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Expanded Profile          Jul 26, 1996 08:52:10      Page:    3 of    5

Patient: PCEPATIENT,ONE (6789)                              Outpatient

Appointment #: 1                                Clinic: DIABETES CLINIC

                      *** Patient Information ***

Date of Birth: APR 01, 1944                    ID: 000-45-6789

         Sex: FEMALE              Marital Status: SINGLE

                                 Religious Pref.: UNKNOWN/NO PREFERENC

Primary Elig.: SC, LESS THAN 50%                      POS: VIETNAM ERA

     Address:                                      Phone:

        321 S 3400 E

        SALT LAKE CITY, UTAH  84105

Radiation Exposure: YES                            Status: NO INPT./LOD. ACT.

  Prisoner of War: NO             Last Admit/Lodger Date:

      AO Exposure: YES           Last Disch./Lodger Date:

+         Enter ?? for more actions

Select Action: Next Screen// [ENTER]

Expanded Profile          Jul 26, 1996 08:52:10      Page:    4 of    5

Patient: PCEPATIENT,ONE (6789)                              Outpatient

Appointment #: 1                                Clinic: DIABETES CLINIC

                     *** Check Out ***

    CLASSIFICATION    [Required]

1      Treatment for SC Condition: NO

2                  Combat Veteran: NO

3           Agent Orange Exposure: YES

4     Ionizing Radiation Exposure: NO

5              SW Asia Conditions: NO

6          Military Sexual Trauma: NO

7         Head and/or Neck Cancer: NO

    PROVIDER    [Required]                  DIAGNOSIS    [Required]

1  PCEPROVIDER,ONE+        

                  Enter ?? for more actions

Select Action: Next Screen// [ENTER]

Expanded Profile          Jul 26, 1996 08:52:10      Page:    5 of    5

Patient: PCEPATIENT,ONE (6789)                              Outpatient

Appointment #: 1                                Clinic: DIABETES CLINIC

+

    STOP CODES            [Not Required]

         Enter ?? for more actions

Select Action: Quit// [ENTER]

12PCE V. 1.0 User ManualAugust 1996

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