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labs-3f45ad90-c5c6-4c27-880e-5d6bcb2dce56.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-a6b4e13c-cdb6-4536-b73d-9ef999513c8e.pdf
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{"name": "labs-a6b4e13c-cdb6-4536-b73d {"name": "labs-a6b4e13c-cdb6-4536-b73d-9ef999513c8e.pdf", "content_type": "application/octet-stream", "size": 640549, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-78695b53-31df-48f9-b6c4-11817bba0bbd"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-0064781c-83a6-48d6-b478-755deca4ebfa.pdf
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{"name": "labs-0064781c-83a6-48d6-b478 {"name": "labs-0064781c-83a6-48d6-b478-755deca4ebfa.pdf", "content_type": "application/octet-stream", "size": 640549, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-b96b9945-5a82-4356-bbeb-7b20cbb91cae"}...
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374bfccd1eb4a0c7d40839532ae6c712cbe3674b92845fcf38 374bfccd1eb4a0c7d40839532ae6c712cbe3674b92845fcf38976ea3f8450d0e...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-791293fb-67d3-470a-a451-598545dcfcbb.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"name": "labs-04e2c8da-5590-4c3e-8f61 {"name": "labs-04e2c8da-5590-4c3e-8f61-03b1e7604c70.pdf", "content_type": "application/octet-stream", "size": 640549, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-31fb61a6-ddfd-4cad-8e8e-892d6aefd8af"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"name": "labs-395046e6-65c6-42e0-b3b6 {"name": "labs-395046e6-65c6-42e0-b3b6-3f025b2469f8.pdf", "content_type": "application/octet-stream", "size": 640962, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-a9ada0da-11ad-410d-8198-19a31632c6a8"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-d985c2a5-5c65-4b21-ae75-7a0867a43f74.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-b9f48744-0bcd-4d4d-90ff-f3b8f264ba96.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv\n11-12-1998\n578788878\nDoe\n52 Castlefall Way NE\nCaglary\nT3J1M7\n52 Castelfall way NEasdasdasd\ncalgary\nt3j1m7\n(123) 456-7876\n123-434-5676\nChoose Province\nDr John"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash\nDiv ss\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash nss\nDiv nss\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash jf\nDiv af\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash ctg\nDiv cty\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash abcdks\nDiv alien\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-44b7a0cf-72c9-4639-a00f-1e8f2bbbae75.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash abcd\nDiv ctg\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-2a4c4482-144b-4b6e-94e9-c73a715b7d7b.pdf
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{"name": "labs-2a4c4482-144b-4b6e-94e9 {"name": "labs-2a4c4482-144b-4b6e-94e9-c73a715b7d7b.pdf", "content_type": "application/octet-stream", "size": 640800, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-12275b51-4375-41df-afe0-d1eaa65daa6c"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash abcd ed\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-9f904d45-7f24-4063-b213-3c288cf67214.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash abc\nDivgfbgb\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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labs-bc323552-5841-4966-b33c-1a8881a81874.pdf
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash abc\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \nKash testing\nDiv\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \n65\nKash jf\nDiv af\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "ABATACEPT for Polyarticular Juvenile \nIdiopathic Arthritis \nSPECIAL AUTHORIZATION REQUEST FORM \nPlease complete all required sections to allow your request to be processed. Patients may or may not meet eligibility requirements as established \nby Alberta Government sponsored drug programs. \nPATIENT INFORMATION COVERAGE TYPE\nPATIENT LAST NAME FIRST NAME INITIAL\n Alberta Blue Cross \n Alberta Human Services \n Other\nDATE OF BIRTH: YYYY/MM/DD ALBERTA PERSONAL HEALTH NUMBER\nSTREET ADDRESS CITY PROV POSTAL CODE ID /CLIENT/COVERAGE N UMBER \nPRESCRIBER INFORMATION \nPRESCRIBER LAST NAME FIRST NAME INITIAL PRESCRIBER PROFESSIONAL ASSOCIATION REGISTRATION \n CPSA \n CARNA \n ACP \n ACO \n ADA+C \n Other \nREGISTRATION NUMBER \nSTREET ADDRESS \nPHONE FAX \nCITY, PROVINCE \nPOSTAL CODE FAX NUMBER MUST BE PROVIDED WITH EACH REQUEST SUBMITTED \nPlease provide the following information for ALL requests \nDiagnosis \n Polyarticular Juvenile Idiopathic Arthritis \n Other ( please specify) ______________________ \nCurrent weight (kg) Dosage \nDosing frequency \nPlease provide reason if a switch from a different biologic agent to abatacept is requested \nNote: Patients will not be permitted to switch back to a previously trialed biologic agent if they were deemed unresponsive to ther apy \nCurrent ACR Pedi 30 FLARE score (provide for ALL requests) \nACR Pedi 30 RESPONSE score at 16 to 20 weeks after first dose \nof previous abatacept treatment (provide for RETREATMENT \nrequests) \nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________ w\nith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. No\n. of active joints* ___________ 6. ESR (mm/hr) ____ ______\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nDate of assessment___________________________ \n1. R\nheumatologist global 4. No. of joints\na\nssessment (0-10) ___________\nwith LROM ___________ \n2. P\natient global 5. CHA\nQ (0-3) ___________\nassessment (0-10) ___________\n3. N\no. of active joints* ___________ 6. ESR (mm/hr) _____ _____\n or CRP ______________\n*joints with swelling not due to deformity or joints with limitation of motion with pain,\ntenderness or both\nPlease provide the following information for ALL NEW requests \nPrevious medications utilized: Dose, duration and response is required \n DMARD(s) (please specify agents) \n Adalimumab\n Etanercept \n Tocilizumab \n Other (please specify agent) \nAdditional information relating to request (e.g. reasons why any of the above therapies were not tried) \nPRESCRIBER'S SIGNATURE DATE Please forward this request to \nAlberta Blue Cross, Clinical Drug Services \n10009 108 Street NW, Edmonton, Alberta T5J 3C5 \nFAX: 780 498-8384 in Edmonton \u2022 1-877-828-4106 toll free all other areas \nONCE YOUR REQUEST HAS SUCCESSFULLY TRANSMITTED, PLEASE DO NOT MAIL OR RE-FAX YOUR REQUEST \nThe information on this form is being collected and pursuant to sections 20, 21 and 22 of the Health Information Act, and sec tions 33 and 34 of the Freedom of Information and \nProtection of Privacy Act, for the purposes of determining or verifying eligibility to participate in a program or receive a benefit, product or health service. If you have any questions \nregarding the collection or use of this information, please contact an Alberta Blue Cross privacy matters representative toll -free at 1-855-498-7302 or write to Privacy Matters, \nAlberta Blue Cross, 10009 108 Street, Edmonton AB T5J 3C5. \n \u00ae*The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC \nBenefits Corporation for use in operating the Alberta Blue Cross Plan. \u00ae\u2020 Blue Shield is a registered trade- mark of the Blue Cross Blue Shield Association. \nABC 60010 (2016/10) \n65\n1.5\n3\nKash abcder\nDiv ajk\n1998-12-11\n578788878\nMequanent\n52 Castlefall Way NE s\nCaglary\nT3J1M7\ncalgary\nT1Y6L4\n1\n4036481926\nChoose Province\nTed"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n\u00a0\n\u00a0\nDavid White\nSAIT\u00a0\nFax:\u00a0 \u00a0 \u00a04032354147\n\u00a0\nRE:\u00a0 \u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 666777881\nDOB:\u00a0\u00a011 December 1998\nGender :\n\u00a0\nDear Dr. White\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nCHIEF COMPLAINT:\n\u00a0\nHISTORY OF PRESENT ILLNESS:\n\u00a0\nREVIEW OF SYSTEMS:\nNo chest pain. No shortness of breath. No numbness. No tingling. No dyspnea on exertion. No chest pain on\nexertion. No nausea. No vomiting. No diarrhea. No fevers. No abdominal pain. No numbness. No tingling. No\nlightheadedness. No dizziness. No melena. No bright red blood per rectum. No cough. No fevers. No chills. No\nheadaches. No orthopnea. No PND. No peripheral edema. No palpitations. No syncope. No snoring. No change in\nvision. No change in hearing. No change in bowel or urinary habits. No excessive weight loss. No bleeding\ndisorders. No night sweats. No lethargy No fatigue. No arthralgias. No skin changes. No change in gait\n\u00a0\nPAST MEDICAL HISTORY:\n\u00a0\nPAST SURGICAL HISTORY:\n\u00a0\nFAMILY HISTORY:\n\u00a0\nSOCIAL HISTORY:\n\u00a0\nALLERGIES:\n\u00a0\nMEDICATIONS:\n\u00a0\nPHYSICAL EXAMINATION:\nThe patient is awake, alert, oriented x 3 and is in no acute distress.\nVitals:\nHEENT: Pupil equal, round and reactive to light. Extraocular movements are intact. Conjunctivae is clear. No\nscleral icterus. Lips are without lesions. Oropharynx is clear.\nPHN / ULI: 666777881 Report Date: 12/29/2025Page 1 of 2 Neck: Trachea is midline. No JVD. No carotid bruits. No thyromegaly. No lymphadenopathy. No neck masses.\nLungs: Clear to auscultation bilaterally. No crackles. No wheezes. No rhonchi\nHeart: Normal S1 S2. Regular rate and rhythm. No peripheral edema. No murmurs. Bilateral radial pulse is\npalpable, equal and within normal limits.\nAbdomen: Soft, nontender, nondistended, bowel sounds positive, no organomegaly.\nNeurological exam: Cranial nerves lil to XII are grossly intact. No focal deficits. Strength is 5/5 in all four\nextremities. Normal gait.\n\u00a0\nINVESTIGATIONS:\n\u00a0\nASSESSMENT AND PLAN: I\n\u00a0\nPatient will continue to follow up regularly with their primary care physician\nIf you have any further questions please do not hesitate to contact us I would like to thank you for allowing me to\nparticipate in the care of this patient\n\u00a0\nYours Sincerely,\nDr. Lovpreet Mangat, MD, FRCPC\nInternal Medicine\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\nPage 2 of 2 PHN / ULI: 666777881 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n\u00a0\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 A43819\n\u00a0\nDr. David White\nFax:\u00a0 4032354147\n\u00a0\nRE:\u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 666777881\nDOB:\u00a0\u00a011 December 1998\nGender :\n\u00a0\nDear Dr. White\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nHe/She is a 27-year-old\n\u00a0\nPAST MEDICAL HISTORY:\nHis/Her past medical history is significant for\n\u00a0\nMEDICATIONS:\n\u00a0\nPHYSICAL EXAMINATION:\nOn examination, blood pressure was mmHg with a heart rate of beats per minute. JVP was normal with normal\nS1, S2, no evidence of S3, S4 or any murmurs Lungs were clear. Abdomen nontender. Legs did not reveal any\nevidence of edema.\n\u00a0\nECG:\nECG in the clinic revealed normal sinus rhythm with no evidence of ischemia.\n\u00a0\nEXERCISE STRESS TEST:\n\u00a0\nIMPRESSION:\n\u00a0\nThank you again.\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\nDr. Anmol S. Kapoor, MD, FRCPC\nCardiologist\nASK/pjd\u00a0\n\u00a0\nDictation file: Anmol\u00a0\n\u00a0\nPHN / ULI: 666777881 Report Date: 12/29/2025Page 1 of 2 DICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 2 of 2 PHN / ULI: 666777881 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nDr. David White\nFax: 4032354147\nRe: Div Kash\nPHN: 578788877\nDOB: 11 December 1998\nDear Dr. White\nI reviewed your patient today.\u00a0\nAs you know,\nALLERGIES:\nHe/She does not have any food or drug allergies.\nPAST MEDICAL HISTORY:\nHis/Her past medical history is significant for the following:\nCURRENT MEDICATION:\nHe/She is on the following medications:\n1. \u00a0\nPHYSICAL EXAMINATION:\nOn examination, he/she looks well. He/She weighs pounds/kg and is\u00a0 tall. His/Her body mass index is . His/Her\nbaseline blood pressure is 124/80 mmHg, pulse 64 bpm and regular Chest is clear. Normal heart sounds. No\ngallop rhythm or murmur.\nEXERCISE STRESS TEST:\nHe/She was stressed according to the Bruce protocol for about 9 minutes and 45 seconds, achieving 15 METs.\nHis/Her heart rate went up from a baseline of 94 to a maximum of 143, which represents 90% of his/her age-\npredicted heart rate. During stress and at peak exercise he/she had no dynamic ST-T changes. This is a negative\nexercise stress test.\u00a0\nINVESTIGATIONS:\nASSESSMENT AND PLAN:\nIn summary,\u00a0\nOnce again, thank you for giving us the chance to participate in the care of your patient.\u00a0\nYours sincerely,\nAhmed Saeed Alghamdi M.B.,Ch.B. , FRECP(C) , FACP , FACC , FASE\nPHN / ULI: 578788877 Report Date: 12/29/2025Page 1 of 2 AA/pjd\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 2 of 2 PHN / ULI: 578788877 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n250 8500 Blackfoot Trail SE Calgary, AB T2J 7E1\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0Tel 403-879-7911 Fax 403-879-7899\nDate: 29 December 2025\n\u00a0\nDear: David White\nFax: 4032354147\n\u00a0\nRef: -\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Chart: A43819\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nAddress: -\nTel: (111) 111-1111\n\u00a0\nThank you for your referral\nThe above patient has been booked for the following appointment:\n\u00a0\n\u00a0 \u00a0\n\u00a0 \u00a0\n\u00a0\nPlease arrive 15 min before your appointment.\n__________\u00a0Patient has been informed on Telephone No.: (111) 111-1111\n__________ Message has been left for the patient on Telephone No.:\u00a0 (111) 111-1111. Kindly assist in informing the\npatient.\u00a0\n\u00a0\nKind regards\nDr Dhalla\nAdvanced Rheumatology\n\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-879-\n7911.\nPage 1 of 1 PHN / ULI: 578788877 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\n\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\nA43819\n\u00a0\nDavid White\nSAIT\u00a0\nFax 4032354147\n\u00a0\nRE:\u00a0 Div Kash\nPHN: 666777881\nDOB: 11 December 1998\n\u00a0\nDear Dr. White\n\u00a0\nThank you very much for allowing me to assess a very pleasant 27 year old - with regards to cardiac\nassessment.\n\u00a0\n- denies chest pains/classic exertional chest pains or with emotional stress. There is non-specific\nshortness of breath on increased exertion without pedal edema, orthopnea or PND. There is no\npalpitations, pre-syncope, syncope or claudication. There are no hormones like birth control, calf\nswelling, calf pain tenderness or redness, recent injury, surgery, immobilization or cancer.\n\u00a0\nCARDIAC RISK FACTORS and PAST MEDICAL HISTORY:\nDiabetes with A1C\nHypertension with BP today - mmHg\nDyslipidemia with LDL mmol/L\nObesity with BMI kg/m2\n\u00a0\nMEDICATIONS:\n-\n\u00a0\nALLERGIES:\nNKDA\n\u00a0\nFAMILY HISTORY:\nNo family history of premature heart disease or stroke (M< 55 and women < 65) in first-degree relatives.\nNo sudden cardiac/unexpected death in extended family.\n\u00a0\nSOCIAL HISTORY:\nThe patient is an ongoing smoker - drinks socially and denies illicit substances.\n\u00a0\nPHYSICAL EXAMINATION:\nThe patient looks well and in no distress. Blood pressure: -, Heart Rate: - JVP was normal. Pedal radial\nand carotid pulses are normal and there is no pedal edema. Heart sounds are normal without any\nPHN / ULI: 666777881 Report Date: 12/29/2025Page 1 of 2 murmurs.\u00a0\nLungs were clear.\n\u00a0\nINVE STIGATIONS:\nECG in the clinic revealed normal sinus rhythm with no evidence of acute ischemia.\nStress Test on file shows no high risk findings at minutes on the Bruce protocol\nEchocardiogramon file shows no gross pathology influencing clinical magement\nCarotid ultrasound on file shows mild or moderate disease\nMPI on file shows overall normal study\nHolter shows overall reassuring findings\n24 hour BP monitor reasonable control\nCXR on file shows no gross cardio-respiratory pathology\nAngiogram on file shows no critical disease with no LM and no pLAD lesions of significance\nAbdominal imaging shows atherosclerosis of the abdo aorta without aneurysm\nBlood work shows eGFR TSH ACR Hemoglobin\n\u00a0\nIMPRESSION and PLAN:\n\u00a0\nThis 27 year old male with risk factors as above is presenting with non-specific symptoms. I have\narranged a stress test. On the whole I feel that the cardiac prognosis is reassuring. For the long run, I\ncounselled with regards to ongoing diet, exercise and weight loss strategies for ongoing risk reduction\nand improved quality of life.\n\u00a0\nI discussed smoking cessation and\n\u00a0\nI will follow-up with Div after the above tests.\n\u00a0\nIn the meantime if there is any questions or concerns please do not hesitate to contact me at any time.\n\u00a0\nYours Sincerely,\nDr.\u00a0Ravi\u00a0Varshney,\u00a0MD,\u00a0FRCPC\u00a0\nCardiologist\u00a0\nRV/\n\u00a0\n\u00a0\nDictation\u00a0file:\u00a0Varshney\u00a0\n\u00a0\nDICTATED\u00a0BUT\u00a0NOT\u00a0READ\u00a0TO\u00a0AVOID\u00a0DELAY\u00a0\n\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 2 of 2 PHN / ULI: 666777881 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nA43819\n\u00a0\nDavid White\nSAIT\u00a0\nFax:\u00a0 \u00a0 \u00a04032354147\n\u00a0\nRE:\u00a0 \u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 666777888\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. White\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nCHIEF COMPLAINT:\n\u00a0\nHISTORY OF PRESENT ILLNESS:\n\u00a0\nREVIEW OF SYSTEMS:\nNo chest pain. No shortness of breath. No numbness. No tingling. No dyspnea on exertion. No chest pain on\nexertion. No nausea. No vomiting. No diarrhea. No fevers. No abdominal pain. No numbness. No tingling. No\nlightheadedness. No dizziness. No melena. No bright red blood per rectum. No cough. No fevers. No chills. No\nheadaches. No orthopnea. No PND. No peripheral edema. No palpitations. No syncope. No snoring. No change in\nvision. No change in hearing. No change in bowel or urinary habits. No excessive weight loss. No bleeding\ndisorders. No night sweats. No lethargy No fatigue. No arthralgias. No skin changes. No change in gait\n\u00a0\nPAST MEDICAL HISTORY:\n\u00a0\nPAST SURGICAL HISTORY:\n\u00a0\nFAMILY HISTORY:\n\u00a0\nSOCIAL HISTORY:\n\u00a0\nALLERGIES:\n\u00a0\nMEDICATIONS:\n\u00a0\nPHYSICAL EXAMINATION:\nThe patient is awake, alert, oriented x 3 and is in no acute distress.\nVitals:\nHEENT: Pupil equal, round and reactive to light. Extraocular movements are intact. Conjunctivae is clear. No\nscleral icterus. Lips are without lesions. Oropharynx is clear.\nPHN / ULI: 666777888 Report Date: 12/29/2025Page 1 of 2 Neck: Trachea is midline. No JVD. No carotid bruits. No thyromegaly. No lymphadenopathy. No neck masses.\nLungs: Clear to auscultation bilaterally. No crackles. No wheezes. No rhonchi\nHeart: Normal S1 S2. Regular rate and rhythm. No peripheral edema. No murmurs. Bilateral radial pulse is\npalpable, equal and within normal limits.\nAbdomen: Soft, nontender, nondistended, bowel sounds positive, no organomegaly.\nNeurological exam: Cranial nerves lil to XII are grossly intact. No focal deficits. Strength is 5/5 in all four\nextremities. Normal gait.\n\u00a0\nINVESTIGATIONS:\n\u00a0\nASSESSMENT AND PLAN: I\n\u00a0\nPatient will continue to follow up regularly with their primary care physician\nIf you have any further questions please do not hesitate to contact us I would like to thank you for allowing me to\nparticipate in the care of this patient\n\u00a0\nYours Sincerely,\nDr. Lovpreet Mangat, MD, FRCPC\nInternal Medicine\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\nPage 2 of 2 PHN / ULI: 666777888 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 A43819\nDr. David White\nFax: 4032354147\nRe: Div Kash\nPHN: 666777888\nDOB: 11 December 1998\nGender :\u00a0\nDear Dr. White\nI reviewed your patient today.\u00a0\nAs you know,\nALLERGIES:\nHe/She does not have any food or drug allergies.\nPAST MEDICAL HISTORY:\nHis/Her past medical history is significant for the following:\nCURRENT MEDICATION:\nHe/She is on the following medications:\n1. \u00a0\nPHYSICAL EXAMINATION:\nOn examination, he/she looks well. He/She weighs pounds/kg and is\u00a0 tall. His/Her body mass index is . His/Her\nbaseline blood pressure is 124/80 mmHg, pulse 64 bpm and regular Chest is clear. Normal heart sounds. No\ngallop rhythm or murmur.\nEXERCISE STRESS TEST:\nHe/She was stressed according to the Bruce protocol for about 9 minutes and 45 seconds, achieving 15 METs.\nHis/Her heart rate went up from a baseline of 94 to a maximum of 143, which represents 90% of his/her age-\npredicted heart rate. During stress and at peak exercise he/she had no dynamic ST-T changes. This is a negative\nexercise stress test.\u00a0\nINVESTIGATIONS:\nASSESSMENT AND PLAN:\nIn summary,\u00a0\nOnce again, thank you for giving us the chance to participate in the care of your patient.\u00a0\nYours sincerely,\nPHN / ULI: 666777888 Report Date: 12/29/2025Page 1 of 2 Ahmed Saeed Alghamdi M.B.,Ch.B. , FRECP(C) , FACP , FACC , FASE\nAA/pjd\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 2 of 2 PHN / ULI: 666777888 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nmpi-mm\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 A43819\nDr. David White\nFax: 4032354147\nRe: Div Kash\nPHN: 666777888\nDOB: 11 December 1998\nGender : gentleman\nDear Dr. White\nI reviewed your patient today.\u00a0\nAs you know,\nALLERGIES:\nHe/She does not have any food or drug allergies.\nPAST MEDICAL HISTORY:\nHis/Her past medical history is significant for the following:\nCURRENT MEDICATION:\nHe/She is on the following medications:\n1. \u00a0\nPHYSICAL EXAMINATION:\nOn examination, he/she looks well. He/She weighs pounds/kg and is\u00a0 tall. His/Her body mass index is . His/Her\nbaseline blood pressure is 124/80 mmHg, pulse 64 bpm and regular Chest is clear. Normal heart sounds. No\ngallop rhythm or murmur.\nEXERCISE STRESS TEST:\nHe/She was stressed according to the Bruce protocol for about 9 minutes and 45 seconds, achieving 15 METs.\nHis/Her heart rate went up from a baseline of 94 to a maximum of 143, which represents 90% of his/her age-\npredicted heart rate. During stress and at peak exercise he/she had no dynamic ST-T changes. This is a negative\nexercise stress test.\u00a0\nINVESTIGATIONS:\nASSESSMENT AND PLAN:\nIn summary,\u00a0\nOnce again, thank you for giving us the chance to participate in the care of your patient.\u00a0\nYours sincerely,\nPHN / ULI: 666777888 Report Date: 12/29/2025Page 1 of 2 Ahmed Saeed Alghamdi M.B.,Ch.B. , FRECP(C) , FACP , FACC , FASE\nAA/pjd\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 2 of 2 PHN / ULI: 666777888 Report Date: 12/29/2025"}...
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{"name": "dictations-2025_10_09_121525 {"name": "dictations-2025_10_09_121525.pdf", "content_type": "application/octet-stream", "size": 40525, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-50488d94-75c2-492f-8916-c5c0f5b8009a"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel:4038797911 Fax:4038797899\nHello Hello\nare they This patient is very critical and we need to find some way to get the help right away\nEffectively clarity Effectively clarity You know the Punjabi\nPrevious line No other way Chart Number : A43819\ntest1234 test\u00a0\nAamir, Rabbiya\nFax:\u00a0 \u00a0test\u00a0\ntest1234 test\u00a0\ntest3\ntest1234 test\u00a0\n\u00a0\nRE:\u00a0Div Kash\nPHN:\u00a0666777888\nDOB:\u00a0\u00a02025-12-12\n\u00a0\u00a0\u00a0\nDear Aamir, Rabbiya,\n\u00a0\u00a0\u00a0\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nThank you very much for allowing me to participate in Div's care. F denies chest pains/classic exertional chest\npains or with emotional stress. There is non-specific shortness of breath on increased exertion without pedal\nedema, orthopnea or PND. There is no palpitations, pre-syncope, syncope or claudication. There are no calf pain\ntenderness or redness, calf swelling, hormones like birth control, injury, surgery, immobilization or cancer.\u00a0\nCARDIAC RISK FACTORS and PAST MEDICAL HISTORY: No Diabetes with A1C No Hypertension with BP today -\u00a0\nmmHg No Dyslipidemia with LDL mmol/L No Obesity with BMI kg/m2\n\u00a0\n\u00a0\n\u00a0\n\u00a0\u00a0\u00a0\n\u00a0\n\u00a0\n\u00a0\u00a0\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nName: Div Kash | PHN: 666777888 | DOB: 12 Dec, 2025\nPage 1 of 2 Dictation\u00a0file:\u00a0Super Admin\u00a0\n\u00a0\nDICTATED\u00a0BUT\u00a0NOT\u00a0READ\u00a0TO\u00a0AVOID\u00a0DELAY\u00a0\n\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\nPage 2 of 2\nName: Div Kash | PHN: 666777888 | DOB: 12 Dec, 2025"}...
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{"name": "dictations-2025_12_11_144139 {"name": "dictations-2025_12_11_144139.pdf", "content_type": "application/octet-stream", "size": 72557, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-04865c9a-e5c2-418a-9c6f-a770905f0434"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel:4038797911 Fax:4038797899\nDate: 11 December 2025\n\u00a0\nDear: Aaron, Stephen\nFax: 5345435435345345435\n\u00a0\nRef: Div Kash\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Chart: A43819\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nPHN: 666777888\nTel: (587) 998-7876\n\u00a0\nThank you for your referral\nThe above patient has been booked for the following appointment:\n{{PATIENTAPPTDATE5DOCNAME}}\u00a0 \u00a0\n\u00a0 \u00a0\n\u00a0 \u00a0\n\u00a0 \u00a0\n\u00a0\n\u00a0\n\u00a0\nPlease arrive 15 min before your appointment.\n__________\u00a0Patient has been informed on Telephone No.: (587) 998-7876\n__________ Message has been left for the patient on Telephone No.:\u00a0 (587) 998-7876. Kindly assist in informing the\npatient.\u00a0\n\u00a0\nKind regards\nAdvanced Cardiology Consultants & Diagnostics Inc.\n#201-3151 27th St NE,\nCalgary AB,\u00a0T1Y 0B4\nTel: 403 235 4109\nFax: 403 235 4147\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\nPage 1 of 1\nName: Div Kash | PHN: 666777888 | DOB: 12 Dec, 1998"}...
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{"name": "dictations-2025_12_18_130558 {"name": "dictations-2025_12_18_130558.pdf", "content_type": "application/octet-stream", "size": 73995, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-70ccb785-13be-4894-bb60-eaead9bda6ff"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel:4038797911 Fax:4038797899\nChart Number : A43819\nAaron, Stephen\nFax:\u00a0 \u00a05345435435345345435\n\u00a0\nRE:\u00a0Div Kash\nPHN:\u00a0666777888\nDOB:\u00a0\u00a01998-12-11\n\u00a0\u00a0\u00a0\nDear Aaron, Stephen,\n\u00a0\u00a0\u00a0\nthis is test body\n\u00a0\n\u00a0\u00a0\u00a0\n\u00a0\n\u00a0\n\u00a0\u00a0\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation\u00a0file:\u00a0Super Admin\u00a0\n\u00a0\nDICTATED\u00a0BUT\u00a0NOT\u00a0READ\u00a0TO\u00a0AVOID\u00a0DELAY\u00a0\n\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\nPage 1 of 1\nName: Div Kash | PHN: 666777888 | DOB: 11 Dec, 1998"}...
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{"name": "dictations-2025_09_17_145637 {"name": "dictations-2025_09_17_145637.pdf", "content_type": "application/octet-stream", "size": 45023, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-7ed858f5-1992-4c25-864f-73abcc3679e2"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel:4038797911 Fax:4038797899\n17 September 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\nA43819\n\u00a0\nAamir, Rabbiya\n\u00a0\nFax:\u00a0 \u00a0 \u00a0\n\u00a0\nRE:\u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 666777888\nDOB:\u00a0\u00a012 December 2025\n\u00a0\nDear Dr.Aamir, Rabbiya\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nF denies chest pains/classic exertional chest pains or with emotional stress. There is non-specific\nshortness of breath on increased exertion without pedal edema, orthopnea or PND. There is no\npalpitations, pre-syncope, syncope or claudication. There are no calf pain tenderness or redness, calf\nswelling, hormones like birth control, injury, surgery, immobilization or cancer.\u00a0\n\u00a0\nCARDIAC RISK FACTORS and PAST MEDICAL HISTORY:\nNo Diabetes with A1C\nNo Hypertension with BP today -\u00a0 mmHg\nNo Dyslipidemia with LDL mmol/L\nNo Obesity with BMI kg/m2\n\u00a0\nMEDICATIONS:sdcsb\n-\nALLERGIES:ver\nNKDA\nFAMILY HISTORY:v3q\nNo family history of premature heart disease or stroke (M-55 and women 65) in first degree relatives. No\nsudden cardiac/unexpected death in extended family\n\u00a0\nSOCIAL HISTORY:\nThe patient is a non-smoker.\u00a0F\u00a0drinks socially and denies illicit substances.\n\u00a0\nPHYSICAL EXAMINATION:\nThe patient looks well and in no distress. Blood pressure: - Heart Rate: - JVP was normal Pedal radial and\ncarotid pulses are normal and there is no pedal edema. Heart sounds are normal without any murmurs\nLungs were clear.\n\u00a0\nINVE STIGATIONS:\nECG in the clinic revealed normal sinus rhythm with no evidence of acute ischemia.\nStress Test\u00a0o file shows no high risk findings at minutes on the Bruce protocol\nEchocardiogram on file shows no gross pathology influencing clinical magement\nName: Div Kash | PHN: 666777888 | DOB: 12 Dec, 2025\nPage 1 of 2 Carotid ultrasound on file shows mild or moderate disease\nMPI on file shows overall normal study\nHolter shows overall reassuring findings\n24 hour BP monitor reasonable control\nCXR on file shows no gross cardio respiratory pathology\nAngiogram on file shows no critical disease with no LM and no pLAD lesions of significance\nAbdominal imaging shows atherosclerosis of the abdo aorta without aneurysm\nBlood work shows eGFR TSH ACR Hemoglobin\n\u00a0\nIMPRESSION and PLAN\nThis 0 year old\u00a0female\u00a0\u00a0with risk factors as above is presenting with non-specific symptoms. I have\narranged a stress test. On the whole I feel that the cardiac prognosis is reassuring. For the long run, I\ncounselled with regards to ongoing diet exercise and weight loss strategies for ongoing risk reduction\nand improved quality of life\n\u00a0\nI discussed smoking cessation and\n\u00a0\nI will follow-up with Div after the above tests.\n\u00a0\nIn the meantime if there is any questions or concerns please do not hesitate to contact me at any time.\n\u00a0\nYours\u00a0Sincerely,\u00a0\nDr.\u00a0Ravi\u00a0Varshney,\u00a0MD,\u00a0FRCPC\u00a0\nCardiologist\u00a0\nRV/\n\u00a0\n\u00a0\nDictation\u00a0file:\u00a0Varshney\u00a0\n\u00a0\nDICTATED\u00a0BUT\u00a0NOT\u00a0READ\u00a0TO\u00a0AVOID\u00a0DELAY\u00a0\n\u00a0\n\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the reader of\nthis message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this\ncommunication or any of its contents is strictly prohibited. If you received this communication in error, Please return it to the sender\nand contact Advanced Cardiology 403-235-4109.\nPage 2 of 2\nName: Div Kash | PHN: 666777888 | DOB: 12 Dec, 2025"}...
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{"name": "dictations-2025_12_29_140218 {"name": "dictations-2025_12_29_140218.pdf", "content_type": "application/octet-stream", "size": 77328, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-4d42390a-a3d3-412b-aa9a-11b78e893208"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A43819\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 5787888787\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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{"name": "dictations-2025_12_29_143531 {"name": "dictations-2025_12_29_143531.pdf", "content_type": "application/octet-stream", "size": 79316, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-48a825e7-c2d8-44c4-b8e7-4cfed5e752e9"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\n\u00a0\nDr. David White\nFax:\u00a0 4032354147\n\u00a0\nRE:\u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 57878887871\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. White\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nHe/She is a 27-year-old\n\u00a0\nPAST MEDICAL HISTORY:\nHis/Her past medical history is significant for\n\u00a0\nMEDICATIONS:\n\u00a0\nPHYSICAL EXAMINATION:\nOn examination, blood pressure was mmHg with a heart rate of beats per minute. JVP was normal with normal\nS1, S2, no evidence of S3, S4 or any murmurs Lungs were clear. Abdomen nontender. Legs did not reveal any\nevidence of edema.\n\u00a0\nECG:\nECG in the clinic revealed normal sinus rhythm with no evidence of ischemia.\n\u00a0\nEXERCISE STRESS TEST:\n\u00a0\nIMPRESSION:\n\u00a0\nThank you again.\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\nDr. Anmol S. Kapoor, MD, FRCPC\nCardiologist\nASK/pjd\u00a0\n\u00a0\nDictation file: Anmol\u00a0\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nPHN / ULI: 57878887871 Report Date: 12/29/2025Page 1 of 2 Information contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 2 of 2 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_142633.pdf
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{"name": "dictations-2025_12_29_142633 {"name": "dictations-2025_12_29_142633.pdf", "content_type": "application/octet-stream", "size": 81645, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-627809f8-34a1-4b4e-9931-9fbe369c3a04"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\n\u00a0\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 A4381909\n\u00a0\nDavid White\nFax: 4032354147\n\u00a0\nRE:\u00a0 \u00a0 Div Kash\nPHN:\u00a0 57878887871\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. White\n\u00a0\nReason for referral:\n1. \u00a0\nHistory of Presenting Illness:\n\u00a0\nPast Medical History:\n1. \u00a0\nMedications:\n1. \u00a0\nFamily History:\n\u00a0\nSocial History:\n\u00a0\nAllergies:\n\u00a0\nPast Surgical History:\n\u00a0\nExamination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\nCardiovascular Examination - normal heart sounds, no murmurs.\nRespiratory Examination - normal breath sounds, no added sounds.\nAbdominal Examination - soft, non-tender, no organomegaly.\nFeet Examination - bilateral normal pulses, normal 10g monofilament, normal vibration sense.\n\u00a0\nInvestigations:\n1. \u00a0\nPHN / ULI: 57878887871 Report Date: 12/29/2025Page 1 of 2 Assessment and Plan:\n1. \u00a0\n\u00a0\nFollow Up:\n\u00a0\n\u00a0\nPlease do not hesitate to contact me if there are any queries.\u00a0\n\u00a0\nBest regards,\n\u00a0\nFaisal\n\u00a0\nDr Faisal Hasan, MD,\u00a0MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/pjd\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nPage 2 of 2 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_140510.pdf
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{"name": "dictations-2025_12_29_140510 {"name": "dictations-2025_12_29_140510.pdf", "content_type": "application/octet-stream", "size": 81653, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-4f1f1e01-a5cb-422f-9c3e-7f5185be6f6d"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\n\u00a0\n23 December 2025\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 A4381909\n\u00a0\nDavid White\nFax: 4032354147\n\u00a0\nRE:\u00a0 \u00a0 Div Kash\nPHN:\u00a0 57878887871\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. White\n\u00a0\nReason for referral:\n1. \u00a0\nHistory of Presenting Illness:\n\u00a0\nPast Medical History:\n1. \u00a0\nMedications:\n1. \u00a0\nFamily History:\n\u00a0\nSocial History:\n\u00a0\nAllergies:\n\u00a0\nPast Surgical History:\n\u00a0\nExamination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\nCardiovascular Examination - normal heart sounds, no murmurs.\nRespiratory Examination - normal breath sounds, no added sounds.\nAbdominal Examination - soft, non-tender, no organomegaly.\nFeet Examination - bilateral normal pulses, normal 10g monofilament, normal vibration sense.\n\u00a0\nInvestigations:\n1. \u00a0\nPHN / ULI: 57878887871 Report Date: 12/29/2025Page 1 of 2 Assessment and Plan:\n1. \u00a0\n\u00a0\nFollow Up:\n\u00a0\n\u00a0\nPlease do not hesitate to contact me if there are any queries.\u00a0\n\u00a0\nBest regards,\n\u00a0\nFaisal\n\u00a0\nDr Faisal Hasan, MD,\u00a0MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/pjd\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nPage 2 of 2 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_141129.pdf
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{"name": "dictations-2025_12_29_141129 {"name": "dictations-2025_12_29_141129.pdf", "content_type": "application/octet-stream", "size": 76941, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-5222d7e7-5a71-493f-be97-ee87f000174c"}...
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f77e4fd444eb5af30890c34e38d68957c111c92b2825867349 f77e4fd444eb5af30890c34e38d68957c111c92b2825867349bb3701b46189d4...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 57878887871\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_140841.pdf
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{"name": "dictations-2025_12_29_140841 {"name": "dictations-2025_12_29_140841.pdf", "content_type": "application/octet-stream", "size": 76941, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-417e22c8-5dd1-47fa-897b-dfa178ff6ff6"}...
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f77e4fd444eb5af30890c34e38d68957c111c92b2825867349 f77e4fd444eb5af30890c34e38d68957c111c92b2825867349bb3701b46189d4...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 57878887871\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_140737.pdf
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{"name": "dictations-2025_12_29_140737 {"name": "dictations-2025_12_29_140737.pdf", "content_type": "application/octet-stream", "size": 76942, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-8a131cad-5caa-4411-8476-2b4259d9eac2"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 57878887871\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 57878887871\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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dictations-2025_12_29_140418.pdf
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 12/29/25 Chart No: A4381909\nDavid White\nSAIT\nFax: 4032354147\n\u00a0\nRE: Div Kash\nPHN: 57878887871\nDOB: 1998-12-11\nGender: MALE\n\u00a0\nDear Dr. White,\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nYours Sincerely,\n\u00a0\n\u00a0\nDictation file: Super Admin\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the recipient(s). If the\nreader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or\ncopying of this communication or any of its contents is strictly prohibited. If you received this communication in error,\nPlease return it to the sender and contact Advanced Cardiology 403-235-4109.\nPage 1 of 1 PHN / ULI: 57878887871 Report Date: 12/29/2025"}...
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{"name": "dictations-2026_01_20_110105 {"name": "dictations-2026_01_20_110105.pdf", "content_type": "application/octet-stream", "size": 94631, "data": {"patient_id": "b3e7cc30-1ba8-11f0-b706-c183bb9a9165"}, "collection_name": "file-e2347fec-69af-45ea-912a-efa7df9adf90"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 01/20/26 Chart No: A4381909\n\u00a0\nDr. Ted Mequanent\nSanti med family clinic 3449 26 ave NE\u00a0\nFax:\u00a0 \u00a0 \u00a04036481926\n\u00a0\nRE:\u00a0 \u00a0 \u00a0 \u00a0Div Kash\nPHN:\u00a0 578788878\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. Mequanent\n\u00a0\nThank you very much for allowing me to participate in Div's care.\n\u00a0\nCHIEF COMPLAINT:\n\u00a0\nHISTORY OF PRESENT ILLNESS:\n\u00a0\nREVIEW OF SYSTEMS:\nNo chest pain. No shortness of breath. No numbness. No tingling. No dyspnea on exertion. No chest pain on\nexertion. No nausea. No vomiting. No diarrhea. No fevers. No abdominal pain. No numbness. No tingling. No\nlightheadedness. No dizziness. No melena. No bright red blood per rectum. No cough. No fevers. No chills. No\nheadaches. No orthopnea. No PND. No peripheral edema. No palpitations. No syncope. No snoring. No change in\nvision. No change in hearing. No change in bowel or urinary habits. No excessive weight loss. No bleeding\ndisorders. No night sweats. No lethargy No fatigue. No arthralgias. No skin changes. No change in gait\n\u00a0\nPAST MEDICAL HISTORY:\n\u00a0\nPAST SURGICAL HISTORY:\n\u00a0\nFAMILY HISTORY:\n\u00a0\nSOCIAL HISTORY:\n\u00a0\nALLERGIES:\n\u00a0\nMEDICATIONS:\n\u00a0\nPHYSICAL EXAMINATION:\nThe patient is awake, alert, oriented x 3 and is in no acute distress.\nVitals:\nHEENT: Pupil equal, round and reactive to light. Extraocular movements are intact. Conjunctivae is clear. No\nscleral icterus. Lips are without lesions. Oropharynx is clear.\nNeck: Trachea is midline. No JVD. No carotid bruits. No thyromegaly. No lymphadenopathy. No neck masses.\nLungs: Clear to auscultation bilaterally. No crackles. No wheezes. No rhonchi\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 1 of 4 Heart: Normal S1 S2. Regular rate and rhythm. No peripheral edema. No murmurs. Bilateral radial pulse is\npalpable, equal and within normal limits.\nAbdomen: Soft, nontender, nondistended, bowel sounds positive, no organomegaly.\nNeurological exam: Cranial nerves lil to XII are grossly intact. No focal deficits. Strength is 5/5 in all four\nextremities. Normal gait.\n\u00a0\nINVESTIGATIONS:\n\u00a0\nASSESSMENT AND PLAN: I\n\u00a0\nPatient will continue to follow up regularly with their primary care physician\nIf you have any further questions please do not hesitate to contact us I would like to thank you for allowing me to\nparticipate in the care of this patient\n\u00a0\nYours Sincerely,\nDr. Lovpreet Mangat, MD, FRCPC\nInternal Medicine\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n2.\n\u00a0\nDate: 20 January 2026\n\u00a0\nRef: Kishwar Azmi\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0237431\n8 Saddletree Close NE\n\u00a0\nTo Whom It May Concern (Airport/Border Authority):\n\u00a0\nKishwar Azmi underwent a diagnostic examination with Advanced Cardiology Consultants and Diagnostics on 20\nJanuary 2026\n\u00a0\nThis examination was a Nuclear Medicine Cardiac Scan which involved an injection of a radiopharmaceutical with\na diagnostic dose of 750 MBq (20 mCi) of 99mTc-Tetrofosmin.\n\u00a0\nThis radiopharmaceutical dose will decay within the body over the next 1-2 weeks and may be detectable with\nradiation survey meters during this time period.\n\u00a0\nAs mentioned above, this is a diagnostic dose, therefore not a risk of exposure to the public.\n\u00a0\nIf you have any questions or concerns, you can contact the Radiation Safety Officer listed below.\n\u00a0\nRegards,\n\u00a0\n______________________________________MRT(NM)\n\u00a0\nAdvanced Cardiology Consultants and Diagnostics Inc.\nBrenda Le RT(NM)\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 2 of 4 Nuclear Medicine Technologist & Radiation Safety Officer\nT: 403.235.4109 ext 305\nE: ble@cardiai.com\n\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-879-\n7911.\n3.\u00a0\n\u00a0\n20 January 2026\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\n\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 237431\n\u00a0\nDr.\n\u00a0\nFax\n\u00a0\nRE:\u00a0 Kishwar Azmi\nPHN: 415397490\nDOB: 28 December 1967\n\u00a0\nDear Dr.\n\u00a0\nThank you very much for allowing me to assess a very pleasant 58 year old - with regards to cardiac assessment.\n\u00a0\n- denies chest pains/classic exertional chest pains or with emotional stress. There is non-specific shortness of\nbreath on increased exertion without pedal edema, orthopnea or PND. There is no palpitations, pre-syncope,\nsyncope or claudication. There are no hormones like birth control, calf swelling, calf pain tenderness or redness,\nrecent injury, surgery, immobilization or cancer.\n\u00a0\nCARDIAC RISK FACTORS and PAST MEDICAL HISTORY:\nDiabetes with A1C\nHypertension with BP today - mmHg\nDyslipidemia with LDL mmol/L\nObesity with BMI kg/m2\n\u00a0\nMEDICATIONS:\n-\n\u00a0\nALLERGIES:\nNKDA\n\u00a0\nFAMILY HISTORY:\nNo family history of premature heart disease or stroke (M< 55 and women < 65) in first-degree relatives. No\nsudden cardiac/unexpected death in extended family.\n\u00a0\nSOCIAL HISTORY:\nThe patient is an ongoing smoker - drinks socially and denies illicit substances.\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 3 of 4 PHYSICAL EXAMINATION:\nThe patient looks well and in no distress. Blood pressure: -, Heart Rate: - JVP was normal. Pedal radial and carotid\npulses are normal and there is no pedal edema. Heart sounds are normal without any murmurs.\u00a0\nLungs were clear.\n\u00a0\nINVE STIGATIONS:\nECG in the clinic revealed normal sinus rhythm with no evidence of acute ischemia.\nStress Test on file shows no high risk findings at minutes on the Bruce protocol\nEchocardiogramon file shows no gross pathology influencing clinical magement\nCarotid ultrasound on file shows mild or moderate disease\nMPI on file shows overall normal study\nHolter shows overall reassuring findings\n24 hour BP monitor reasonable control\nCXR on file shows no gross cardio-respiratory pathology\nAngiogram on file shows no critical disease with no LM and no pLAD lesions of significance\nAbdominal imaging shows atherosclerosis of the abdo aorta without aneurysm\nBlood work shows eGFR TSH ACR Hemoglobin\n\u00a0\nIMPRESSION and PLAN:\n\u00a0\nThis 58 year old female with risk factors as above is presenting with non-specific symptoms. I have arranged a\nstress test. On the whole I feel that the cardiac prognosis is reassuring. For the long run, I counselled with\nregards to ongoing diet, exercise and weight loss strategies for ongoing risk reduction and improved quality of\nlife.\n\u00a0\nI discussed smoking cessation and\n\u00a0\nI will follow-up with Kishwar after the above tests.\n\u00a0\nIn the meantime if there is any questions or concerns please do not hesitate to contact me at any time.\n\u00a0\nYours Sincerely,\nDr.\u00a0Ravi\u00a0Varshney,\u00a0MD,\u00a0FRCPC\u00a0\nCardiologist\u00a0\nRV/\n\u00a0\n\u00a0\nDictation\u00a0file:\u00a0Varshney\u00a0\n\u00a0\nDICTATED\u00a0BUT\u00a0NOT\u00a0READ\u00a0TO\u00a0AVOID\u00a0DELAY\u00a0\n\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 4 of 4 PHN / ULI: 578788878 Report Date: 01/20/2026"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 01/20/26 Chart No: A4381909\nDr. Ted Mequanent\nFax: 4036481926\n\u00a0\nRE:\u00a0 \u00a0 Div Kash\nPHN:\u00a0 578788878\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. Mequanent\n\u00a0\nProfile:\n1. \u00a0\nMedication List:\n1. \u00a0\nAllergies:\n\u00a0\n\u00a0\nMany thanks for your consideration.\n\u00a0\nSincerely yours,\nDr. Faisal Hasan, MD, MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/\n\u00a0\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nA4381909\u00a0\u00a0\u00a0 Date: 20 January 2026\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\n2.\n\u00a0\n20 January 2026\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 237431\n\u00a0\nDr.\nFax:\n\u00a0\nRE:\u00a0 \u00a0 Kishwar Azmi\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 1 of 4 PHN:\u00a0 415397490\nDOB:\u00a0\u00a028 December 1967\n\u00a0\nDear Dr.\n\u00a0\nReason for referral:\n1. \u00a0\nHistory of Presenting Illness:\n\u00a0\nPast Medical History:\n1. \u00a0\nMedications:\n1. \u00a0\nFamily History:\n\u00a0\nSocial History:\n\u00a0\nAllergies:\n\u00a0\nPast Surgical History:\n\u00a0\nExamination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\nCardiovascular Examination - normal heart sounds, no murmurs.\nRespiratory Examination - normal breath sounds, no added sounds.\nAbdominal Examination - soft, non-tender, no organomegaly.\nFeet Examination - bilateral normal pulses, normal 10g monofilament, normal vibration sense.\n\u00a0\nInvestigations:\n1. \u00a0\nAssessment and Plan:\n1. \u00a0\n\u00a0\nFollow Up:\n\u00a0\n\u00a0\nPlease do not hesitate to contact me if there are any queries.\u00a0\n\u00a0\nBest regards,\n\u00a0\nFaisal\n\u00a0\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 2 of 4 Dr Faisal Hasan, MD,\u00a0MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/pjd\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n\u00a0\n\u00a0\n3.\n\u00a0\n20 January 2026\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0237431\n\u00a0\nDr.\nFax:\n\u00a0\nRE:\u00a0 \u00a0 Kishwar Azmi\nPHN:\u00a0 415397490\nDOB:\u00a0\u00a028 December 1967\n\u00a0\nDear Dr.\n\u00a0\nProfile:\n1. \u00a0\nCurrent Medications:\n1. \u00a0\nFollow Up Visit:\n\u00a0\nPhysical Examination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\n\u00a0\n\u00a0\nInvestigations:\n1. \u00a0\nCare Plan:\n1. \u00a0\nFollow Up:\n\u00a0\nPlease do not hesitate to contact me if there any queries.\u00a0\n\u00a0\nSincerely yours,\n\u00a0\nDr. Faisal Hasan, MD, MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 3 of 4 FH/pjd\u00a0\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\nPage 4 of 4 PHN / ULI: 578788878 Report Date: 01/20/2026"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 01/20/26 Chart No: A4381909\nDr. Ted Mequanent\nFax: 4036481926\n\u00a0\nRE:\u00a0 \u00a0 Div Kash\nPHN:\u00a0 578788878\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. Mequanent\n\u00a0\nProfile:\n1. \u00a0\nMedication List:\n1. \u00a0\nAllergies:\n\u00a0\n\u00a0\nMany thanks for your consideration.\n\u00a0\nSincerely yours,\nDr. Faisal Hasan, MD, MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/\n\u00a0\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nA4381909\u00a0\u00a0\u00a0 Date: 20 January 2026\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\n2.\n\u00a0\n20 January 2026\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 237431\n\u00a0\nDr.\nFax:\n\u00a0\nRE:\u00a0 \u00a0 Kishwar Azmi\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 1 of 3 PHN:\u00a0 415397490\nDOB:\u00a0\u00a028 December 1967\n\u00a0\nDear Dr.\n\u00a0\nReason for referral:\n1. \u00a0\nHistory of Presenting Illness:\n\u00a0\nPast Medical History:\n1. \u00a0\nMedications:\n1. \u00a0\nFamily History:\n\u00a0\nSocial History:\n\u00a0\nAllergies:\n\u00a0\nPast Surgical History:\n\u00a0\nExamination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\nCardiovascular Examination - normal heart sounds, no murmurs.\nRespiratory Examination - normal breath sounds, no added sounds.\nAbdominal Examination - soft, non-tender, no organomegaly.\nFeet Examination - bilateral normal pulses, normal 10g monofilament, normal vibration sense.\n\u00a0\nInvestigations:\n1. \u00a0\nAssessment and Plan:\n1. \u00a0\n\u00a0\nFollow Up:\n\u00a0\n\u00a0\nPlease do not hesitate to contact me if there are any queries.\u00a0\n\u00a0\nBest regards,\n\u00a0\nFaisal\n\u00a0\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 2 of 3 Dr Faisal Hasan, MD,\u00a0MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/pjd\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nPage 3 of 3 PHN / ULI: 578788878 Report Date: 01/20/2026"}...
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{"status": "completed", "conte {"status": "completed", "content": "8500 Blackfoot Trl SE #250\nCalgary, AB, T2J 7E1\nTel: 4038797911 | Fax: 4038797899\nDate 01/20/26 Chart No: A4381909\nDr. Ted Mequanent\nFax: 4036481926\n\u00a0\nRE:\u00a0 \u00a0 Div Kash\nPHN:\u00a0 578788878\nDOB:\u00a0\u00a011 December 1998\n\u00a0\nDear Dr. Mequanent\n\u00a0\nProfile:\n1. \u00a0\nMedication List:\n1. \u00a0\nAllergies:\n\u00a0\n\u00a0\nMany thanks for your consideration.\n\u00a0\nSincerely yours,\nDr. Faisal Hasan, MD, MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/\n\u00a0\n\u00a0\nDICTATED BUT NOT READ TO AVOID DELAY\n\u00a0\nA4381909\u00a0\u00a0\u00a0 Date: 20 January 2026\n\u00a0\nInformation contained in this communication may be confidential and is intended only for the use of the\nrecipient(s). If the reader of this message is not the intended recipient, you are hereby notified that any\ndissemination, distribution, or copying of this communication or any of its contents is strictly prohibited. If you\nreceived this communication in error, Please return it to the sender and contact Advanced Cardiology 403-235-\n4109.\n2.\n\u00a0\n20 January 2026\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 237431\n\u00a0\nDr.\nFax:\n\u00a0\nRE:\u00a0 \u00a0 Kishwar Azmi\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 1 of 3 PHN:\u00a0 415397490\nDOB:\u00a0\u00a028 December 1967\n\u00a0\nDear Dr.\n\u00a0\nReason for referral:\n1. \u00a0\nHistory of Presenting Illness:\n\u00a0\nPast Medical History:\n1. \u00a0\nMedications:\n1. \u00a0\nFamily History:\n\u00a0\nSocial History:\n\u00a0\nAllergies:\n\u00a0\nPast Surgical History:\n\u00a0\nExamination:\nBlood pressure:\nHeight: cm.\nWeight: kg.\nBMI:\nCardiovascular Examination - normal heart sounds, no murmurs.\nRespiratory Examination - normal breath sounds, no added sounds.\nAbdominal Examination - soft, non-tender, no organomegaly.\nFeet Examination - bilateral normal pulses, normal 10g monofilament, normal vibration sense.\n\u00a0\nInvestigations:\n1. \u00a0\nAssessment and Plan:\n1. \u00a0\n\u00a0\nFollow Up:\n\u00a0\n\u00a0\nPlease do not hesitate to contact me if there are any queries.\u00a0\n\u00a0\nBest regards,\n\u00a0\nFaisal\n\u00a0\nPHN / ULI: 578788878 Report Date: 01/20/2026Page 2 of 3 Dr Faisal Hasan, MD,\u00a0MRCP (UK), MRCP (Diabetes and Endocrinology)\nEndocrinologist\nFH/pjd\u00a0\nInformation\u00a0contained\u00a0in\u00a0this\u00a0communication\u00a0may\u00a0be\u00a0confidential\u00a0and\u00a0is\u00a0intended\u00a0only\u00a0for\u00a0the\u00a0use\u00a0of\u00a0the\u00a0recipient(s).\u00a0If\u00a0the\u00a0reader\u00a0of\u00a0this\u00a0message\u00a0is\u00a0not\u00a0the\u00a0intended\u00a0recipient,\u00a0you\u00a0are\u00a0hereby\u00a0notified\u00a0that\u00a0any\u00a0dissemination,\u00a0distribution,\u00a0or\u00a0copying\u00a0of\u00a0this\u00a0communication\u00a0or\u00a0any\u00a0of\u00a0its\u00a0contents\u00a0is\u00a0strictly\u00a0prohibited.\u00a0If\u00a0you\u00a0received\u00a0this\u00a0communication\u00a0in\u00a0error,\u00a0Please\u00a0return\u00a0it\u00a0to\u00a0the\u00a0sender\u00a0and\u00a0contact\u00a0Advanced\u00a0Cardiology\u00a0403-\n235-4109.\n\u00a0\n\u00a0\n\u00a0\n\u00a0\nPage 3 of 3 PHN / ULI: 578788878 Report Date: 01/20/2026"}...
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