BioSys Solutions
IBRP TESTING CASE REPORT
For Intra-Company Use Only
REPORTER INFORMATION
Today's Date: 11/16/2020
Clinic: Alpha
Clinician: Dr. Natalie House
Phone: (210) 555-0107
Reporter: Joan Torres
Phone: (210) 555-0119
IBRP TESTING INFORMATION
Lab #: 14
Specimen #: F-04
Test Type
BGS/biopsy: Negative
Psychological evaluation (performed by on-site counselor): Negative
PATIENT INFORMATION
First Name: Amy
Last Name: Kushnier
Phone: (210) 555-0110
Address: PLQ-303, Adjacent Personnel Complex
City: Haverford
Zip Code: 10023
County: Stanford
State: New York
Date of Birth: 2/17/1984
Age: 36
Sex: F
Race
White_Y
Black/African American_
Asian_
American Indian/Alaskan Native_
Native Hawaiian/Pacific Islander_
Other_
Ethnicity
Hispanic_
Not Hispanic_Y
Does the patient work in a physical interactivity occupation (e.g, biopsy or blood sample retrieval, floor exploration, drug administration, surgical treatment, etc)?
Yes_
No_X
Department Title_
Employee Occupation_
Does the patient work in a visually restrained position (e.g, Internal Imagining System operator, EKG monitor, staff resource manager, data analyst, etc)?
Yes_X
No_
Department Title: Technology
Employee Occupation: IIS Monitor
Does the patient oversee transfer of biopsy and blood samples?
Yes_
No_X
Shift:
CLINICAL INFORMATION
Date Of Symptom Onset: 11/04/2020
OR Asymptomatic: N/A
Is Patient Admitted: Y_X N_
Is Patient Pregnant: Y_ N_X
Is Patient Deceased: Y_ N_X
Admittance Date: 11/16/2020
Discharge Date: TBD
Date Of Death: N/A
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