 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    726.64&nbsp;- PATELLAR TENDINITIS
    </font>
    </td>
    </tr>

    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">

    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></


    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    6</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Calcium channel blockers<BR>Endocrinology - Oral glucose lowering a
    gents<BR>GI Agents - H+/K+ ATPase enzyme inhibitors (ie omeprazole)<BR>Miscellan
    eous - Not covered elsewhere<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This


    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    toradol shot
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>Semester:</b></font></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    58 years

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>

    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Endocrinology - Glucose elevating agents<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    7 years
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Physician
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    724.2&nbsp;- LUMBAGO
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    300.00&nbsp;- ANXIETY STATE UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    6</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Narcotics<BR>Psychiatric - Antidepressants<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"

    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    pain management referral
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information

    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>

    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    70 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">

    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>

    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border


    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Cardiology - Diuretics<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">

    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This


    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-006</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">

    <p align="right"><font size="2"><b>Semester:</b></font></td>


    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    46 years

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>

    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">


    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    278.00&nbsp;- OBESITY UNSPEC
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.1&nbsp;- PURE HYPERGLYCERIDEMIA
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#3 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    244.9&nbsp;- UNS HYPOTHYROIDISM
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Endocrinology - Thyroid<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    fish oil
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>

    <td width="50%"><b><font size="2">&nbsp; Case ID #:


    1532-20150305-007</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">

    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    30 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>

    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    466&nbsp;- ACUTE BRONCHITIS AND BRONCHIOLITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>

    <td width="90%" bgcolor="#FFFFFF" align="left">


    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-008</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">

    <p align="right"><b><font size="2">Date of Service:


    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    72 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;

    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    053&nbsp;- HERPES ZOSTER
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX

    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    7</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - Narcotics<BR>Infectious Diseases - Antiviral agents<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>

    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150305-009</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/5/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>

    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics


    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    42 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    12 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    250.00&nbsp;- DIABETES UNCOMPL TYPE II
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Endocrinology - Insulin<BR>Endocrinology - Oral glucose lowering agents<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>

    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150309-001</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">

    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    53 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    9 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">

    <b><font size="2">Social Problems Addressed:</font></b></td>


    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    727.05&nbsp;- OTH TENOSYNOVITIS HAND/WRIST
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    401.9&nbsp;- UNS HYPERTENSION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>

    <td width="90%" bgcolor="#FFFFFF" align="left">


    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Analgesic/Antipyretic - NSAIDS<BR>Cardiology - ACE inhibitors<BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    toradol
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150309-002</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">

    <p align="right"><b><font size="2">Date of Service:


    3/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>

    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    64 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicare
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;

    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    >10
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    585.3&nbsp;- CHRONIC KIDNEY DISEASE STAGE III
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    272.4&nbsp;- OTH/UNS HYPERLIPIDEMIA
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon

    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    10</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>

    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>


    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">

    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;


    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150309-003</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>

    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">


    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    45 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Black or African American
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Male
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>

    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    10 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Other
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">

    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    466&nbsp;- ACUTE BRONCHITIS AND BRONCHIOLITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>

    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">


    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    4</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    ENT - Non-narcotic antitussives<BR>Infectious Diseases - Fluoroquinolones<BR>Mis
    cellaneous - Not covered elsewhere<BR>

    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    medrol dose pack<BR>solumedrol
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>
    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"
    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>

    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150309-004</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>

    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">


    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    38 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Medicaid
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral

    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    8 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    6-10
    </font></td>

    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    343&nbsp;- INFANTILE CEREBRAL PALSY
    </font>
    </td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#2 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    276.5&nbsp;- VOLUME DEPLETION
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>

    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon
    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    1</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    0</font></td>
    </tr>

    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>
    <br clear=all style='page-break-before:always'>

    <table border="0" width="100%" cellpadding="0" cellspacing="0" bgcolor="#C0C0C0"


    >
    <tr>
    <td bgcolor="#000000" colspan="2">
    <font color="#FFFFFF" size="2">&nbsp; <b>Albany State University CHP&nbsp;
    &nbsp; </b>(Acct #7157)</font></td>
    </tr>
    <tr>
    <td width="50%"><b><font size="2">&nbsp; Case ID #:
    1532-20150309-005</font></b><font size="2"></font></font><b><font size="
    2">&nbsp;</font></b></td>
    <td width="50%">
    <p align="right"><b><font size="2">Date of Service:
    3/9/2015&nbsp;</font></b><font size="2"></font></b></font></font
    ></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td WIDTH="100%" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Student Information
    - Warren,Alexander</b></font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>Semester:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Spring
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <font size="2"><b>Course:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    Nurs 6820 Practicum
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2">Preceptor: </font></b></td>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <font size="2">
    BRYANT, Bill
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">Clinical Site</font></b><font size="2"><b>:</b></font>
    </td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">

    Southland MD
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF" align="right" height="18" valign="top">
    <b><font size="2">
    Setting Type</font></b><font size="2"><b>:</b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF" height="18">
    <font size="2">
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" bgcolor="#000000" align="right" colspan="2" style="border
    -style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Patient Demographics
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><font size="2"><b>
    Age:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    52 years
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Race</font></b><font size="2"><b>:</b
    ></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    White, Non Hispanic
    </font></td>
    </tr>
    <tr>
    <td WIDTH="50%" bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Gender</font></b><font size="2"><b>:<
    /b></font></td>
    <td WIDTH="50%" bgcolor="#FFFFFF"><font size="2">
    Female
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Insurance</font></b><font size="2"><b
    >:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Private insurance
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF">
    <p align="right"><b><font size="2">Referral</font></b><font size="2"><b>
    :</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    No referral
    </font></td>
    </tr>
    <tr>
    <td valign="top" bgcolor="#000000" colspan="2" style="border-style: solid;
    border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Information
    </b></font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Time with Patient:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    11 minutes</font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <p align="right"><font size="2"><b>
    Consult with Preceptor:</b></font></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of Decision-Making:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Low complexity
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Student Participation:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Primary (>50%)
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Reason for Visit:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Follow-up (Routine)
    </font></td>
    </tr>

    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Encounter #:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    2-5
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right">
    <b><font size="2">Type of HP:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    Expanded Problem Focused
    </font></td>
    </tr>
    <tr>
    <td bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">Social Problems Addressed:</font></b></td>
    <td bgcolor="#FFFFFF">
    <font size="2">
    &nbsp;</font></font></td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" bordercolor="#99CCFF">
    <tr>
    <td width="100%" bgcolor="#000000" align="center" colspan="2" style=
    "border-style: solid; border-width: 2px">
    <font color="#FFFFFF" size="2"><b>ICD-9 Diagnosis Codes<
    /b></font></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    466&nbsp;- ACUTE BRONCHITIS AND BRONCHIOLITIS
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px">

    <p align="center"><font color="#FFFFFF" size="2"><b>CPT Billing Codes</b></fon


    t></td>
    </tr>
    <tr>
    <td width="10%" bgcolor="#FFFFFF" align="right" valign="top">
    <b><font size="2">#1 -</font></b><font size="2">&nbsp;
    </font>
    </td>
    <td width="90%" bgcolor="#FFFFFF" align="left">
    <font size="2">
    99213&nbsp;- OFFICE/OP VISIT, EST PT, 2 KEY COMPONENTS: EXPAND PROB HX; EXPAND P
    ROB EXAM;MED DECISION LOW COMPLEX
    </font>
    </td>
    </tr>
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#FFFFFF" colspan="2">
    <p align="center">&nbsp;</td>
    </tr>
    </table>
    <table border="0" cellspacing="0" WIDTH="100%" cellpadding="1">
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" style="border
    -style: solid; border-width: 2px" bordercolor="#99CCFF">
    <p align="center"><b><font size="2" color="#FFFFFF">Medications</font></
    b></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <p><b><font size="2"># OTC Drugs taken regularly:</font></b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># Prescriptions currently prescribed:</font></b>
    </td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    3</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="right">
    <b><font size="2"># New/Refilled Prescriptions This Visit:</font><
    /b></td>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">
    <font size="2">
    2</font></td>
    </tr>
    <tr>
    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">

    <u>
    <b><font size="2">Types of New/Refilled Prescriptions This Visit:</font></b></u>
    <font size="2"><BR>
    Infectious Diseases - Cephalosporins<BR>Infectious Diseases - Fluoroquinolones<B
    R>
    &nbsp;</font></td>

    <td width="50%" bgcolor="#FFFFFF" align="left" valign="top">


    <u>
    <b><font size="2">Adherence Issues with Medications:</font></b></u><font size="2
    "><BR>
    &nbsp;</font></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td WIDTH="100%" align="right" bgcolor="#000000" colspan="2" bordercolor="
    #99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><b><font size="2" color="#FFFFFF">Other Questions About This
    Case</font></b></td>
    </tr>
    </table>
    <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" WIDTH="100%" bgcolor="#FFFFFF"
    >
    <tr>
    <td width="100%" bgcolor="#000000" align="left" valign="top" colspan
    ="2" bordercolor="#99CCFF" style="border-style: solid; border-width: 2px">
    <p align="center"><font color="#FFFFFF" size="2"><b>Clinical Notes</b></font></t
    d>
    </tr>
    <tr>
    <td width="100%" bgcolor="#FFFFFF" align="left" valign="top" colspan
    ="2">
    <font size="2">
    </font>
    </td>
    </tr>
    </table>
    <P></P>

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