Page 16 of The Dream Hotel
Safe-X, Inc.
STFOF Division
Facility: Madison
Location: Ellis, California
Medical Visit Report
Patient: Sara T. Husseyn
Age: 38
Complaint: Anxiety. Requests benzodiazepine.
Timestamp: 10-16-13-03
Allergies
Allergen
Onset
Notes
TDAP vaccine
Age 21
Swelling on the arm
Pollen, grass
Age 15
Treated with antihistamine
Fragrance
Age 15
Treated with antihistamine
Dust
Age 15
Treated with antihistamine
Women’s Health
Date of last menstrual period
10-12
Total number of pregnancies
2
D&C
1
Number of live births
2 [twins]
Pregnancy complications
None on record
Behavioral History
Category
Notes
Risk (pre-retention)
Risk (in retention)
Tobacco use
never smoked
-3
0
Drug use
no, last use sixteen years ago
+1
0
Alcohol use
yes, 3-5 drinks a week
+3
0
Marital status
married
-3
0
Sexual partner(s)
Pre-retention: 1 (male), regular
In-retention: 1 (female), casual
-3
+3
Birth control
yes
-3
0
Sexual assault(s)
age 19, victim
+3
+3
Family History
Disease/condition
Relation
Age of onset
Cancer (lymphoma)
mother
57
Psychiatric (depression)
father
45
Heart disease
N/A
N/A
Macular degeneration
N/A
N/A
Medical History
Diagnosis
Age of onset
Status
General anxiety disorder
15
Ongoing
Nephrolithiasis
27
No recurrence
Impression & Care Plan
Sara Husseyn is a 39 y.o. female patient presenting with complaints of anxiety. She requests a dose of benzodiazepine (Xanax. Risk +3)
Patient vitals were taken. Blood oxygen level normal. Blood pressure within normal range. Heartbeat elevated.
Benzodiazepine was denied, as supplies are reserved for sedation in situation-critical cases.
Sara Husseyn was given an opportunity to ask questions, and all questions were answered to the best of my ability. I encouraged her to email me if she has any further questions or concerns.
Signed: Adelina S. Flores.