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Click here or scroll down to respond to this candidateHealth Information ManagementStreet Address W. 6th Ave.Denver CO Street Address
Ponton, Todd EdwardMRN: Street Address , DOB: 7/30/1963, Sex: MPatientImmunizationsImmunizations never marked as reviewedPonton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 1 Expiration date: 8/14/2021COVID-19 (Moderna Monovalent, 12+ Years)COVID-19 (Moderna Monovalent, 12+ Years)Administered by: Amanda Phan, DDS Administered on: 4/3/2021 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 207 VIS date: 12/12/20Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 031B21A HRSA Expiration date: 9/22/2021Administered by: Patricia ArcherCOVID-19 (Moderna Monovalent, 12+ Years)Administered by: Dina Segura, MA Administered on: 10/14/2021 Dose: 0.5 mL Site: Left deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 207 VIS date: 08/27/2021Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 035C21A Expiration date: 10/22/2021Administered on: 3/6/2021 1419 Dose: 0.5 mLCOVID-19 (Pfizer Bivalent, 12+ Years)Administered by: Emily Cortez Quezada,MAAdministered on: 4/3/2023 1640 Dose: 0.3 mLSite: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 300 VIS date: 8/31/2022Product: Pfizer COVID Bival(12y up)(PF) Manufacturer: Pfizer, Inc Lot number: GL0446 Expiration date: 5/11/2023Site: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE COVID-19 (Pfizer Bivalent, 12+ Years)Administered by: Karina Tasejo Galdamez,MAAdministered on: 8/16/2023 1424 Dose: 0.3 mLCVX code: 207 VIS date: 12/12/20Product: Moderna COVID-19 Vaccine (EUA) Manufacturer: Moderna Lot number: 010A21A Race: White or CaucasianEthnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 10/14/2021Race: White or CaucasianEthnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 4/3/2021Race: White or CaucasianEthnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 3/6/2021QuestionnaireQuestion AnswerRace: White or CaucasianEthnicity: Not Hispanic, Latino, or Spanish Origin EUA Fax Sheet Offered Date: 4/3/2023QuestionnaireQuestion AnswerQuestionnaireQuestion AnswerQuestionnaireQuestion AnswerHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MPatient (continued)Immunizations (continued)Ponton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 2 Administered on: 10/1/2021 CVX code: 135Location: PATIENT RECORDCVX code: 300 VIS date: 4/28/2023Influenza, Recombinant, Quadrivalent, Preservative Free Administered on: 12/14/2020 Dose: 0.5 mL Site: Right deltoid Route: C28161 CVX code: 185Manufacturer: Sanofi Pasteur Lot number: QFAA2033 Location: KING SOOPERS - 35 Product: Pfizer COVID Bival(12y up)(PF) Manufacturer: Pfizer, Inc Lot number: GL0447 Influenza, SeasonalAdministered on: 3/7/2020 CVX code: 158External: Patient reported Location: PATIENT RECORD Expiration date: 1/31/2024Influenza, SeasonalAdministered by: Claudia Tweet, MA Administered on: 11/3/2021 1540 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 158 VIS date: 08/06/2021Product: Fluzone Quad 2021-2022 Manufacturer: Sanofi Pasteur Lot number: UJ694AA Expiration date: 6/30/2022Influenza, SeasonalAdministered by: Karina Tasejo Galdamez,MAAdministered on: 9/27/2023 1349 Dose: 0.5 mLSite: Left deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 158 VIS date: 08/06/2021Product: Fluzone Quad 2023-2024 (PF) Manufacturer: Sanofi Pasteur Lot number: UT8091KA Expiration date: 6/30/2024Site: Right deltoidInfluenza, Seasonal, Preservative FreeAdministered on: 2/8/2020 Site: Left deltoid Route: C28161 CVX code: 150Manufacturer: Sanofi Pasteur Lot number: UT6719MA Location: DTC FAMILY HEALTH AND WALK-INRoute: Intramuscular NDC: PHONE NUMBER AVAILABLEInfluenza, High DoseEthnicity: Not Hispanic, Latino, or Spanish Origin QuestionnaireQuestion AnswerQuestionnaireQuestion AnswerVIS Offered Date: 9/27/2023Patient/ Parent denies vaccine contraindications No Consented for flu vaccine YesInfluenza Vaccine - DH Employee? (Do not edit, Billing use only)NoVIS Offered Date: 11/3/2021Patient/ Parent denies vaccine contraindications Yes EUA Fax Sheet Offered Date: 8/16/2023QuestionnaireQuestion AnswerRace: White or CaucasianHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MPatient (continued)Immunizations (continued)Ponton, Todd Edward (MR # 20182940) Printed at 12/3/2023 10:29 PM Page 3 CVX code: 150Location: PATIENT RECORDInfluenza, Seasonal, Preservative FreePCV20 (Pneumococcal Conjugate)Administered by: Karina Tasejo Galdamez,MAAdministered on: 6/8/2023 1525 Dose: 0.5 mLSite: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 216 VIS date: 5/12/2023Product: Prevnar 20 (PF) Manufacturer: Pfizer, Inc Lot number: GR3621 Expiration date: 9/30/2024Administered on: 3/15/2019 Site: Left deltoidPPSV23 (Pneumococcal Polysaccharide)Administered on: 2/1/2018 CVX code: 33Location: PATIENT RECORDRoute: C28161CVX code: 150TdapAdministered by: Claudia Tweet, MA Administered on: 3/18/2020 0954 Dose: 0.5 mL Site: Right deltoid Route: Intramuscular NDC: PHONE NUMBER AVAILABLE CVX code: 115 VIS date: 02/24/2015Product: Boostrix Manufacturer: GlaxoSmithKline Lot number: HT479 Expiration date: 8/8/2021Manufacturer: Sanofi Pasteur Lot number: UJ069ABTdapAdministered on: 1/1/2010 CVX code: 115Location: PATIENT RECORDLocation: DTC FAMILY HEALTH ANDWALK-INTdapAdministered on: 4/5/2011 CVX code: 115Location: CIGNA HEALTHCARE OF COLORADOInfluenza, Seasonal, Preservative FreeAdministered on: 1/1/2020VIS Offered Date: 3/18/2020Patient/ Parent denies vaccine contraindications Yes QuestionnaireQuestion AnswerHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic ENCOUNTERPATIENTGUARANTORCOVERAGEPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 4 Unit:Hospital Service: No service for patient encounter. Bed: Room/bed info not found Admitting Provider: Referring Physician: Lande, Michele A Attending Provider: Adm Diagnosis:Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)Address: 7075 Leetsdale Dr Apt J12 Sex: MaleCity: Denver CO 80224-3501Primary Care Provider: Michele A Lande, NP Primary Phone: PHONE NUMBER AVAILABLE EMERGENCY CONTACTContact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll2. *No Contact Specified*No FatherGuarantor: Todd Edward Ponton DOB: 7/30/1963Address: 7075 Leetsdale Dr Apt J12 Sex: MaleDenver,CO 80224-3501Relation to Patient: Self Home Phone: PHONE NUMBER AVAILABLE Guarantor ID: 1194232 Work Phone:GUARANTOR EMPLOYEREmployer: Status: NOT EMPLO*PRIMARY INSURANCEPayor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITYSubscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554Pat. Rel. to Subscriber: SelfSECONDARY INSURANCEPayor: Plan:Group Number: Insurance Type:Subscriber Name: Subscriber DOB:Denver Health MedicalCenter 22Patient Class: OutpatientPHONE NUMBER AVAILABLEMRN: 20182940Contact Serial #: PHONE NUMBER AVAILABLEEncounter Date/Time: 11/20/2023Patient: Todd Edward PontonHospital Account:Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Visit Information Follow up in about 2 weeks (around 12/4/2023) for BH Follow-up, already scheduled by front desk. Medication ListPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 5 Michele A Lande, NPSubscriber ID:DepartmentName Address Phone FaxWellington E. Webb Center for PrimaryCare- Adult Clinic301 W 6th AvenueDenver CO 80204PHONE NUMBER AVAILABLE PHONE NUMBER AVAILABLEFollow-up and DispositionsPat. Rel. to Subscriber:Contact Serial # PHONE NUMBER AVAILABLE December 3, 2023 Chart ID (No chart ID available) Provider InformationMedication ListEncounter Provider Referring ProviderLeigh M Kunkle, Psy.D.This report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Active at the End of VisitInstructions: Advair Diskusomeprazole (PriLOSEC) 20mg capsuleInstructions: once daily.Entered by: Michele A Lande, NP Entered on: 3/18/2020 Entered by: Michele A Lande, NP Entered on: 3/18/2020 albuterol 90 mcg/actuation inhalerEntered by: Michele A Lande, NP Entered on: 3/18/2020 Start date: 3/12/2020fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray Instructions: fluticasone propionate 50 mcg/actuation nasal spray,suspension PLACE ONE SPRAY IN EACH NOSTRIL EVERY DAYEntered by: Michele A Lande, NP Entered on: 3/18/2020 fluticasone propion-salmeteroL (Advair Diskus) 500-50 mcg/dose DISKUS montelukast (Singulair) 10 mg tabletInstructions: once daily.Entered by: Michele A Lande, NP Entered on: 3/18/2020 calcium carbonate-vitamin D3 (Caltrate with Vitamin D3) 600 mg(1,500mg) -800 unit tablet alcohol swabs (Alcohol Prep Swabs) pads, medicated Instructions: Caltrate 600Entered by: Michele A Lande, NP Entered on: 3/18/2020 Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Medication List (continued)Ponton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 6 Entered by: Michele A Lande, NP Entered on: 4/3/2023 Start date: 3/28/2023Refill: 3 refills by 3/18/2021dulaglutide (Trulicity) 0.75 mg/0.5 mL pen injector Authorized by: Michele A Lande, NP Ordered on: 5/1/2023 Start date: 5/1/2023 Quantity: 6 mLRefill: 1 refill by 4/30/2024gabapentin (NEURONTIN) 600 MG tabletInstructions: Take 1 tablet (600 mg total) by mouth 3 (three) times a day. Authorized by: Michele A Lande, NP Ordered on: 6/8/2023 Start date: 6/8/2023 Quantity: 270 tabletRefill: 2 refills by 6/7/2024Authorized by: Michele A Lande, NPrivaroxaban (XARELTO) 10 mg tabletInstructions: Take 1 tablet (10 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 8/16/2023 Start date: 8/16/2023 Quantity: 90 tabletRefill: No refills remainingOrdered on: 3/18/2020metFORMIN (GLUCOPHAGE) 500mg tabletatorvastatin (LIPITOR) 40 MG tabletInstructions: TAKE ONE TABLET BY MOUTH DAILYAuthorized by: Michele A Lande, NP Ordered on: 9/14/2023 Start date: 9/14/2023 Quantity: 90 tabletRefill: 3 refills by 9/13/2024lisinopriL (ZESTRIL) 40mg tabletInstructions: Take 1 tablet (40 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 90 tabletRefill: 2 refills by 9/26/2024Instructions: Take 2 tablets (1,000 mg total) by mouth 2 (two) times a day. Authorized by: Michele A Lande, NPhydrOXYzine (ATARAX) 25mg tabletInstructions: Take 1 tablet (25 mg total) by mouth 3 (three) times a day as needed for anxiety. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 tabletRefill: 1 refill by 9/26/2024Ordered on: 2/27/2023Start date: 2/27/2023DULoxetine (CYMBALTA) 20 MG capsuleInstructions: Take 1 capsule (20 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 capsuleRefill: 1 refill by 9/26/2024Quantity: 360 tabletRefill: No refills remainingacetaminophen (TYLENOL) 500 MG tabletStart date: 3/18/2020 Quantity: 200 eachclindamycin (CLEOCIN T) 1 % external solutionInstructions: [None received]Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Medication List (continued)Clinical Provider NotesIntegrated Behavioral Health Brief ScreenVisit Type: In Person Behavioral Health VisitConsult Question: Individual TherapyTodd Edward Ponton is a 60 y.o. male referred by Michele A Lande, NP to address results of a behavioral health screen. Verbal consent to treatment was obtained at check-in due to in person/video visit Identification Verified: Identification was verified at check-in due to in person / video visit Address Verified: Address was verified at check-in due to in person/video visit. ASSESSMENT:Encounter DiagnosisName Primary?Situational anxiety YesPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 7 Progress NotesNoneLeigh M Kunkle, Psy.D. at 11/20/2023 1600Stopped in VisitInstructions: Take 2 tablets (1,000 mg total) by mouth every 8 (eight) hours as needed for mild pain . Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 ibuprofen (ADVIL) 600mg tabletInstructions: Take 1 tablet (600 mg total) by mouth every 6 (six) hours as needed for mild pain or moderate pain. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 15 tabletRefill: No refills remainingStart date: 11/8/2023 Quantity: 100 tablettamsulosin (FLOMAX) 0.4 mg capsuleInstructions: Take 1 capsule (0.4 mg total) by mouth once daily. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 30 capsuleRefill: No refills remainingRefill: No refills remainingphenazopyridine (PYRIDIUM) 100 MG tabletInstructions: Take 1 tablet (100 mg total) by mouth 3 (three) times a day as needed for bladder spasms. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 9 tabletRefill: No refills remainingHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Clinical Provider Notes (continued)PHQ-9 and GAD-7:EPDS Score (10+ = Positive Screen) :Other screening tool administered: Screened for situational anxiety Treatment Goals: See Self Management Action PlanPLAN (include follow up plan with clinic/BH provider and/or referral and coordination of care with other treatment entities):Follow up with BHC, In-Person, in 2-3 weeks, schedule at check out SUBJECTIVE/OBJECTIVE:HPI (review psychosocial history including substance use, family history of mental health/medical concerns, potential risks/barriers to pt engaging in treatment):- Lots of health stressors since last visitReported that he had bladder tumor removed a couple of weeks ago, found it was cancerous Described plan for upcoming surgery to remove remaining tumor cells, potential need for chemo after that Expressed feeling scared, overwhelmed in receiving and processing this news about his health; finding ways to limit anxious worryingEndorsed nervousness, feeling on-edge, anxiety with continued uncertainty about outcome of court case; next court date on Monday, will learn if plea accepted or not Noted that he has been spending time with friends/loved ones, on hobbies and starting his new business; helping keep mind on meaningful/enjoyable thingsAgreeable to continued focus on behavioral activation, health management, supportive self-talk to manage numerous current stressorsCollaboration with Medical Provider: WrittenMed profile reviewed: noIntervention Provided:I spent 14 minutes providing follow up on a behavioral health screen and engaging patient in Behavioral Health Education. Details of intervention include: Discussed situational stressors, anxious symptoms and coping. Normalized and validated fear and anxiety associated with recent bladder cancer diagnosis and subsequent surgeries, promoted emotional expression, built rapport and highlighted patients strengths and successes in support-seeking. Reinforced and encouraged continued focus on behavioral activation, engaging with social supports and future-oriented thinking.. This intervention supported patient to engage in collaborative problem solving and develop today's treatment goals. Supported patient to acquire the skills necessary to complete goals. Response to teaching: verbalize Provider masked for encounter: No.Mandatory Disclosure/Confidentiality:The mandatory disclosure is on file; see imaged document Patient Rights and Grievance Form:Patient Rights and Grievance form was given to patient. Ponton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 8 No data to displayNo data to displayHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/20/202311/20/2023 - Clinical Support in Wellington E. Webb Center for Primary Care- Adult Clinic (continued) Clinical Provider Notes (continued)Ponton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 9 Electronically signed by Leigh M Kunkle, Psy.D. at 11/21/2023 4:21 PM Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/9/202311/09/2023 - Infusion in Infusion ServicesENCOUNTERPATIENTGUARANTORCOVERAGEPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 10 Unit:Hospital Service: No service for patient encounter. Bed: Room/bed info not found Admitting Provider: Referring Physician: Lande, Michele A Attending Provider: Adm Diagnosis: Polycythemia [D75.1] Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)Address: 7075 Leetsdale Dr Apt J12 Sex: MaleCity: Denver CO 80224-3501Primary Care Provider: Michele A Lande, NP Primary Phone: PHONE NUMBER AVAILABLE EMERGENCY CONTACTContact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll2. *No Contact Specified*No FatherGuarantor: Todd Edward Ponton DOB: 7/30/1963Address: 7075 Leetsdale Dr Apt J12 Sex: MaleDenver,CO 80224-3501Relation to Patient: Self Home Phone: PHONE NUMBER AVAILABLE Guarantor ID: 1194232 Work Phone:GUARANTOR EMPLOYEREmployer: Status: NOT EMPLO*PRIMARY INSURANCEPayor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITYSubscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554Pat. Rel. to Subscriber: SelfSECONDARY INSURANCEPayor: Plan:Group Number: Insurance Type:Subscriber Name: Subscriber DOB:Denver Health MedicalCenter 22Patient Class: OutpatientPHONE NUMBER AVAILABLEMRN: 20182940Contact Serial #: PHONE NUMBER AVAILABLEEncounter Date/Time: 11/9/2023Patient: Todd Edward PontonHospital Account:Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/9/202311/09/2023 - Infusion in Infusion Services (continued) Visit InformationMedication ListPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 11 Michele A Lande, NPSubscriber ID:DepartmentName Address Phone FaxInfusion Services 660 Bannock StreetDenver CO 80204PHONE NUMBER AVAILABLE PHONE NUMBER AVAILABLEPat. Rel. to Subscriber:Contact Serial # PHONE NUMBER AVAILABLE December 3, 2023 Chart ID (No chart ID available) Provider InformationMedication ListReferring ProviderThis report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Active at the End of VisitInstructions: Advair Diskusomeprazole (PriLOSEC) 20mg capsuleInstructions: once daily.Entered by: Michele A Lande, NP Entered on: 3/18/2020 Entered by: Michele A Lande, NP Entered on: 3/18/2020 albuterol 90 mcg/actuation inhalerEntered by: Michele A Lande, NP Entered on: 3/18/2020 Start date: 3/12/2020fluticasone propionate (FLONASE) 50 mcg/actuation nasal spray Instructions: fluticasone propionate 50 mcg/actuation nasal spray,suspension PLACE ONE SPRAY IN EACH NOSTRIL EVERY DAYEntered by: Michele A Lande, NP Entered on: 3/18/2020 fluticasone propion-salmeteroL (Advair Diskus) 500-50 mcg/dose DISKUS montelukast (Singulair) 10 mg tabletInstructions: once daily.Entered by: Michele A Lande, NP Entered on: 3/18/2020 calcium carbonate-vitamin D3 (Caltrate with Vitamin D3) 600 mg(1,500mg) -800 unit tablet alcohol swabs (Alcohol Prep Swabs) pads, medicated Authorized by: Michele A Lande, NP Ordered on: 3/18/2020 Start date: 3/18/2020 Quantity: 200 eachRefill: 3 refills by 3/18/2021Instructions: Caltrate 600Entered by: Michele A Lande, NP Entered on: 3/18/2020 Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/9/202311/09/2023 - Infusion in Infusion Services (continued) Medication List (continued)Ponton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 12 Authorized by: Michele A Lande, NP Ordered on: 5/1/2023 Start date: 5/1/2023 Quantity: 6 mLRefill: 1 refill by 4/30/2024Authorized by: Michele A Lande, NP Ordered on: 2/27/2023 gabapentin (NEURONTIN) 600 MG tabletInstructions: Take 1 tablet (600 mg total) by mouth 3 (three) times a day. Authorized by: Michele A Lande, NP Ordered on: 6/8/2023 Start date: 6/8/2023 Quantity: 270 tabletRefill: 2 refills by 6/7/2024Start date: 2/27/2023 Quantity: 360 tabletrivaroxaban (XARELTO) 10 mg tabletInstructions: Take 1 tablet (10 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 8/16/2023 Start date: 8/16/2023 Quantity: 90 tabletRefill: No refills remainingRefill: No refills remainingatorvastatin (LIPITOR) 40 MG tabletInstructions: TAKE ONE TABLET BY MOUTH DAILYAuthorized by: Michele A Lande, NP Ordered on: 9/14/2023 Start date: 9/14/2023 Quantity: 90 tabletRefill: 3 refills by 9/13/2024lisinopriL (ZESTRIL) 40mg tabletInstructions: Take 1 tablet (40 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 90 tabletRefill: 2 refills by 9/26/2024metFORMIN (GLUCOPHAGE) 500mg tablethydrOXYzine (ATARAX) 25mg tabletInstructions: Take 1 tablet (25 mg total) by mouth 3 (three) times a day as needed for anxiety. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 tabletRefill: 1 refill by 9/26/2024clindamycin (CLEOCIN T) 1 % external solutionDULoxetine (CYMBALTA) 20 MG capsuleInstructions: Take 1 capsule (20 mg total) by mouth once daily. Authorized by: Michele A Lande, NP Ordered on: 9/27/2023 Start date: 9/27/2023 Quantity: 30 capsuleRefill: 1 refill by 9/26/2024Instructions: [None received]acetaminophen (TYLENOL) 500 MG tabletInstructions: Take 2 tablets (1,000 mg total) by mouth every 8 (eight) hours as needed for mild pain . Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 100 tabletRefill: No refills remainingEntered by: Michele A Lande, NP Entered on: 4/3/2023 Start date: 3/28/2023Instructions: Take 2 tablets (1,000 mg total) by mouth 2 (two) times a day. dulaglutide (Trulicity) 0.75 mg/0.5 mL pen injector Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/9/202311/09/2023 - Infusion in Infusion Services (continued) Medication List (continued)LabsPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 13 LabNoneStopped in VisitHematocrit [144907058] (Final result)Electronically signed by: Angela McGee, RN on 11/09/23 1509 Status: Completed Ordering user: Angela McGee, RN 11/09/23 1509 Ordering provider: Michele A Lande, NP Authorized by: Michele A Lande, NP Ordering mode: Transcribed from paper From therapy plan: THERAPEUTIC PHLEBOTOMY Frequency: STAT 11/09/23 - Class: Clinic Collect Quantity: 1Lab status: Final result Instance released by: Angela McGee, RN 11/9/2023 3:18 PM DiagnosesPolycythemia [D75.1]Instructions: Take 1 tablet (600 mg total) by mouth every 6 (six) hours as needed for mild pain or moderate pain. phenazopyridine (PYRIDIUM) 100 MG tabletInstructions: Take 1 tablet (100 mg total) by mouth 3 (three) times a day as needed for bladder spasms. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 9 tabletRefill: No refills remainingAuthorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 15 tabletRefill: No refills remainingQuestionnaireQuestion AnswerRelease to patient Immediateibuprofen (ADVIL) 600mg tabletSpecimen InformationID Type Source Collected By23L-313H0130 Blood Blood Angela McGee, RN 11/09/23 1518 tamsulosin (FLOMAX) 0.4 mg capsuleHematocrit [144907058] (Normal) Resulted: 11/09/23 1535, Result status: Final result Ordering provider: Michele A Lande, NP 11/09/23 1518 Order status: Completed Filed by: Lab, Background User 11/09/23 1535 Collected by: Angela McGee, RN 11/09/23 1518 Resulting lab: DENVER HEALTH PAVILLION L, OUTPATIENT MEDICAL CENTERCLIA number: 06D2197244Acknowledged byMichele A Lande, NP on 11/13/23 0727Karina Tasejo Galdamez, MA on 11/13/23 0941Instructions: Take 1 capsule (0.4 mg total) by mouth once daily. Authorized by: Rohan G Bhalla, MD Ordered on: 11/8/2023 Start date: 11/8/2023 Quantity: 30 capsuleRefill: No refills remainingHematocrit 42.7 38.0 - 52.0 % DH OMCComponentsComponent Value Reference Range Flag LabHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MEnc Date 11/9/202311/09/2023 - Infusion in Infusion Services (continued) Labs (continued)Ponton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 14 Testing Performed ByResult NotesNotify the patient labs are normalLab - Abbreviation Name Director Address Valid Date Range All Reviewers ListKarina Tasejo Galdamez, MA on 11/13/2023 9:41 AMMichele A Lande, NP on 11/13/2023 7:28 AM96 - DH OMC DENVER HEALTHPAVILLION L,OUTPATIENTMEDICAL CENTERUnknown 660 BannockDenver CO 8020409/01/20 0719 - PresentIndicationsPolycythemia [D75.1 (ICD-10-CM)]Michele A Lande, NP11/13/2023 7:28 AM MSTHealth Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MAdm 11/8/2023, D/C 11/8/202311/08/2023 - Admission (Discharged) in Operating Room ENCOUNTERPATIENTGUARANTORCOVERAGEPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 15 Unit: PAV A ORHospital Service: Surgery Bed: PAV A OR POOL/PAV A OR Admitting Provider: Rohan G Bhalla, MD Referring Physician: Attending Provider: Adm Diagnosis: Bladder tumor [D49.4] Name: Todd Edward Ponton DOB: 7/30/1963 (60 yrs)Address: 7075 Leetsdale Dr Apt J12 Sex: MaleCity: Denver CO 80224-3501Primary Care Provider: Michele A Lande, NP Primary Phone: PHONE NUMBER AVAILABLE EMERGENCY CONTACTContact Name Legal Guardian? Relationship to Patient Home Phone Work Phone 1. Ponton,BIll2. *No Contact Specified*No FatherGuarantor: Todd Edward Ponton DOB: 7/30/1963Address: 7075 Leetsdale Dr Apt J12 Sex: MaleDenver,CO 80224-3501Relation to Patient: Self Home Phone: PHONE NUMBER AVAILABLE Guarantor ID: 1194232 Work Phone:GUARANTOR EMPLOYEREmployer: Status: NOT EMPLO*PRIMARY INSURANCEPayor: DENVER HEALTH MEDIC* Plan: DENVER HEALTH MEDICAID Group Number: Insurance Type: INDEMNITYSubscriber Name: PONTON,TODD EDWARD Subscriber DOB: Subscriber ID: O095554Pat. Rel. to Subscriber: SelfSECONDARY INSURANCEPayor: Plan:Group Number: Insurance Type:Subscriber Name: Subscriber DOB:Denver Health MedicalCenter 22Patient Class: OP SurgPHONE NUMBER AVAILABLEMRN: 20182940Contact Serial #: PHONE NUMBER AVAILABLEEncounter Date/Time: 11/8/2023 0724Patient: Todd Edward PontonHospital Account:Health Information Management301 W. 6th Ave.Denver CO 80204Ponton, Todd EdwardMRN: 20182940, DOB: 7/30/1963, Sex: MAdm 11/8/2023, D/C 11/8/202311/08/2023 - Admission (Discharged) in Operating Room (continued) Visit InformationMedication ListPonton, Todd Edward (MR # 20182940) CSN:PHONE NUMBER AVAILABLE Printed at 12/3/2023 10:29 PM Page 16 Admit Date/Time: 11/08/2023 7:24 AM IP Adm. Date/Time: Admission Type: Elective Point of Origin: Ambulatory Surgery CenterAdmit Category:Means of Arrival: Primary Service: Surgery Secondary Service: N/A Transfer Source: Service Area: DENVER HEALTH Unit: Operating Room Admit Provider: Rohan G Bhalla, MD Attending Provider: Rohan G Bhalla, MD Referring Provider: Subscriber ID:Discharge InformationDate/Time: 11/08/2023 1:10 PM Disposition: Home/self Care (Routine) Destination: Provider: Rohan G Bhalla, MD Unit: Operating RoomPat. Rel. to Subscriber:Contact Serial # PHONE NUMBER AVAILABLE December 3, 2023 Chart ID (20182940-DH ENC-4) Admission InformationMedication ListArrival Date/Time:This report is for documentation purposes only. The patient should not follow medication instructions within. For accurate instructions regarding medications, the patient should instead consult their physician or after visit summary. Prior To Admission |
