IBUTM Brokers Report for Brokers Insurance Services


    Case#: / Name: Catherine XXXXXX

    Age: 73 / Gender: Female

    Plan term: UL / Face Amt: 5,000,000

   



Underwriter's Initials:
TMK
(Click for Contact Info)



Brokers Report:

73 y/o female non-smoker. Medical history includes hyperlipidemia, reflux, and osteoporosis Borderline hypertension was also noted in '01-'05, but readings were better in '06. No meds noted for this so far. There were no current BP readings. She apparently had cataract surguries in 12/02 and 10/03, but not clear. Records from Dr Pacropis were illegible, and mainly consisted of various test copies and labwork. The only narrative notes included were from '02 and '03 (visits for surgery clearance), so no good details on overall medical history, although she appears to be doing well. Records from Dr. Smith end 6/07, where it was noted that her last colonoscopy was in '02 (no details on the results), and she was to check with GI doctor on when a repeat is due.

Need current blood pressure readings, names of all meds currently taking, and would obtain GI records. I would also confirm that the surgeries in 12/02 and 10/03 were for cataracts, and obtain copies of narrative notes from office visits over the past 5 yrs from Pacropis (if possible). Case may qualify for preferred rates so far, subject to missing info.





IBUTM Case summary for Brokers Insurance Services


    Case#: / Name: Catherine XXXXXX

    Age: 73 / Gender: Female

    Plan term: UL / Face Amt: 5,000,000

   



Underwriter's Initials:
TMK
(Click for Contact Info)

Case Summary:

Significant History (Briefly list significant Medical History. Also include significant Family History, Foreign Travel, Avocations, Occupations and ADL's)
73 y/o female non-smoker. Medical history includes hyperlipidemia, GERD, and osteoporosis. Some of the records were illegible, so remaining hx (if any) not clear. Borderline hypertension noted in '01-'05, but readings were better in '06. No meds noted for this so far. No current BP readings. She apparently had cataract surguries in 12/02 and 10/03, but not clear. No details on fam hx.

PREFERRED GUIDELINES:
Tobacco non-tobacco
Height/Weight 5'3" 140 lbs
Cholesterol Profile chol 190/4.3, trigs 211 (6/07)
Current Labs Normal?
Regular Medications lipitor, evista, asa
Family History no details
Blood Pressure
(only if not on BP medication)		 no currrent info
Cardiac Tests within 2 years
(50 and over only)		 see below
Normal Stress Test
(with good exercise capacity)
Normal Chest Xray
(within 5 years, 50 and over)
PFT
(within 5 years, 50 and over)

REQUIREMENTS RECEIVED (Include date received):
Hippa Auth
Aps-Dr Smith
Aps-Dr Brown
Aps-Dr Martin

RISK FACTORS SUMMARY:
Hyperlipidemia
GERD
Osteoporosis
Hx of borderline hypertension

DATE: SOURCE: (Include page numbers)
Aps (Dr. Smith) Dr's writing is illegible. Could only make out bits and pieces. Med hx includes GERD, hyperlipidemia and osteoporosis. Any other past med hx is unclear (if any). No good details provided, as chart mainly consisted of copies of labwork, etc. There were only a couple of office visits--one from 12/02, and one from 10/03 ---for surgery clearance---presumably for cataracts, but not clear. Rx nexium in '02. No other details. Records end w/ 6/07 labwork. Ekg p3,15,21,27.

6/07: chol 190/4.3, trigs 211(150), bun/cr 27(22)
8/06: chol 188/3.8
6/05: chol 189/3.7, trigs 152, bun/cr 25(28)
11/04: chol 198/3.6

11/03 & 6/05 paps wnl
Aps (Dr. Brown)OBGYN: Chart was brief--only a few visits from '00 to present. Some of the writing is illegible. Borderline htn mentioned in '01 and '03. No current BP readings, and apparently no meds thus far. Rx prilosec prn in '03. Records end w/ 6/07 visit for routine exam-- no compliants. Exercise 3-4 x per wk. Pap and mammo wnl. 6/07 DEXA revealed borderline osteoporosis of the lumbar spine. Bone mineral density decreased 4.4% since '04 study. Osteopenia both femurs--unchanged on the right ,and decreased 5% on the left. Last colonoscopy 3/02. No details on results. Dr noted plans to confirm w/ GI when she is due for repeat. No further details.

BP: 8/06=120/81, 6/06=131/80,12/05=130/80, 6/05=154/80, 1/03=148/70, 12/01=145/80
Aps (Dr. Martin)Chart was brief---only contained copies of various tests and labwork--nothing beyond '04. No narrative notes included.

5/04 pap wnl
5/04 DEXA: osteopenia lumbar spine and R femur
4/03 mammo wnl