Jeremy Williams

651 Cook Roads
Lake Steven, VT 18576 
 Jeremy Williams (id #922514, dob: 2000 Nov 06) 
 DATE OF ENCOUNTER: 2014 May 28 
 Patient 
 PATIENT 
 Jeremy Williams (88yo, F) ID# 922512 
 Appt. Date/Time 
 2016 Mar 15 11:00AM 
 dob 
 2000 Nov 06 
 Service Dept. 
 MGPC_Grove City Broadway 
 - 
 Provider 
 MOIRA SKURATOWICZ, APRN 
 Insurance 
 Med Primary: AETNA 
 Insurance # : W218225600
 Policy/Group # : 010959913038392 
 PCP : MILLER, TERESA 
 Prescription: CVS|CAREMARK - Member is eligible. details 
 Patient's Care Team 
 Primary Care Provider (Primary Insurance): MILLER, TERESA: 3667 MARLANE DR, GROVE CITY, OH 43123, Ph 133-890-3913, Fax 364-157-6118 
 Vitals 
 2016 Mar 15 03:12 pm 
 Ht: 5 ft 4 in 
 Measurements 
 None recorded. 
 Allergies 
 Reviewed Allergies 
 Ibuprofen: Hives (Moderate) 
 DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; 
 YEAST: - REACTION: HIVES, RASH; 
 Medications
