Ms. Amy Pearson DDS

45116 Yvonne Union
Barronfort, UT 91767 
 Ms. Amy Pearson DDS (id #922514, DOB: 11-13-2001) 
 DATE OF ENCOUNTER: 06-26-2020 
 Patient 
 PATIENT 
 Ms. Amy Pearson DDS (36yo, F) ID# 922512 
 Appt. Date/Time 
 02-17-2021 11:00AM 
 DOB 
 11-13-2001 
 Service Dept. 
 MGPC_Grove City Broadway 
 - 
 Provider 
 MOIRA SKURATOWICZ, APRN 
 Insurance 
 Med Primary: AETNA 
 Insurance # : W216960846
 Policy/Group # : 010942917473715 
 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 376-887-6118, Fax 314-582-1179 
 Vitals 
 02-17-2021 03:12 pm 
 Ht: 5 ft 4 in 
 Measurements 
 None recorded. 
 Allergies 
 Reviewed Allergies 
 Insulin: Hives (Moderate) 
 DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; 
 YEAST: - REACTION: HIVES, RASH; 
 Medications
