CapMed_CFC40BDD-F625-403A-835F-DC113D11CB7E English V1.0 Creation Time 2007-04-26T18:40:41Z AA0001 AA0001 AA0002 Patient-generated Medical Summary: New Patient BB0010 Onset 2007-04-26T04:00:00Z Diagnosis ACUTE BRONCHITIS 466.0 ICD-9 Chronic AA0003 Physician BB0011 Onset 2007-04-26T04:00:00Z Diagnosis Asthma, Acute Exacerbation 493.02 ICD-9 Chronic AA0003 Physician BB0012 Onset 2007-04-26T04:00:00Z Diagnosis EXTRINSIC ASTHMA W/O STATUS ASTH 493.00 ICD-9 Chronic AA0003 Physician BB0001 Initial Occurrence 2003-12-29T04:00:00Z Allergy AMOXICILLIN AA0001 Patient BB0003 AA0001 Patient AMOXICILLIN BB0004 Initial Occurrence 2003-12-29T04:00:00Z Allergy CEFPROZIL AA0001 Patient BB0006 AMOXICILLIN AA0001 Patient CEFPROZIL BB0007 Initial Occurrence 2006-07-04T04:00:00Z Allergy METHYLPHENIDATE HCL AA0001 Patient BB0009 CEFPROZIL AA0001 Patient METHYLPHENIDATE HCL BB0079 Date Prescribed 2007-04-12T04:00:00Z Prescription StopDate 2008-04-12T04:00:00Z Medication Prior History No Longer Active AA0001 Patient ALBUTEROL SULFATE PROAIR HFA 90MCG 3 Inhale 2 times per mouth every 4 hrs as needed : 1 BB0082 Date Prescribed 2006-10-02T04:00:00Z Prescription StopDate 2007-10-02T04:00:00Z Medication Prior History No Longer Active AA0001 Patient MONTELUKAST SODIUM SINGULAIR 5MG 180 Take two tablets by mouth daily : 1 BB0014 Administration Date 1998-04-12T04:00:00Z AA0001 Patient DTaP BB0016 Administration Date 1994-11-16T04:00:00Z AA0001 Patient DTaP BB0018 Administration Date 1993-11-22T04:00:00Z AA0001 Patient DTaP BB0020 Administration Date 1993-09-28T04:00:00Z AA0001 Patient DTaP BB0022 Administration Date 1993-07-14T04:00:00Z AA0001 Patient DTaP BB0024 Administration Date 2006-12-11T04:00:00Z AA0001 Patient flu (split) (3 yrs or older) BB0026 Administration Date 2005-10-23T04:00:00Z AA0001 Patient Flu(split) (3yrs or older) BB0028 Administration Date 2004-10-04T04:00:00Z AA0001 Patient Flu(split) (3yrs or older) BB0030 Administration Date 1999-10-11T04:00:00Z AA0001 Patient Flu(split) (3yrs or older) BB0032 Administration Date 2006-08-24T04:00:00Z AA0001 Patient Hepatitis A BB0034 Administration Date 1994-08-23T04:00:00Z AA0001 Patient Hib (HbOC) BB0036 Administration Date 1993-11-22T04:00:00Z AA0001 Patient Hib (HbOC) BB0038 Administration Date 1993-09-28T04:00:00Z AA0001 Patient Hib (HbOC) BB0040 Administration Date 1993-07-14T04:00:00Z AA0001 Patient Hib (HbOC) BB0042 Administration Date 1998-04-12T04:00:00Z AA0001 Patient MMR BB0044 Administration Date 1994-08-23T04:00:00Z AA0001 Patient MMR BB0046 Administration Date 1998-04-12T04:00:00Z AA0001 Patient Polio inactivated(IPV) BB0048 Administration Date 1994-11-16T04:00:00Z AA0001 Patient Polio inactivated(IPV) BB0050 Administration Date 1993-09-28T04:00:00Z AA0001 Patient Polio inactivated(IPV) BB0052 Administration Date 1993-07-14T04:00:00Z AA0001 Patient Polio inactivated(IPV) BB0054 Administration Date 2003-05-26T04:00:00Z AA0001 Patient Td BB0056 Administration Date 1993-11-22T04:00:00Z AA0001 Patient Vaccine against viral Hepatitis BB0058 Administration Date 1993-06-03T04:00:00Z AA0001 Patient Vaccine against viral Hepatitis BB0060 Administration Date 1993-05-08T04:00:00Z AA0001 Patient Vaccine against viral Hepatitis BB0062 Administration Date 1998-04-12T04:00:00Z AA0001 Patient Varicella BB0087 Assessment Time 2006-12-12T17:43:05Z Temperature AA0001 Patient BB0086 Assessment Time 2006-12-12T17:43:05Z Temperature AA0001 Patient 98 0 BB0089 Assessment Time 2006-12-12T17:43:05Z Weight AA0001 Patient BB0088 Assessment Time 2006-12-12T17:43:05Z Weight AA0001 Patient 108 0 BB0066 Result Time 2006-05-16T04:00:00Z MEAS BLOOD OXY LEV 94760 AA0001 Patient BB0065 Result Time 2006-05-16T04:00:00Z AA0001 Patient 0 BB0069 Result Time 2006-02-28T04:00:00Z AIRWAY INHALATION TREAT 94640 AA0001 Patient BB0068 Result Time 2006-02-28T04:00:00Z AA0001 Patient 0 BB0072 Result Time 2005-02-15T04:00:00Z AEROSOL/VAPOR INHALA 94665 AA0001 Patient BB0071 Result Time 2005-02-15T04:00:00Z AA0001 Patient 0 BB0075 Result Time 2004-10-18T04:00:00Z BREATHING CAPACITY TEST 94010 AA0001 Patient BB0074 Result Time 2004-10-18T04:00:00Z AA0001 Patient 0 BB0078 Result Time 2004-03-18T04:00:00Z AEROSOL/VAPOR INHAL 94664 AA0001 Patient BB0077 Result Time 2004-03-18T04:00:00Z AA0001 Patient 0 AA0001 Julie Traveller Female SSN 999999999 AA0001 Patient

Home 110 Hometown Road Hometown MA 11111

111-111-1111 Home 111-111-1112 Work AA0001 Patient AA0002 Personal Health Record by CapMed, A Division of Bio-Imaging Technologies, Inc. Personal Health Record 4.8.1

Business 826 Newtown-Yardley Roadt Newtown PA US 18940

1.866.CAPMED6 Business info@capmed.com Business http://www.capmed.com Business AA0001 Patient AA0003 Eugenia Marcus

Business 200 Washington Street Suite 201 Blue Building Newton MA US 02462

1.617.244.8664 Business info@pediatrichealthcare.com Business http://www.pediatrichealthcare.com Business AA0001 Patient