Kim, Y ong Ho (MR #)
Encounter Date: 03/12/2010
PENINSULA EMERGENCY DEPARTMENT 1501 TROUSDALE DR
Burlingame, CA, 94010
The examination, treatment and interpretation of diagnostic studies and laboratory tests you received in the emergency department have been provided to you on an emergency basis only and should not be considered to be a substitute for comprehensive, all¬inclusive medical care. Any specialty tests (e.g., EKG, x-rays, etc.) that you may have been provided have been interpreted by the Emergency Physician on a preliminary basis. You will be notified promptly of any findings that we feel are significant. A copy of your medical record and the results of any laboratory and’ other diagnostic studies are available to your follow-up doctor upon request. Your follow-up physician should evaluate you for any new or continuing problems because it is impossible to recognize and treat all elements ‘of injury or illness in an emergency department visit. IF YOU BELIEVE THAT YOUR CONDITION HAS WORSENED OR NEW PROBLEMS DEVELOP, PLEASE RETURN TO THE EMERGENCY DEPARTMENT OR SEE YOUR DOCTOR IMMEDIATELY.
Take this sheet with you to your physician on your next visit.
Your medication list is based on information given by or verified by you (patient) and your family or other sources. It is not meant to substitute for advice/directions given by the prescribing physician, your pharmacist or primary care physician. Please contact them with questions. Discard old lists and update any records with all medication providers or retail pharmacies. Check with your physician before continuing over-the¬counter medications, herbals and/or supplements.
- Do not drive, drink alcohol, or operate machinery for at least 8 hours if you received narcotic or sedative medications.
You were seen by:
EO Diagnosis EO Diagnosis ED Diagnosis
light headed diarrhea dehydration, mild
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Hydrate, rest. See your doctor for re-evluation. Consider Gi workup for history of upset stomach and diarrhea. Return if worse, changes or any concerns. Motrin for pain for bike accident. I don’t see any signs of trauma from the bike accident.
While a life threatening emergency has not been found or considered likely, if your symptoms are not improving or if at any time there are worsening, please contact your primary physician or return to the emergeny department. Return to the Emergency room if you are worse, not better, there are changes in your symptoms or any concerns or if you cannot follow up with your regular physician as planned. Please ask us if you do not understand the workup and evaluation that occurred while you were in the
Kim, Y ong Ho (MR #)
Encounter Date: 0311212010
The treatment you received in the emergency department has been provided on an emergency basis only and is not a substitute for comprehensive medical care.
Ali patients need follow-up visits with a primary care doctor, because it is impossible to recognize and treat all elements of injury or illness in an emergency department visit.
Always return to ER if your symptoms are worsening or changing. Some problems cannot be diagnosed the first time we see you, and although we do the best we can, it is always possible that the diagnosis was incorrect.
Records from your visit may not automatically reach your doctor. Please call your doctor’s office to tell them you were here so they can access your emergency visit data.
on: 03!12/201 (No Known Allergies)
NaCI 0.9% IV 50ln 1000 Intravenous Given mL
ondansetron (ZOFRAN) Inj 8 mg mg
ZUANICH, REBECCA ZUANICH, REBECCA
California Law requires any child under the age of 6 or under 60 pounds to be restrained in a federally approved car safety seat whenever traveling in a motor vehicle.
Stopping smoking is one of the most important steps you can take to improve your health. Please call 1-800-NO-BUTTS (800-662-8887) for information on stopping smoking.
••• Suii~r Health For billing inquires please contact our business office at 650-652-
‘]jl With You. For Life. 3000 between 9:00a – 4:00p Monday thru Friday. You can also
M’II P . I H Ith S . email us at email@Sutterhealth.org
I s- emnsu a ea ervlces .
1501 Trousdale Drive Date of Bill Admit Date:
Burlingame, CA 94010 5/26/2010 3/12/2010
Services Provided at Patient Name Patient Account#
PENINSULA MEDICAL CENTER KIM, YONG HO 100400210
Insurance Comoanv HEALTH NET HMO OTHER
KIM,YONG HO 900crenshaw blvd
LOS ANGELES, CA 90019
SVC Date Rev Code Description Charges
- -=-~-=– ._-~–“‘-“”- :~-,—=-~:~c.:- _’-_~ __ ‘:’~—-:——— —=::””,:_’–~ — — -.—-,-._– – – -.-~__=_~—-‘–:_..c._, _
3/12/2010 0250 81000092 NACLO.9% SOLN 1,000 ML 1 103.23
3/12/2010 0636 J2405 81000008 ONDANSETRON 2MG/ML SOLN 8 70.95
3/13/2010 0250 81000000 ACETAMINOPHEN 325MG TABS 3 2.01
3/12/2010 0301 80048 42000000 HCHG BASIC METABOLIC 1 107.53
3/12/2010 0301 83690 42100301 HCHG LIPASE 1 88.01
3/12/2010 0301 80076 42000009 HCHG HEPATIC FUNCTION 1 104.28
3/12/2010 0309 36415 47100001 HCHG VENIPUNCTURE 1 27.47
3/12/2010 0302 86140 45000035 HCHG C REACTIVE PROTEIN 1 65.17
3/12/2010 0450 99284 55000010 HCHG ED LEVEL 4 1 2,500.00
3/12/2010 0940 96374 52000031 HCHG IV PUSH INITIAL DRUG 1 228.61
3/13/2010 0306 87045 46000002 HCHG CULTURE STOOL 1 117.31
SALMONELLA AND SHIGELLA
3/13/2010 0306 87493 40900056 . HCHG C DIFF AMPLIFIED 1 120.00
4/30/2010 HEALTH NET – Payment 2,500.93
4/30/2010 HEALTH NET – Adjustment 883.64
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Please refer to hospital account numbers for all inquiries and correspondence. This detail bill reflects charges, payments and adjustments posted on this hospital account as of the date this detail was rinted.
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~ Sutter Health
~ With You. For Life.
Mills-Peninsula Health Services 1501 Trousdale Drive
Burlingame, CA 94010
Summary of Account
0250 – PHARMACY – GENERAL CLASSIFICATION 0301 – LABORATORY – CHEMISTRY
0302 – LABORATORY – IMMUNOLOGY
0306 – LABORATORY – BACTERIOLOGY AND MICROBIOLOGY 0309 – LABORATORY – OTHER LABORATORY
0450 – EMERGENCY ROOM – GENERAL CLASSIFICATION 0636 – PHARMACY – DRUGS REQUIRING DETAILED CODING 0940_ -_OTHER THEBAPEUILCSf,HV-lGES:liENERAL CLASSIFICATION
Amount105.24 299.82 65.17 237.31 27.47
2,500.00 70.95 22a,61
Insurance Payments and Adjustments Post Date
Total Insurance Payments and Adjustments
Total Patient Payments and Adjustments
- ———- — _.—- ——- .
Please refer to hospital account numbers for all inquiries and correspondence. This detail bill reflects charges, payments and adjustments posted on this hospital account as of the date this detail was printed.
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