October 13, 2015

RE:

B.L. Letter of Medical Necessity

Dr. Shara Pajarillaga

1112 East Tower
St. Lukes Medical Center, Quezon City
Dear Dr. Cruz,
I am respectfully referring Ms. B.L. for management of her asthma. She came in complaining about increasing
exacerbations of asthma. She reports that she increases the frequency of her fluticasone MDI, salmeterol MDI, and
albuterol MDI to four to five times/day when she has a flare-up.
Co-Morbids are as follows:
Type 2 Diabetes (2005); controlled with insulin, ; rosiglitazone 4 mg daily
Hypertension; controlled with diltiazem 180 mg daily
Hyperlipidemia; managed with fluvastatin 20 mg at bedtime
Bronchial asthma; managed with fluticasone metered dose inhaler, two puffs twice a day; salmeterol MDI two puffs
twice a day, albuterol MDI two to four puffs every 46 hours for shortness of breath (as needed)
The patient already underwent a knee replacement surgery (2012) and is also allergic to penicillin.
Attached herewith is the copy of her laboratory results including a limited physical exam during our consult.
If you have any further questions you may email me at jowi.cruz@dlsu.edu.ph. Thank you and more power!
Jowi Tsidkenu Cruz M.D., J.D.
Main Building, Medical Arts, 2E
The Johns Hopkins Hospital

PHYSICAL EXAMINATION
General. Patient is not in cardiorespiratory distress.
Vital Signs.
Pulse Rate: 88 bpm; regular
Anthropometric
(normal)
Measurements:
Respiratory Rate: 22; (normal)
Height: 511
Blood Pressure: 130/78 mmHg
Weight: 192 lbs
(elevated)
BMI: 36.3 (Obese II)
Thorax and Lungs. Clear to auscultation bilaterally without wheezing, rales, or
rhonchi.
LABORATORY FINDINGS

Hemoglobin
A1c(A1C)
Creatinine
Blood urea nitrogen
Total cholesterol
HDL cholesterol

Laboratory
Results
7.0%

Normal Values

0.7 mg/dl
16 mg/dl
Lipid Panel
211 mg/dl
52 mg/dl

0.71.4 mg/dl
721 mg/dl

LDL cholesterol
(calculated)
Triglycerides

128 mg/dl

Urinary albumin

<30 g/mg

154 mg/dl

Liver Function Test are within normal limits.

Chest X-ray: Unremarkable

<5.9%; target: <7%

<200 mg/dl
3586 mg/dl; target: >55
mg/dl
<130 mg/dl; target: <100
mg/dl
<150 mg/dl; target: <150
mg/dl
<30 g/mg