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  • Screening Medical Information

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    yeshakbir
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    This document contains personal and medical information for Seyoum Denboba, including his date of birth, Medicaid and Medicare numbers, primary doctor and specialists with contact information and dates of last visits, medical diagnoses including stage 4 prostate cancer diagnosed in 2021, asthma diagnosed 30 years ago, GERD diagnosed 40 years ago, and age-related macular degeneration diagnosed 5 years ago. It also lists Mr. Denboba's current medications including Abiraterone and Prednisone for prostate cancer, Finasteride and Tamsulosin for an enlarged prostate, and Omeprozole for GERD.

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    This document contains personal and medical information for Seyoum Denboba, including his date of birth, Medicaid and Medicare numbers, primary doctor and specialists with contact information and dates of last visits, medical diagnoses including stage 4 prostate cancer diagnosed in 2021, asthma diagnosed 30 years ago, GERD diagnosed 40 years ago, and age-related macular degeneration diagnosed 5 years ago. It also lists Mr. Denboba's current medications including Abiraterone and Prednisone for prostate cancer, Finasteride and Tamsulosin for an enlarged prostate, and Omeprozole for GERD.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    4 views3 pages

    Screening Medical Information

    Uploaded by

    yeshakbir
    This document contains personal and medical information for Seyoum Denboba, including his date of birth, Medicaid and Medicare numbers, primary doctor and specialists with contact information and dates of last visits, medical diagnoses including stage 4 prostate cancer diagnosed in 2021, asthma diagnosed 30 years ago, GERD diagnosed 40 years ago, and age-related macular degeneration diagnosed 5 years ago. It also lists Mr. Denboba's current medications including Abiraterone and Prednisone for prostate cancer, Finasteride and Tamsulosin for an enlarged prostate, and Omeprozole for GERD.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 3

    Name: ___SEYOUM DENBOBA__________________

    DOB: _07/23/1936______
    Medicaid Number:_____________
    Medicare Number:_1UP0 VE9 HY00____________
    Primary doctor and other specialists
    Name and last name Phone number Date of last visit Reason of Visit
    i.e. annual physical
    Primary Kajal Dasgupta MA 703 359 7919 01/13/2021 Annual physical
    Oncology Aloysius Clarence 703 287 6700 11/15/2021 Every two months check up
    Pereira
    OPHTHALMOLOGY Ali 703 287 6400 12/20/2021 After surgery check up
    Mohammad Khorrami and
    Daniel Albertus
    Urology Daude Degene 703 287 4585 3/31/2021 Follow up

    Medical Diagnoses Date of diagnosis (how long ago was diagnosed)


    For example: Hypertension For example: diagnosed in 2015 or 01/15/15, or 5 years ago

    Stage 4 prostate cancer 03/10/2021

    INTERMITTENT ASTHMA (Chronic) 30 years ago


    Digestive
    GERD (GASTROESOPHAGEAL
    REFLUX DISEASE) (Chronic) 40 years ago
    Eye
    BILAT EXUDATIVE AGE RELATED
    MACULAR DEGENERATION 5 years ago
    (Chronic)
    Current Medications (include over the counter)
    Name of medication Dosage Frequency Reason was prescribed
    For example: Aspirin 80mg One time a day For heart issues
    250mg One time a day For prostate cancer
    Abiraterone
    5 mg One time a day For prostate cancer
    Prednisone
    Finasteride 5mg One time a day For enlarge prostate

    Tamsulosin 0.5 mg One time a day For enlarge prostate

    Omeprozole 20 mg One time a day GERD

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