Amherst Family Practice, PC

1867 Amherst Street Suite 101 | WINCHESTER, VA 22601- 2801 | T. (540) 667- 8724 F. (540) 662- 5638

Fitzpatrick, Ana | DOB: 12/26/1954 (66yo)| MRN: 12318716

Date: 12/28/2020

Visit Summary for Ana Fitzpatrick

Reason f or Visit
Medicare Annual Wellness Visit

Prevent ion Plan and Saf et y Evaluat ion

AWV - f emale prevent ion plan:

Advance Direct ives:

POLST completed. Educational information provided

Chronic Care Management Services:

After review of the completed Health Risk Assessment and the patient's medical record, and in consultation
with the patient, a Personal Preventive Services Plan was created today. A summary of recommendations for
immunizations and screening for cancer, osteoporosis, and cardiovascular disease follows and was given to
the patient:

Immunizat ions:

Influenza: 09/15/2020
Pneumonia (PCV13): 06/22/2020
Pneumonia (PCV23): due:
Tetanus (Tdap/Td): 06/05/2017
Shingles/Zoster: Shingrix recommended

12/19/2019

Prevent ive Services:

Test Status
Mammogram 08/25/2020
Pap Smear 12/19/2019
Colon Cancer Screening Colonoscopy | 01/09/2018
Low dose lung CT not recommended
Bone Density/DEXA 01/04/2018
Diabetes (glucose/A1C) normal blood glucose
Cardiovascular (lipids) 12/21/2020 due: ordereddeclinedas per disease management
plancompletedN/A
Hepatitis C (if born 1945-
1965)
STD screening
Visual Acuity N/A since patient is NOT a Welcome to Medicare patient
 It ems t hat may be af f ect ing your healt h:age, dyslipidemia

Please schedule all t est ing and ref erral appoint ment s as ordered by your provider. If you have
any quest ions, please call t he of f ice

AWV - saf et y evaluat ion:

I have reviewed the patient’s answers on the HRA and determined the patient can successfully perform
ADLs

I have assessed the patient’s hearing by the whisper test.RE:4/5 LE:4/5there is no evidence of hearing
impairment

I have assessed the patient’s risk of fall today through the Timed Up and Go Test. 12 sec. and determined
that the patient is at low risk for falls

Assessment and Plan

The following list includes any diagnoses that were discussed at your visit.

Follow up in 6 months with fasting labwork prior (cmp,lipids,vit d).

She is overall stable and doing well. Her labs are reviewed.

Her medicare screens show normal memory and mood, low fall risk.

Discussed with patient recommendations of healthy diet low in carbohydrates, cardiovascular exercise 30 minutes
three times a week. Recommended staying up to date on age appropriate screenings and immunizations.

Patient expressed understanding of instructions and had no questions.

1. Adult healt h examinat ion

Z00.00: Encounter for general adult medical examination without abnormal findings
WELL VISIT, OVER 65: CARE INSTRUCTIONS
PREVENTING FALLS: CARE INSTRUCTIONS
ADVANCE DIRECTIVES: CARE INSTRUCTIONS

2. Dyslipidemia -

lipids slightly increased, counseled on diet

E78.2: Mixed hyperlipidemia

atorvastatin 20 mg tablet -
TAKE 1 TABLET BY MOUTH EVERY DAY AT BEDTIME Qty: 90 tablet(s) Refills: 3 Pharmacy: WALMART
PHARMACY 1406

Medicat ions
Your medical records indicates you are on the following medicine. If this list is not consistent with the medications you
are taking, or if you are taking additional over-the-counter medications, please inform your provider.

Reviewed Medications
aspirin 81 mg t ablet ,delayed release 11/30/17 entered
Take 1 tablet(s) every day by oral route.

at orvast at in 20 mg t ablet 11/22/20 filled

TAKE 1 TABLET BY MOUTH EVERY DAY AT BEDTIME

Calcium 500 + D 500 mg (1,250 mg)-200 unit t ablet 11/30/17 entered

Take 1 tablet(s) every day by oral route.

ergocalcif erol (vit amin D2) 1,250 mcg (50,000 unit ) capsule 12/18/20 filled
TAKE 1 CAPSULE BY MOUTH ONCE EVERY MONTH FOR 90 DAYS

f lut icasone propionat e 50 mcg/act uat ion nasal spray,suspension 04/07/20 filled
USE 1 SPRAY(S) IN EACH NOSTRIL ONCE DAILY

met oprolol t art rat e 50 mg t ablet 08/27/20 filled

TAKE 1 TABLET BY MOUTH TWICE DAILY

Vit amin D3 50 mcg (2,000 unit ) capsule 11/30/17 entered

Take 1 capsule(s) every day by oral route.

Vit als
Ht : 5 ft 1 in Standing Wt : 201 lbs 9.6 oz With BMI: 38.1
(154.94 cm) clothes (91.44 kg)

BP: 130/76 sitting L BP Cuf f Size: adult Pulse: 71 bpm regular

arm

RR: 16 O2Sat : 96% Room Air at T : 98.2 F° oral (36.78

Rest C)

Not es: Vision screening

with corrective
lenses
RE:20/26 LE:320/20
Hearing:
RE:4/5 LE:4/5
Nurse:1:54 - 1:58

Recent Result s
Discussed t he f ollowing document s:
CMP, SERUM OR PLASMA - 12/21/20
Results:
- SODIUM: 142 NORMAL
- POTASSIUM: 4.1 NORMAL
- CHLORIDE: 105 NORMAL
- CARBON DIOXIDE: 29 NORMAL
- ANION GAP: 8.4 NORMAL
- GLUCOSE: 94 NORMAL
- BUN: 21 HIGH
- CREATININE: 0.71 NORMAL
- BUN/CREATININE RATIO: 30 NORMAL
- CALCIUM: 9.4 NORMAL
- TOTAL PROTEIN: 7.1 NORMAL
- ALBUMIN: 3.8 NORMAL
- GLOBULIN: 3.3 NORMAL
- A/G RATIO: 1.2 NORMAL
- BILIRUBIN TOTAL: 0.5 NORMAL
- ALKALINE PHOSPHATASE: 92 NORMAL
- AST (SGOT): 19 NORMAL
- ALT (SGPT): 35 NORMAL
- EGFR AFRICAN AMER: 103 NORMAL
- EGFR NON-AFRICAN AMER: 90 NORMAL
LIPID PANEL, SERUM - 12/21/20
Results:
- CHOLEST EROL: 205 HIGH
- TRIGLYCERIDES: 89 NORMAL
- HDL CHOLEST EROL: 73 HIGH
 - HDL CHOLEST EROL: 73 HIGH
- LDL DIRECT : 113 HIGH
- RISK RATIO (CHOL/HDL): 2.8 NORMAL

Allergies
Please review your allergy list for accuracy. Contact your provider if this list needs to be updated.

Reviewed Allergies
NKDA

Vaccines
Here is a copy of your most up-to-date vaccination list.

Reviewed Vaccines
Vac c ine Type D ate Amt. Ro ute S ite ND C Lo t # Mfr. Exp. D ate VIS Vac c inato r
D ate o n VIS G ive n

D iphthe ria, Te tanus , Pe rtus s is

Tdap 0 6 /0 5/17

Influe nz a

influe nz a, 0 9 /15/20 0 .7 Intramus c ular D e lto id, UJ478AB S ano fi 0 6 /30 /21 0 8/15/19 0 9 /15/20 S amantha
high-do s e , mL Le ft Pas te ur No c ito
quadrivale nt (AFP)

influe nz a, 12/13/18 0 .5 Intramus c ular Arm, UT6 375JA S ano fi 0 6 /30 /19 0 8/0 7/15 12/13/18 Jamie
inje c table , mL Le ft Pas te ur White
quadrivale nt, Uppe r
pre s e rvative
fre e

influe nz a, 12/0 4/17 0 .5 Intramus c ular D e lto id, UI876 AB S ano fi 0 6 /30 /18 0 8/0 7/15 12/0 4/17 Jo rdan
inje c table , mL Le ft Pas te ur Me rrine r
quadrivale nt,
pre s e rvative
fre e

Pne umo c o c c al

pne umo c o c c al 0 6 /22/20 0 .5 Intramus c ular D e lto id, 0 0 0 0 519 710 1 CD O 412 Pfiz e r, 0 1/31/22 10 /30 /19 0 6 /22/20 Naide li
c o njugate PCV mL Le ft Inc Re ye s
13

VIIS checked 06/22/2020 KF

MD & VIIS checked 12/6/2019 JW

Surgical/GYN Hist ory

Reviewed Surgical History
Colonoscopy - 01/09/2018 - normal 10 yr f/u
Ophthalmology - Cataract Surgery - 11/05/2013 - left eye with implant
Colonoscopy - 01/02/2006

Reviewed GYN History

LMP: Unknown (Notes: No lmp due to meno).
Date of Last Pap Smear: 12/19/2019 (Notes: neg, neg hpv).
Date of Last Mammogram: 08/25/2020 (Notes: negative).
Mammogram Result: Normal.
Date of Last Bone Density: 01/04/2018 (Notes: osteopenia).

Demographics

Name: Fitzpatrick, Ana

Address: 139 Pembridge Dr
Winchester,VA 22602-6854
Phone: (215) 495-4760
Insurance: Medicare-VA (Medicare)
DOB: 12/26/1954

Please be sure to schedule all testing and referral appointments as ordered by your provider. The annual wellness
visit is important for prevention and early detection of illness. Thank you for coming in and we hope to see you next
year!
Sincerely,
Electronically Signed by: MEGAN WILLIAMS, DO