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15 Hospital Center Common
Hilton Head, SC 29926
(843) 682-2800
(843) 682-2828

300 New River Parkway,
Suite 2
Hardeeville, SC 29910
(843) 208-2900
(843) 208-2901



	The following is an example of a HHHF Urgent Care Medical File:

Date File Created: Tuesday April 25, 2000

Date of Last Edit: Tuesday April 25, 2000

Patient Information

First Name:

Address:

Last Name:

City:

Phone:

State:

E-mail:

Zip:

Birthday:

mm/dd/yyyy

Country:

Emergency Contact

Name:

Phone:

Physicians (You can put up to 3 names)

Name 1:

Phone 1:

Name 2:

Phone 2:

Name 3:

Phone 3:

Medical Information

Blood Type:

Allergies:

Current Medicines:

Vitamins, Supplements, Herbs:

All previous surgery:

Insurance Information

	Provider 1	Provider 2
Carrier:	BlueCross BlueShield	State Farm
ID #:	555-555-5555	222-22-222
Group #:	1234-56
Extra Info:

Critical Data

Historical Illnesses

Patient Images

Date	Type	Description
4/20/2001	Images	Cardiac Catheterization 1
10/12/2000	Images	Cardiac Catheterization 2
9/22/2000	Images	Cardiac Catheterization 3
9/13/2000	Doctor's Notes	Cardiology Follow Up
4/20/2001	Images	ECG
4/20/2001	Doctor's Notes	Sample Labs
4/20/2001	Images	Stenosis Diagram.jpg
4/20/2001	Doctor's Notes	NMR Lipo Profile Page 1
4/20/2001	Doctor's Notes	NMR Lipo Profile Page 2