Personal Information:

Reg.No:123                                                                                                                       Bar Code: 2011320

Patient Name Category: General                                                                            

Sex: Female

First Name: Mrs. Reagene

Middle Name: Bautista   

Last Name: Fernando

Date of Birth:May 2, 1952

Age:60                                                                           

Father/Husband Name: Michael Fernando

Religion: Catholic

Chief Complaint: Dizziness

Past Health History             

The client verbalized “Kumpleto ako sa mga bakuna na dapat makuha, kasi alam ko na kailangan ito ng aking katawan para mas mabawasan ang panganib na magkaroon ng sakit lalo na sa edad ko kinakailangan din ng suporta para hindi ako kaagad magkaroon ng malalang karamdaman.” Mrs. Fernando stated had undergone episiotomy and experienced pre-eclampsia when she delivered her second child. Mrs. Fernando stated “Hindi ko rin kasi alam kung may history ang pamilya ko ng hypertension." She also added " hindi naman ako nag out of town".


Contact Information:

Address: 345 Bagong Barrio, Caloocan City Manila, Philippines                           Telephone:  417-3784                                                      

Pin/Zip Code: 123456  

 Mobile:  09353507212

E-mail: ReaFernando@yahoo.com                                          

Name of Kin: Lyka Fernando

Country: Philippines                                                                                                       Designation: Admin Officer       

City:Caloocan                                                                                                                    Reference Doctor: Dr. Samonte

                                                                                                          Blood Group: O Positive

Date of Entry: 05-02-13       

Time of Entry: 12:51