Demographics
DOB: Jun 29, 1980
Sex: F
Status: active
Email: Independent1757@gmail.com
Mobile: 5036074742
Home: 5036074742
Department: WEST SALEM
Primary Provider: Emily Charlton
Last Synced: Jun 17, 2026, 2:13 PM
Address: 11415 SE Stevens Rd, HAPPY VALLEY, OR, 97086-7543
Allergy (3)
| Type | Description | Onset / Date | Status |
|---|---|---|---|
| Allergy | — | — | |
| Allergy | Aug 20, 2015 | — | |
| Allergy | Oct 13, 2003 | — |
Problem (14)
| Type | Description | Onset / Date | Status |
|---|---|---|---|
| Problem | Jun 27, 2024 | — | |
| Problem | Jul 22, 2025 | — | |
| Problem | Jul 22, 2025 | — | |
| Problem | Sep 10, 2025 | — | |
| Problem | Jul 22, 2025 | — | |
| Problem | Sep 17, 2025 | — | |
| Problem | Jul 22, 2025 | — | |
| Problem | Sep 17, 2025 | — | |
| Problem | Dec 31, 2025 | — | |
| Problem | Jul 22, 2025 | — | |
| Problem | Sep 10, 2025 | — | |
| Problem | Jan 30, 2026 | — | |
| Problem | Sep 10, 2025 | — | |
| Problem | Jul 22, 2025 | — |
Vital (7)
| Type | Description | Onset / Date | Status |
|---|---|---|---|
| Vital | Aug 1, 2024 | — | |
| Vital | Jan 30, 2026 | — | |
| Vital | Jan 30, 2026 | — | |
| Vital | Jan 30, 2026 | — | |
| Vital | Aug 1, 2024 | — | |
| Vital | Aug 1, 2024 | — | |
| Vital | Aug 1, 2024 | — |
Well-Life Assistant
File: FORMAN, Angela
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