Nathan Fox

602 William Islands Apt. 027
West Michaelshire, DC 32655 
 Nathan Fox (id #922514, DOB: 22 Mar 1989) 
 Encounter Date: 24 Oct 2019 
 Patient 
 PATIENT NAME 
 Nathan Fox (59yo, F) ID# 922512 
 Appt. Date/Time 
 11 Feb 2020 11:00AM 
 DOB 
 22 Mar 1989 
 Service Dept. 
 MGPC_Grove City Broadway 
 - 
 Provider 
 MOIRA SKURATOWICZ, APRN 
 Insurance 
 Med Primary: AETNA 
 Insurance # : W212268246
 Policy/Group # : 010921919293932 
 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 600-279-6261, Fax 787-847-3514 
 Vitals 
 11 Feb 2020 03:12 pm 
 Ht: 5 ft 4 in 
 Measurements 
 None recorded. 
 Allergies 
 Reviewed Allergies 
 Loratadine: Hives (Moderate) 
 DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; 
 YEAST: - REACTION: HIVES, RASH; 
 Medications
