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EHD Program Facility Records by Street Name
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4100 – Safe Body Art
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PR0537714
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COMPLIANCE INFO
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Entry Properties
Last modified
4/20/2023 1:10:57 PM
Creation date
4/5/2023 2:38:38 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0537714
PE
4110
FACILITY_ID
FA0021735
FACILITY_NAME
WRONG SIDE OF THE TRACKS (VEAZEY, RYAN S)
STREET_NUMBER
512
Direction
N
STREET_NAME
UNION
STREET_TYPE
RD
City
MANTECA
Zip
95337
CURRENT_STATUS
02
SITE_LOCATION
512 N UNION RD
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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Veazey, Ryan S (MR # 110007* 40) <br />Immuhization Summary Ryan S Veazey (MRN 1 1 00072931 40) <br />Patient Information <br />Patient Name Sex DOB + AGE <br />Veazey, Ryan S (1 1 00072931 40) Male 2/21/1990 (22 Y) <br />PCP Center <br />DAVID POWELL ALLEN MD MAN -HOSPITAL <br />Current Immunizations <br />Never Reviewed <br />DTP (Diphtheria, Tetanus, Pertussis) <br />11/6/1990 (8 M), 7/7/1990 (4 M), 5/8/1990 (10 W) <br />.............. <br />DTaP (Diphtheria, Tetanus, acellular <br />......_-............. <br />3/10/1995 (5 Y), 5/2/1994 (4 Y) <br />Pertussis) ........... <br />HAV ped/adol 2 dose sch (Hepatitis A) <br />.....__........... . .......................... .....................:............ _.... ............. ........... <br />3/15/2006 (16 Y) <br />HBV (Hepatitis B) <br />.. <br />3/15/2006 (16 Y), 11/1/2005 (15 Y), 6/11/2001 (11 Y) <br />.. <br />HIB HbOC (Haemophilus influenzae b) <br />3/10/1995 (5 Y), 11/6/1990 (8 M), 7/6/1990 M), 5/8/1990 (10 W) <br />MMR (Measles, Mumps, Rubella) <br />............(4 .......................................................... <br />3/10/1995 (5 Y) <br />POL-OPV (Polio, live virus) <br />_..,.............. ..._.......... w.. <br />3/10/1995 (5 Y), 5/2/1994 (4 Y), 11/6/1990 (8 M), 7/6/1990 (4 M), <br />5/8/1990"(1,0, W):: <br />Td 7yrs-adult (Tetanus, diphtheria) <br />11/1/2005 (15 Y) <br />lmmmmmgr= <br />Vaccine Preventable Disease Immunity is shown below IF PRESENT in the problem list or medical history. <br />Eg. HX OF VARICELLA = personal history of varicella on date listed. Patient does not require additional <br />vaccination for diseases listed below. PPD skin tests show as mm of skin induration. Abnormal and Normal <br />are based on risk factors. Treatment and Chest Xray results are not on this report. <br />Recent Lab Results <br />Test Date !Value Units <br />PPDINTERP 4/26/1995 00 MM <br />'.�. 0 4 - <br />If you need to view reference ranges or additional results, please go to Chart Review, Lab Tab <br />.�+`I ;f 1AFd <br />i E MEDiC,bL OU'p <br />ISF- <br />°1 `�V.1(OS G�` �VE• <br />172 <br />�*JTCCA, <br />Printed by MENDOZA, ELIZABETH A [Y922777] at 7/16/2012 9:29:33 AM <br />
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