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<body>
<h1 class="h1center">Clinical Summary</h1>
<table class="header_table">
<tr>
<td class="td_header_role_name"><span class="td_label">Patient</span></td>
<td class="td_header_role_value">Delphine Burwell</td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Date of birth</span></td>
<td class="td_header_role_value">July 8, 1993 </td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Sex</span></td>
<td class="td_header_role_value">Female</td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Race</span></td>
<td class="td_header_role_value"></td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Ethnicity</span></td>
<td class="td_header_role_value"></td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Contact info</span></td>
<td class="td_header_role_value"> Primary Home:<br>6415 Ravenhollow Court<br>FITCHBURG,&nbsp;WI&nbsp;53593,&nbsp;USA<br>Tel: +1-410-377-2787<br></td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Patient IDs</span></td>
<td class="td_header_role_value">IDC2210008 1.2.840.114350.1.13.5325.1.7.3.688884.100<br>555-55-5555 2.16.840.1.113883.4.1<br></td>
</tr>
</table>
<table class="header_table">
<tbody>
<tr>
<td class="td_header_role_name"><span class="td_label">Document Id</span></td>
<td class="td_header_role_value">c412dec8-bd81-11e6-8704-d2068206269d 1.2.840.114350.1.13.5325.1.7.1.1</td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Document Created:</span></td>
<td class="td_header_role_value">December 8, 2016, 14:06:11, CST </td>
</tr>
</tbody>
</table>
<table class="header_table">
<tbody>
<tr>
<td class="td_header_role_name"><span class="td_label">Performer (primary care physician)</span></td>
<td class="td_header_role_value"></td>
</tr>
</tbody>
</table>
<table class="header_table">
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<tr>
<td class="td_header_role_name"><span class="td_label">Author</span></td>
<td class="td_header_role_value">Epic - Version 8.4</td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Contact info</span></td>
<td class="td_header_role_value"><br><br></td>
</tr>
</tbody>
</table>
<table class="header_table">
<tbody>
<tr>
<td class="td_header_role_name"><span class="td_label">Document maintained by</span></td>
<td class="td_header_role_value">Current Stage 1 Primary &lt;b&gt;</td>
</tr>
<tr>
<td class="td_header_role_name"><span class="td_label">Contact info</span></td>
<td class="td_header_role_value">124 Ok Corral Avenue<br>Suite 1704B 250<br>snakes on a plane<br>4th Line<br>MADISON,&nbsp;WI&nbsp;53719,&nbsp;USA<br>Tel: +1-608-771-0280<br></td>
</tr>
</tbody>
</table>
<hr align="left" color="teal" size="2">
<h3>Care Team Information</h3>
<div>
<ul>
<li>
<table>
<span style="font-weight:bold; ">My Care Team</span>
<tbody>
<tr>
<td>Focus: Care Coordination</td>
</tr>
<tr>
<td>Nature: Integrated</td>
</tr>
<tr>
<td>Setting: Personal</td>
</tr>
<tr>
<td>From 1996 to present</td>
</tr>
</tbody>
</table>
<table>
<colgroup>
<col width="33%" span="3">
</colgroup>
<tbody>
<tr>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Dr. Uel B. Better</span>
<tbody>
<tr>
<td>Role: PCP</td>
</tr>
<tr>
<td>Speciality: Internal Medicine</td>
</tr>
<tr>
<td>Person Address: 100 Main St. Suite 100, Hope
Valley, RI 02832
</td>
</tr>
<tr>
<td>Person Contact Phone: (401)539-2461</td>
</tr>
<tr>
<td>Person Contact Email:
ubbetter@direct.aclinic.org.
</td>
</tr>
<tr>
<td>Organization Name: Hope Woods Health
Services
</td>
</tr>
<tr>
<td>From: Aug 1, 2016</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Dr. Fiora W. Omen</span>
<tbody>
<tr>
<td>Role: Gynecologist</td>
</tr>
<tr>
<td>Speciality: Obstetrics/Gynecology</td>
</tr>
<tr>
<td>Person Address: Not on File</td>
</tr>
<tr>
<td>Person Contact Phone: Not on File</td>
</tr>
<tr>
<td>Person Contact Email: Not on File </td>
</tr>
<tr>
<td>Organization Name: Center for Womens
Health
</td>
</tr>
<tr>
<td>From: 1999</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
</tr>
<tr class="normRow">
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Reverend Will Namaste</span>
<tbody>
<tr>
<td>Role: Pastor</td>
</tr>
<tr>
<td>Speciality: Spiritual Health</td>
</tr>
<tr>
<td>Person Address: Not on File</td>
</tr>
<tr>
<td>Person Contact Phone: (987)123-1234</td>
</tr>
<tr>
<td>Person Contact Email:
Will.Namaste123@gmail.com
</td>
</tr>
<tr>
<td>Organization Name: Four Corners Community
Church Presbyterian
</td>
</tr>
<tr>
<td>From: 2016</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Dr. Patricia Primary</span>
<tbody>
<tr>
<td>Role: PCP</td>
</tr>
<tr>
<td>Speciality: Internal Medicine</td>
</tr>
<tr>
<td>Person Address: Not on File</td>
</tr>
<tr>
<td>Person Contact Phone: Not on File</td>
</tr>
<tr>
<td>Person Contact Email: Not on File </td>
</tr>
<tr>
<td>Organization Name: ML Medical Group</td>
</tr>
<tr>
<td>From: Jan 1, 2000 - To: July 31, 2016</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
</tr>
</tbody>
</table>
<br>
<br>
</li>
<li>
<table>
<span style="font-weight:bold; ">Shoulder Injury Care Team</span>
<tbody>
<tr>
<td>Focus: Condition</td>
</tr>
<tr>
<td>Nature: Clinical</td>
</tr>
<tr>
<td>Setting: Specialty</td>
</tr>
<tr>
<td>From October 1, 2016 to present</td>
</tr>
</tbody>
</table>
<table>
<colgroup>
<col width="33%" span="3">
</colgroup>
<tbody>
<tr>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Beatrice Strong</span>
<tbody>
<tr>
<td>Role: Physical Therapist</td>
</tr>
<tr>
<td>Speciality: Physical Therapy</td>
</tr>
<tr>
<td>Person Address: Not on File</td>
</tr>
<tr>
<td>Person Contact Phone: Not on File</td>
</tr>
<tr>
<td>Person Contact Email:
BeStrongPTN@FirstChoicePhysical.Direct.MD
</td>
</tr>
<tr>
<td>Organization Name: First Choice Physical
Therapy
</td>
</tr>
<tr>
<td>From: 2009</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Dr. S. Teddy Hands</span>
<tbody>
<tr>
<td>Role: Orthopedic Surgeon</td>
</tr>
<tr>
<td>Speciality: Orthopedic Surgeon</td>
</tr>
<tr>
<td>Person Address: Not on File</td>
</tr>
<tr>
<td>Person Contact Phone: Not on File</td>
</tr>
<tr>
<td>Person Contact Email: Not on File </td>
</tr>
<tr>
<td>Organization Name: Bayview Orthopedic Associates</td>
</tr>
<tr>
<td>From: November 10, 2016 to November 10, 2016</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
<td>
<ul>
<li>
<table>
<span style="font-weight:bold; ">Beau D. Stretch</span>
<tbody>
<tr>
<td>Role: Personal Trainer</td>
</tr>
<tr>
<td>Speciality: Physical Therapy Assistant</td>
</tr>
<tr>
<td>Person Address: YMCA, 123 Healthy Way, Westerly, RI 02891</td>
</tr>
<tr>
<td>Person Contact Phone: Not on File</td>
</tr>
<tr>
<td>Person Contact Email:
DBStretch@FirstChoicePhysical.Direct.MD
</td>
</tr>
<tr>
<td>Organization Name: First Choice Physical
Therapy
</td>
</tr>
<tr>
<td>From: January 5, 2017</td>
</tr>
</tbody>
</table>
</li>
</ul>
</td>
</tr>
</tbody>
</table>
</li>
</ul>
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