ELAINE ELLIS CENTER OF HEALTH • 10001 RHODE ISLAND AVE, COLLEGE PARK MD 20740-1141

RUIZ HERRERA, Emily BELEN (id #32256, dob: 07/19/2019)

10001 RHODE ISLAND AVE

COLLEGE PARK, MD 20740-1141
Phone: (301) 441-1605, Fax: (301) 345-1609
Date: 03/05/2024
Dear Emily Ruiz Herrera,

The following is a summary of your visit today. If you have any questions, please contact our office.

Sincerely,

Electronically Signed by: ABOSEDE SOBO, DNP

_____________________________________________

Patient Ruiz Herrera, Emily Belen (4y7mo, F) #32256

DOB 07/19/2019

Patient Demographics:
Address 500 Chillum Road Home Phone (202) 612-0694
Hyattsville, MD 20783
Work Phone

Encounter Notes:
Encounter immunizations
Reason/Date 03/05/2024 - 03:00PM - School Partners
History of None recorded
Present
Illness
Vitals None recorded
Assessment 1. Active or passive immunization
and Plan Z23: Encounter for immunization
VARIVAX (PF) 1,350 UNIT/0.5 ML SUBCUTANEOUS SUSPENSION -
varicella Site: Arm, Left Upper Qty: (0.5) mL Administered on 03/05/2024
Perform Date: 03/05/2024

Return to Office
Patient will return to the office as needed

Patient Medical History:

Allergies List Allergies not reviewed (last reviewed 11/27/2023)

Medications No medications reported

Past Medical (none recorded)
History
Problem List Problems not reviewed (last reviewed 11/27/2023)