SYNTHETIC RECORD - Example Union Square Medical Partners - Medication History - 2026-06-20
Patient reference SYN-3345.
METHOTREXATE 15 MG PO WEEKLY - status: inactive - start 2026-01-10 - end 2026-05-20 - reason: inadequate response
FOLIC ACID 1 MG PO DAILY - status: inactive - start 2026-01-10
ATORVASTATIN 20 MG PO DAILY - status: active
Physician note
problem_list
SYNTHETIC RECORD - Example Union Square Medical Partners - Problem List Update - 2026-06-25
Patient reference SYN-3345. 63-year-old man.
- Seropositive rheumatoid arthritis, diagnosed 2017, followed at this practice since.
- Methotrexate has never been tried for this patient's joint symptoms; he has relied on acetaminophen alone.
- Hyperlipidemia, managed with a statin.
- Plan: discuss Immunara given the extent of untreated joint involvement.
Fax cover
fax_cover
SYNTHETIC RECORD - Example Union Square Medical Partners - Fax Cover Sheet - 2026-06-28
To: CivicCare Plus Pharmacy Benefits
Re: Prior authorization request for Immunara
Patient reference SYN-3345. Member ID: not provided; the patient's insurance card was not available at the time of this visit. Pages: 1 of 1.