Maureen Randolph

283 Sarah Road
West Sandra, MI 44120 
 Maureen Randolph (id #922514, DATE OF BIRTH: 13-09-1990) 
 Encounter Date: 18-12-2018 
 Patient 
 Patient Name 
 Maureen Randolph (36yo, F) ID# 922512 
 Appt. Date/Time 
 30-12-2021 11:00AM 
 DATE OF BIRTH 
 13-09-1990 
 Service Dept. 
 MGPC_Grove City Broadway 
 - 
 Provider 
 MOIRA SKURATOWICZ, APRN 
 Insurance 
 Med Primary: AETNA 
 Insurance # : W219963613
 Policy/Group # : 010964687220697 
 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 721-690-8965, Fax 712-518-8637 
 Vitals 
 30-12-2021 03:12 pm 
 Ht: 5 ft 4 in 
 Measurements 
 None recorded. 
 Allergies 
 Reviewed Allergies 
 Albuterol inhaler: Hives (Moderate) 
 DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; 
 YEAST: - REACTION: HIVES, RASH; 
 Medications
