Save as a PDF filePrint Background ColorsAllow Landscape RotationPrint "Non-printable" Rows
Include List NamesInclude Line Formatting
Select a delimiter:
Tab Comma Semicolon Vertical Bar
Select a qualifier:
None Double Quote Single Quote
Display Password
Enter a Password:
Re-enter Password:
A Password is needed to encrypt & lock the app.
0
ParList
ParKey
ForList
ForKey
Default
MoreOpts
Doc
Name
Med
Prescriber
--Unknown--
OTC (Drug),OTC (Vitamin),OTC (Herbal)
Phar
Name
Med
Provider
--Unknown--
(doctor),(not applicable)
Doc
Name
Hist
Doctor
--Unknown--
None
0
OldVer
ListMap
ColumnMaps
OldColHeads
last
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1,2,3,4,5,6,7,8,9,10,11,12,13
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,,,,,,,,
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1,2,3,4,5,6,7,8,9,10
,,,,,,,,,
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1,2,3,4,5,6,7,8
,,,,,,,
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1,2,3,4,5,6,7,8,9,10
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1,2,3,4,5,6,7
,,,,,,
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1,2,3,4,5,6,7,8,9,10,11
,,,,,,,,,,,
last
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1,2,3,4,5,6,7
,,,,,,
1.20
0
1,2,3,4,5,6,7,8,9,10,11,12,13
,,,,,,,,,,,,,
1.20
1
1,2,3,4,5,6,7,8,9
,,,,,,,,
1.20
2
1,2,3,4,5,6,7,8,9,10
,,,,,,,,,
1.20
3
1,2,3,4,5,6,7,8
,,,,,,,
1.20
4
1,2,3,4,5,6,7,8,9,10
,,,,,,Fax Number,,,
1.20
5
1,2,3,4,5,6,7
,,,,,,
1.20
6
1,2,3,4,5,6,7,8,9,10,11
,,,,,,,,,,,
1.20
7
1,4,3,5,6,7
,Last Date,Complete?,,,
0,2,3,1,4,5,7,6
decrypted
unregistered
25002500251492227144079
Time
Action
Name
Row
Col
Undo
Redo
xxxxx
ListName
OptList
p
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p
pppppppp
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pppppppp
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ppppp
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xxtabnone
x
Edit Help
Screen and Data Organization
Lists
- Each list covers a different category of medically-relevant
information. Current lists
are: Personal Data, Doctors, Medication, Emergency Contacts, Pharmacies,
Medical History/Conditions, Immunization, and Insurance Plans
Rows
- Each row contains all details for a particular item in the category (list). For example: The
first row in the Emergency Contacts list might have information about a close relative.
Columns
- Each column specifies a type of detail that helps describe each item
in a list. An example would be the "Specialty" column in the Doctors list.
Cells
- A cell contains one detail (specified by the column) for just one of
the items (row) in the list. For example: a "Dr. Smith" row might have
"Orthopedics" in the cell under "Specialty".
Note:
Personal Data has only one row because the app is designed to manage info for just one person at a time.
Helpful Tip:
Filling in Doctor and Pharmacy names first (just the names) will make it easier to fill out other lists later.
Changing List Info (the quick way)
Just click the cell you want to change and
then update the text. In some cases, a drop-list will appear instead;
this lets you select from data you already entered in another list.
When you press the "Enter" or "Tab" key (or click somewhere else) the
table adjusts to fit the new text.
Basic Row Editing Tools
▲ (up arrow)
moves the row containing the ▲ icon up one row.
▼ (down arrow)
moves the row containing the ▼ icon down one row.
−
(minus sign)
deletes the row containing the − icon.
+
(plus sign)
adds a row immediately above the row containing the + icon.
adds a row at the end of the
list.
Note:
Up or down arrows may be grayed out if the row cannot move in that direction.
Changing List Info(the better way)
Click the ✎ (edit) icon in the row you want to
change. This will open a box designed to edit just that row. In
addition to simply editing text, you can use "helper" buttons provided
to the right of some fields:
Drop List Shortcuts
- Some text, like doctor specialties and state names, can be simply picked
from a list by clicking the adjacent v button.
Internet Lookups
- Existing text can be used to get more information from Internet services such as Google, Mapquest, and Medline.
There are also several features only available in the edit box:
Printable
- Uncheck this option to make the row invisible when you use the "Print" screen. This
lets you store data that YOU care about, but the medical professional
reading your print-out does not need. A "non-printable" row is
displayed with a gray background and italic text in the Edit screen.
Color
- This lets you choose a background color to highlight or visually group items. For example:
You may want to color each medication according to the time of day that you take it.
Save As New Row
- This button lets you save changes in a new row instead of updating the
original row. You can even make an exact duplicate of the original row
- and then change it later. For example: Each part of a multi-drug
compound or doctors from the same practice can be added with minimal typing.
Sorting a List
At
the top of every list, there is an up and a
down arrow (▲▼) to the left of each column name. These arrows let
you
sort the whole list alphabetically according to the text in that
column. Clicking an arrow above any column containing dates will
sort the list by those dates instead.
The ▼ arrow will sort from top to bottom (Z or latest date on the bottom).
The ▲ arrow will sort from bottom to top (Z or latest date at the top).
Note:
If a list is already sorted in a particular direction, that arrow is grayed out.
Select and Change Multiple Rows
By checking one or more
boxes(□) on the left side of a list you can change
all of the selected rows at the same time. Use the button
to display the following options:
Background:
Choose the background color you want for all of the checked rows; then
click the button.
Printing:
Click to make all
checked rows invisible or click to make
all checked rows visible when printing. Any rows where you disable printing will appear with a gray
background and the text will be italic on the Edit screen.
Bulk Delete:
Click the button to delete all of the rows you selected.
Cancel:
Don't do anything to the checked rows.
Rearranging the Lists
If you want change
where a list appears on the Edit and Print screens, use the up/down arrows ▲▼ next
to its name. Similar to the row-moving up/down arrows, one of them may
be grayed out if the list cannot move in that direction.
Changing Your Mind (Undo/Redo)
Almost anything you
can do on the Edit screen can be undone with the button.
If you change your mind again and want to "undo an undo", the
button allows that as well. There are some details worth noting however:
Maximum "Undo/Redo":
A total of 25 changes can be tracked by the Undo and Redo buttons.
If you make enough changes to exceed the limit (every
change is a potential Undo), the app starts overwriting the Redo list.
When those are exhausted, it starts overwriting the oldest Undo
changes. The numbers inside the Undo and Redo buttons show how
many of each are currently available.
Redo Auto-clear:
As soon as you make a change by hand (edit text, move rows, change
colors, etc.) the list of available Redo's is reset to "0".
This is because there can't be two "branches" of updates at the
same time (your edits being one and the Redo's being the other).
Multi-Component Undo:
When you do certain changes that affect multiple things at once, the
Undo/Redo buttons will also perform those multiple actions.
For instance, if you use to delete 3 rows from a list,
when you click all 3 rows will re-appear. Similarly, if you use the
"Edit" box to change a particular row,
will reverse all changes made in that box.
Important Note:
Avoid the browser's "Back" button; that will just quit MyOwnMedInfo and open a previous web site.
Saving Your Data
The medical
information you enter in the app may be held in three different places:
Browser Memory:
By default, any data you enter is saved in your
browser's memory so that you can easily edit and manipulate it while
the page and browser are open. HOWEVER, it all disappears as soon as
you close the browser or tab. Which is why the app also uses...
Browser Local Storage:
Like cookies, this lets JavaScript save data to the local hard disk. To avoid losing data if you accidentally close
the page, the app writes all your changes to Local Storage. When you re-open the app, it offers to re-load those changes.
Make sure Cookies are enabled to ensure this "safety net" is available.
Saving the App File:
Unfortunately, Local Storage isn't good enough by
itself because your data is only available when you load the app from exactly
the same folder. Also, anything that "cleans up" your browser's cookies
also deletes your data! To make your data portable and safe, you need
to save it as part of the app file itself. The process is similar for
the two compatible browsers:
FireFox:
Select "Save Page As..." from the "File" or "FireFox" menu and find your
original app file. Then, make sure "Save as type:" is set
to "Web Page,complete" and click .
Chrome:
Select "Save page as..." from the "Customize & Control" menu and
find your original app file. Then, make sure "Save as type:" is
set
to "Webpage, Complete" and click .
Not Saving Data
The
button next to "Undo" & "Redo" offers some control of the app's automatic data management. Most importantly,
the pop-up box shows when your data has been saved in each of the three places. Two things to look for are:
If the "Saved in
application" line is earlier than either "Saved in browser" lines, you
probably need to save the App file soon (described above).
If "Saved in browser storage" says
"Feature Disabled", you REALLY need to save the App file and re-enable cookies NOW.
Of course, there
are situations where you do not want "everything saved everywhere". Two buttons are provided for that:
- If you are using a borrowed or public computer, you probably don't
want others to see your medical records.
Once you have saved the app file FIRST (presumably on a removable
device), click this button right before closing the browser.
- Since every Undo/Redo item is normally saved along with your data, you may not want them in the "final" version of your data.
When you are SURE you don't want to Undo/Redo anymore, click this button and then save the App file.
Note:
If Local Storage/Cookies is disabled, the Data Status and Undo/Redo buttons will be highlighted in red.
This does not affect other app functions, but provides a reminder to save the app file often if you are making changes.
Print Help
Weirdness Disclaimer
While the app tries to handle details like font scaling, page
orientation, and space optimization, you may not always agree with its
assumptions. You may also want a bit more control of its
output than the default "print everything" scheme.
Consequently, the app offers a number of options that let you customize its print output.
Be aware however, that what you get on paper is a combination of two
general rules: what you prevent from
printing and what you want
printed. If something looks weird, it's probably not a bug -
it just means the options need adjustment.
Saving Space
The problem is that paper doesn't have a scroll bar.
The only way to make all your data visible is to make it fit
on the paper. In order to keep a consistent tabular layout
the app must either reduce the font
size or use more pages. To help avoid unreadably tiny
text or piles of paper, the default policy is to prevent the
following from printing: Lists that have no printable rows, Columns
with no printable cells, and Rows containing only blank or default values. These
"Do NOT Print" options next to the
button have the following effects when checked.
Empty Lists
- If any list has no
rows, existing rows contain only blank/default values, or its rows are
"print disabled", the entire list will be hidden - including title and heading text.
Empty Columns
- If all cells in any column contain blank or default values, the whole column will not appear in the list when printing.
Empty Rows
- If any row (in any list) contains only blank or default values, that row will not appear when printing.
Another way to save space on your printout is to hide rows that are no
longer relevant (such as medicine you no longer take).
However, the options to enable/disable printing for
specific rows are provided through the Edit dialog
and the
button on the Edit screen - not here in the Print screen.
Selecting Lists / Columns to print
If you need more detailed control, click the button.
The large table that appears will let you choose exactly what type of information you want
printed
(by default, everything is checked). The left side of the table
lets you choose which lists can be printed, while the right side
lets you choose the columns to include in each list.
List Selection
- If a list is empty and "Do Not Print Empty
Lists" is checked, this option is grayed-out (since it wasn't going to print anyway)..
Column Selection
- If the adjacent list option is unchecked or
grayed out, the column selections area will also be grayed out.
However, individual column options can still be checked and
unchecked; this prevents a "circular dependency issue" that
is too complicated to explain here. If a particular
column is empty and "Do Not Print Empty Columns" is checked,
the individual column option will be grayed out (since it wouldn't print anyway).
Ultimately, the best way to understand how the "Do Not
Print" and "Select" options interact is to click around and
see what happens.
Other Options
Just below the "Column Selection" area are three check-boxes that
normally don't need to be changed, but may be occasionally useful:
Print Background Colors
- If you set the colors in the first place, presumably you want them to
print as well. However, if you want to save ink when printing a
rough draft, you can uncheck this option. Note: Even when this
box is checked, FireFox requires a manual setting that specifically
allows backgrounds to be printed. Go to "Print - Page Setup" or "File - Page
Setup" and check the "Print Background" box in the Format &
Options tab
Allow Landscape Rotation
- If any list doesn't fit horizontally without over-reducing the
font size, the app will rotate the page 90 degrees and print landscape
(sideways) instead. This should make the print output more
readable, but it may also increase the number of pages needed.
Uncheck this box if you want to keep your pages
in portrait orientation. BTW: This feature has
nothing to do with the browser's own "Orientation" controls.
Print "Non-printable" Rows
- Just in case you want to print a copy for yourself that
includes rows you normally keep hidden, you can check this box
to make them appear in your printouts. This is also handy if you
don't remember which rows you had previously disabled for printing.
Save as a PDF file
Since printing is NOT a strength for most web browsers,
the
button offers a more reliable alternative. As long as you have a PDF reader available (like Adobe
Reader or Foxit Reader) you can save and print this file
instead of printing through the browser. Another advantage
of saving as a PDF is that it's portable.
Once you save the file, you can easily copy, send,
and print it without having to use the app itself. The default file name is the same as your app file name but
with an added time-stamp and ".pdf" instead of ".html". Note:
FireFox also gives you the option of just opening the file (with your PDF reader) instead of saving it.
The Print Preview
The lower part of the screen shows essentially what will appear on the
paper when you print or save as a PDF. If you have entered
your name in Personal Data, the title will be "Medical Information for
(your name)". The subtitle will always show the last time
your data was updated. When a page breaks in the middle of a
list, that list's title is duplicated on the next page along with
"(continued)"; this is followed by duplicates of the column headers and
the remaining rows. For lists that include address
information, the street, city, state, and zip are combined into a single "address"
field to help save space.
Print Settings Persistence
Although there is no Undo/Redo for changes you make in the Print
screen, all settings are saved to the browser's Local Storage and the
app file (when you save it). This means that you can setup a
"standard" configuration that you use every time you
print your medical information.
Export Help
What it's for
The Export function has two purposes: The primary purpose is to provide
a data-migration path when major updates to My Own Medical Info are released. Since
your data is stored within the app file, it may need to be exported and
then imported into the new version (minor updates should be able to use
data kept in the browser's Local Storage instead). The other
reason is to let you access your medical information outside of the
app itself. The file you export can be easily imported into a
spreadsheet or database tool. In fact, a file created with
the default settings can be simply dragged into MS Excel or
OpenOffice Calc.
Include Options
On the right side of the button bar, there are two options that let you
control what gets included with your data:
Include List Names
- You probably want to leave this checked most of the time. However, if you want to import that
data to another application, having extra rows containing list names may cause problems.
Include Line Formatting
- Leave this checked when using Export to upgrade the app, but uncheck
it if you are exporting to another application (like a spreadsheet or database).
Select a Delimiter
By default, the TAB character is used to separate columns in the
exported file. While this "invisible"
character can make the file visually confusing, it is the
best delimiter to use since none of your data can accidentally include that
character. In fact, any Tabs that you may have entered in
the app are automatically converted to spaces before you get a chance
to do an Export. The other delimiters (comma, semicolon, and
vertical bar) are offered only for compatibility with applications
where you may want to import the data. If you use one of
these three characters and it is also found within your data, the
on-screen preview will highlight it in red. If that happens you
will need to use a qualifier as well...
Select a Qualifier
A qualifier must be used if your data contains the same character used
as a delimiter. To prevent this embedded character from
corrupting a future import, the qualifier is placed to the left and
right of your data fields. The combination of delimiters and
qualifiers is much less likely to be found within your data than a
single delimiter. Even so, it's still possible that you have to try a
couple of delimiter/qualifier pairs before you find one compatible with
your data (no warning in the preview screen).
Export order
Although you can re-arrange the lists in the Edit screen according to
your personal preference, the export only saves them in the
app's default "raw" order. Since list names might not be
included in an export, this fixed order is used to identify each list when
upgrading (importing) to a new version.
Save Export File
The
button opens a browser-generated dialog box that lets you choose where
you save the file. The default file name is the same as your app file name but
with an added time-stamp and ".txt" instead of ".html".
While you can rename it to anything you like, it is probably best
to at least leave the ".txt" extension on the file name
Export Settings Persistence
Although there is no Undo/Redo for changes you make in the Export
screen, all settings are saved to the browser's Local Storage and the
app file (when you save it). This means that you can setup a
"standard" configuration that you use every time you need to export data.
Import Help
What it's for
This function is mostly intended for re-loading data
exported from an older version of My Own Medical Info. While it is also
possible to export data, edit it with other software, and then re-import it,
there is a risk that such modified data may be rejected.
(the import filter is very picky about column headers and
delimiters).
Pick a File to Import
The button
opens a browser-generated dialog box that lets you browse for your import file
(presumably a file that you previously Exported from the app).
This button is automatically pressed when you go to the Import screen - but you can
also click it to select a different file after previewing a previous choice.
Once you have selected a file (and clicked "Open"), the app will try to detect its format.
If recognized, a preview of the import file will appear with its delimiters highlighted in yellow.
If the file is not recognized, an error message will appear instead.
The Import Buttons
Once the app recognizes an import file, two different import buttons will be enabled in the information box:
- Although it says "Replace" you would normally use this to import your
(previously exported) data into a newer (empty) version of the app.
However, you may occasionally want to replace an "experimental"
version of your data with data that you previously backed up to an
export file.
In either case, when you choose this type of import, the imported
data will be all that appears in the app.
When you click this button, you will be warned that this type of
import cannot be undone except by closing the app without saving it.
This is because you are essentially "resetting" the app when you
do the import.
- This button lets you add previously exported data to the data you already have in the app.
All imported data will be appended to the appropriate lists - with the exception of "Personal Data".
Since Personal Data can only have one line, it will remain unchanged from this type of import.
This type of import can be undone with a single click of
the button.
Referential Integrity Fixup
When importing data, the app may require some
values in one list to match values in another list.
If the app version that made the export didn't have that
"relationship", one of the imported lists will be missing the required
"parent" data.
For example: the file may have a Prescriber in the Medication list, but there is no matching
(doctor's) Name in the Doctors list.
Unless the matching value is found in the existing app data, a warning is shown along with two options:
- Using the previous example, this would add the Prescriber value
from the Medication list as a Name
in the Doctor list.
- Again, using the example, this would replace the unmatched Prescriber value
with a default value such as "--unknown--".
Privacy Help
What it's for
This screen is simply called "Privacy" for a reason.
While My Own Medical Info's encryption scheme is good enough to discourage most friends, relatives,
and casual snoopers, calling it "Security" or "Data Protection" would be pretentious.
The intent is to offer about the same privacy as a locked file cabinet where you might keep
your printed medical records, bills, prescriptions, etc.. Note:
In spite of it's limitations, there is no "backdoor" or "password recovery" option. DO NOT forget your password!
Display Password
If you want to prevent someone from seeing your password when they glance at the screen, you can un-check this option.
However, if there is no-one standing behind you, it may be easier to enter the password when you can see it on-screen.
Enter/Re-enter a Password
To avoid ridiculously trivial passwords, the app requires passwords at least 5 characters long.
Of course, the longer you make it the more secure it will be.
You must also enter the password twice to avoid using one that contains any mistakes.
Encrypt & Lock
Once you enter matching passwords over 4 characters long,
the button is enabled.
Pressing this button will encrypt all your data in the browser's memory AND the browser's local storage.
It will also prevent you from doing anything else with the app (because the data is encrypted).
At this point you should save the app file and close the browser.
If you change your mind before closing the browser, you can simply click the
button to put everything back the way it was.
However, once you save the file and close the browser, you will need a password to unlock the app (and your data).
Decrypt & Unlock
When you open your app after you "Encrypt & Lock" it, you will be prompted to Enter a Password.
Once you have entered at least 5 characters, the button will be enabled.
If you entered the password correctly, clicking the button will decrypt your data and return you to the Edit screen.
If the password was invalid, an error message will ask you to try again. Note:
If you want to maintain your privacy, don't forget to re-encrypt and save the file.
Personal DataYour own ID and contact information
0
HeadText
ElemMax
CellType
Print
Cust1
Cust2
Title
Name
30
celltextin
p
Use the format that matches your doctors' medical records
Birth Date
20
celltextin
p
Use mm/dd/yyyy format to save space
SS#
11
celltextin
p
Social Security Number
Blood
3
celltextin
p
Blood Type (O, A, B, AB) and RH factor ( + or - )
Home Phone
20
celltextin
p
Cell Phone
20
celltextin
p
Work Phone
20
celltextin
p
Address
35
celltextin
p
Your primary residence
Town
25
celltextin
p
State
15
celltextin
p
Use the 2-letter postal abbreviation to save space
Zip
10
celltextin
p
Printable
1
cellflag
PickPrint
Uncheck this to hide the row when printing
Color
10
cellflag
PickColor
Use colors to mark rows that have something in common
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Kent Allard
7/31/1930
835-03-1234
AB-
212-286-2860
718-981-1234
515-243-3273
79 7th Ave.
New York
NY
10011
p
White
MedicationsYour (current) prescribed, recommended, and self-selected medicine
0
HeadText
ElemMax
CellType
Print
Cust1
Cust2
Title
Primary Name
30
celltextin
p
DrugLook
The name actually found on the box or bottle
Alt Name
30
celltextin
p
DrugLook
Familiar generic or brand name equivalent OR compound components
Purpose
35
celltextin
p
The ailment or condition treated by this medecine
Dose
15
celltextin
p
GetMedDose
Usually specified in milligrams (mg) for pills or milliliters (ml) for liquids
Freq
15
celltextin
p
GetMedFreq
How often it's taken: 1 Weekly? 3 Daily? As needed?
Prescriber
30
celloptin
p
GetPrescrib1
GetPrescrib2
The doctor (from your list) who prescribed or recommended the medicine
Provider
30
celloptin
p
GetProvider1
GetProvider2
The pharmacy (from your list) where you last purchased the medicine
Printable
1
cellflag
PickPrint
Uncheck this to hide the row when printing
Color
10
cellflag
PickColor
Use colors to mark rows that have something in common
0
1
2
3
4
5
6
7
8
9
simvastatin
(Zocor)
elevated cholesterol
20mg
Daily
John McIntyre
CVS
p
Red
Plavix
clopidogrel
coronary artery disease
75 mg
Daily
John McIntyre
Walgreens
p
Red
metformin-SR
(Glucophage XR)
non-alcoholic fatty liver disease
850 mg
Daily
Rupert Sayre
CVS
p
Blue
Advair Diskus
fluticasone propionate
COPD
100 mcg
2 Daily
Rupert Sayre
Walgreens
p
Blue
Advair Diskus
salmeterol
COPD
50 mcg
2 Daily
Rupert Sayre
Walgreens
p
Blue
omeprazole
(Prilosec)
ulcers
20 mg
2 Daily
Rupert Sayre
CVS
p
Blue
amoxicillin
ulcers
1000 mg
2 Daily
Rupert Sayre
CVS
p
Blue
Biaxin
clarithromycin
ulcers
500 mg
2 Daily
Rupert Sayre
Walgreens
p
Blue
sertraline
(Zoloft)
obsessive compulsive disorder
50 mg
Daily
Frasier Crane
CVS
p
Orange
Thiotimoline
rosacea karlsbadensis
causal disassociation
42 mcg
As Needed
Sam Beckett
--Unknown--
p
Violet
Radithor
radium
chronic fatigue
1 vial
Daily
Nick Riviera
(doctor)
p
Green
Anguis Oleum
panacea
everything
1 bottle
At Night
Nick Riviera
(doctor)
p
Green
ketoconazole
(Nizoral)
athlete's foot
2% cream
Daily
OTC (Drug)
(not applicable)
p
White
DoctorsDoctors you currently see - plus others that prescribed current medication or performed major surgery
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Cust1
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Title
Name
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DocLookButt
Just enter the Doctor's first and last name (leave off the "Dr.")
Specialty
25
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GetDocSpec
General Practitioner, Cardiologist, Dermatologist, etc.
Phone
20
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Primary office phone number
Address
35
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DocMapButt
Primary office address
Town
25
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Primary office town
State
15
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GetStateName
Primary office state
Zip
10
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Primary office zip code
Other Info
30
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Other information such as a practice name
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Color
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John McIntyre
Cardiology
310-369-1000
10201 W. Pico Blvd. Bldg 88, Rm 30
Los Angeles
CA
90035
p
Red
Rupert Sayre
General Practice
515-243-3273
4 Times Square
New York
NY
10036
p
Blue
Frasier Crane
Psychiatry
212-975-4321
51 W. 52nd St.
New York
NY
10019
p
Orange
Sam Beckett
Historic Anomalies
818-777-1000
100 Universal City Plaza
Universal City
CA
91608
p
Violet
Nick Riviera
Quack
600-362-8672
123 Fake St.
Springfield
NT
12345
p
Green
Peter Venkman
Parapsychology
310-244-4000
10202 West Washington Blvd.
Culver City
CA
90232
p
White
Stephen Strange
Neurosurgery
212-576-4000
135 W. 50th Street, 7th Floor
New York
NY
10020
p
White
Heathcliff Huxtable
Dentistry
818-464-9600
16027 Ventura Blvd.
Encino
CA
91436
p
White
Alan Harper
Chiropractor
818-954-6000
4000 Warner Blvd.
Burbank
CA
91522
p
White
Emergency ContactsPeople (in order of preference) who should be contacted in case of emergency
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Cust1
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Title
Name
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The contact's full name
Relation
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GetRelation
Indicate whether they are a spouse, son, daughter, friend, etc.
Home Phone
20
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Home phone number
Work Phone
20
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Work phone number
Cell Phone
20
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Cell phone number
Other Info
25
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more details about how or why to contact them
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Margo Lane
Friend
415-955-8269
323-965-7316
p
White
Harry Vincent
Friend
312-649-3523
248-458-7991
call work # first
p
White
PharmaciesPharmacies where you regularly get prescriptions filled
0
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CellType
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Cust1
Cust2
Title
Name
30
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GetPharm
Business name of the pharmacy (like CVS, Rite Aid, Walgreens, etc.)
Address
35
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The location you use most
Town
25
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State
15
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GetStateName
Zip
10
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Phone
20
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PharmPhoneButt
(for calling in a prescription)
Fax
20
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(alternate method for sending prescriptions)
Other Info
30
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10
Walgreens
200 Wilmot Rd.
Deerfield
IL
60015
847 940-2500
for brand names
p
White
CVS
1 CVS Drive
Woonsocket
RI
02895
800-746-7287
for generics
p
White
Medical History & ConditionsAnything medically relevant that could affect diagnosis and/or treatment of a new problem
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CellType
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Cust1
Cust2
Title
Type
25
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GetIssueType
The general type of condition or event
Common Label
30
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Names of conditions like "diabedes" or "latex allergy" - also procedure names like "rhinoplasty" or "lasik"
Date
25
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Leave blank for current conditions
Details
50
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Specific relevant details
Doctor
30
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GetTreater1
GetTreater2
Doctor (from your list) who performed procedure or is currently treating a condition
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Curable Illness
Peptic Ulcers
n/a
being treated
Rupert Sayre
p
Blue
Disease-Chronic
COPD
n/a
being treated
Rupert Sayre
p
Blue
Disease-Chronic
liver disease
n/a
being treated
Rupert Sayre
p
Blue
Surgery
Atherosclerosis
3/17/2004
Angioplasty for blocked LCX
John McIntyre
p
Red
Implant
Coronary Artery Stent
3/17/2004
Endeavour (Medtronic) in LCX
John McIntyre
p
Red
Implant
Coronary Artery Stent
5/21/2005
Xience V (Abbot) in LCX
John McIntyre
p
Red
Chronic Disease
Fatigue
n/a
being treated
Nick Riviera
p
Green
Family History
Lycanthropy
n/a
(maternal grandfather) monitored by >>
Peter Venkman
p
White
Transplant
Bibliographic Extension
1/1/1988
ultimately returned to donor
Stephen Strange
p
White
Allergy-Enviroment
Photodermatitis
n/a
(generally avoid light to avoid symptoms)
None
p
White
Insurance PlansInsurance information that hospitals and doctors like to have before treating you
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Cust1
Cust2
Title
Type
20
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GetInsType
The type of Insurance (Medical, Prescription, Dental, Vision, etc.)
Company
30
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GetInsCo
Company Name (like Medicare, Aetna, United Health etc.)
Plan
30
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The plan's name or title
Group ID
25
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The Group number - typically the same for co-workers using the same plan
Personal ID
25
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The ID number assigned to the specific insurance customer
Cust Phone
20
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The phone number provided for customers to call for assistance
Doc Phone
20
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The phone number provided for doctors and hospitals to call about billing issues
Fax
20
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A fax number that can be used to submit insurance claims
Other Info
30
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Important details not covered by the other categories
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Health
Medicare
Parts A & B
835-03-1234A
800-633-4227
p
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Health
Mutual of Omaha
Medigap Plan "C"
793053MC
835-03-1234 01
800-228-7104
800-775-1000
p
White
Prescription
Humana
Preferred Rx PDP
D4375
1234A6789
866-945-4481
800-448-6262
Medicare Part D
p
White
Dental
Delta Dental
DeltaCare Individual
27566
314253-6475
800-932-0783
p
White
ImmunizationAll vaccinations - parts of combined vaccines like DPT and MMR should be entered separately
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Cust1
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Title
Vaccine
30
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GetImmune
The vaccine name based on the disease it helps you avoid
Doses Needed
2
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The date for the latest dose in a series OR your latest booster shot
Last Dose #
2
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If a vaccine is given as multiple doses, how many were administered so far?
Dose Date
20
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The date for the latest dose in a series OR your latest booster shot
Other Details
50
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p
More specific vaccine information, such as Brand name
Printable
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Color
10
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