IAL IDENT F N O C Page 1 of 1
Survey Comparison Report SAMPLE REPORT
iPlanet Health 11701 Lake Victoria Gardens Ave Suite 7108 Palm Beach Gardens, FL 33410 561-337-9435 iplanethealth@gmail.com www.iplanethealthoffice.com
For Patient: Codio, Mirlene .
Doctor: Ward Hale, AP
Survey 02/03/2012
Group Description
Survey
Survey Survey Score (0 to 1000) Score 0
(Higher is better)
500
1000
678 Group Score
1
Sympathetic Dominance
02/03/2012
21
2
Parasympathetic Dominance
02/03/2012
13
3
Sugar Handling
02/03/2012
34
4
Cardiovascular
02/03/2012
1
5
Biliary and Liver Dysfunction
02/03/2012
63
6
Digestive
02/03/2012
96
7
Endocrine
02/03/2012
0
7a
Endocrine - Hyperthyroid
02/03/2012
1
7b
Endocrine - Hypothyroid
02/03/2012
42
7c
Endocrine - Hyperpituitary
02/03/2012
1
7d
Endocrine - Hypopituitary
02/03/2012
10
7e
Endocrine - Hyperadrenal
02/03/2012
1
7f
Endocrine - Hypoadrenal
02/03/2012
14
8
Foundational Issues
02/03/2012
29
F
Female
02/03/2012
31
Percent of Highest Score 0%
(Lower is better)
50%
Report created by Systems Survey Maestro v6.51 - Copyright (c) 2002-2011 Greene Software. All rights reserved. Licensed to: E. Ward Hale
100%
These are your functional stress findings based on this survey
Printed on:
2/20/2012
In your Systems Review each system exhibiting functional stress will be explained in this fashion . Page 1 of 9
Patient Group Descriptions iPlanet Health 11701 Lake Victoria Gardens Ave Suite 7108 Palm Beach Gardens, FL 33410 561-337-9435 iplanethealth@gmail.com www.iplanethealthoffice.com
. For Patient: Codio, Mirlene
Survey Date: 2/3/2012
Doctor: Ward Hale, AP
Group:
6
Next Visit (4 Weeks):
Digestive
Primary indicators of Digestive symptoms from your Systems Survey form are: (99) Lower bowel gas several hours after eating
(102) Pass large amounts of foul-smelling gas
(103) Indigestion 1/2 - 1 hour after eating; may be up to 3-4 hrs
(104) Mucous colitis or "irritable bowel"
(105) Gas shortly after eating
(106) Stomach "bloating" after eating
Secondary (underlying) indicators of Digestive symptoms from your Systems Survey form are: (1) Acid food upset
(20) Sour stomach often
(27) Indigestion soon after meals
(93) Bad breath (halitosis)
(143) Bloating of abdomen
(164) Bowel disorders
Report created by Systems Survey Maestro v6.51 - Copyright (c) 2002-2011 Greene Software. All rights reserved. Licensed to: E. Ward Hale
Printed on:
2/20/2012
Page 1 of 1
Patient Supplement Schedule Please Post This On Your Refrigerator For Patient: .Codio, Mirlene
Survey Date: 2/3/2012
Doctor: Ward Hale, AP
Next Visit (4 Weeks): Upon Arising
Supplement
Breakfast
10 am
Lunch
3 pm
Dinner
A-F Betafood® ..........................
2
2
2
Catalyn® ................................
2
2
2
Symplex® F .............................
1
1
1
Zypan® ...................................
2
2
2
Before Sleep
7 pm
Supplement Descriptions: A-F Betafood® Supports Gall Bladder and Liver function and supports Thyroid function. Relieves fat digestion problems and helps fight sweet cravings. Should be used with caution when gall stones are present or suspect. Catalyn® High concentration of multiple vitamin factors used to support repair and healing for long-term conditions. Used for supplementing highly refined diets, lowered resistance, and to speed action of other nutritional supplements. Symplex® F Combination of Thyroid, Adrenal, Pituitary, and Ovary support factors for general female glandular support. Zypan® Supports Digestive and Pancreas function. Assists with digestion and absorption of nutrients and minerals found in diet, and can assist to relieve digestive discomfort due to dietary imbalance. Clinician Notes:
iPlanet Health 11701 Lake Victoria Gardens Ave Suite 7108 Palm Beach Gardens, FL 33410 561-337-9435 iplanethealth@gmail.com www.iplanethealthoffice.com
APPROVED
By Ward at 7:18 am, 2/21/12
Authorizing Signature E. Ward Hale Not Valid Unless Signed By a Qualified Doctor
Report created by Systems Survey Maestro v6.51 - Copyright (c) 2002-2011 Greene Software. All rights reserved. Licensed to: E. Ward Hale
Date
Printed on:
2/20/2012
Note: This protocol is being provided for educational purposes. A final protocol will be decided upon based on other findings and further consultation.
. Page 1 of 1
Patient Score Sheet iPlanet Health 11701 Lake Victoria Gardens Ave Suite 7108 Palm Beach Gardens, FL 33410 561-337-9435 iplanethealth@gmail.com www.iplanethealthoffice.com
For Patient: .Codio, Mirlene Doctor: Ward Hale, AP
Your Survey Score: 678 (0-1000, where 1000 is a perfect score)
Survey Date: 2/3/2012 Next Visit (4 Weeks):
Group Totals Group Percent of Score Group Score
Group Description 6 5 7b 3 F 8 1 7f 2 7d 7a 7c 7e 4
Digestive Biliary and Liver Dysfunction Endocrine - Hypothyroid Sugar Handling Female Foundational Issues Sympathetic Dominance Endocrine - Hypoadrenal Parasympathetic Dominance Endocrine - Hypopituitary Endocrine - Hyperthyroid Endocrine - Hyperpituitary Endocrine - Hyperadrenal Cardiovascular
96 63 42 34 31 29 21 14 13 10 1 1 1 1
27% 18% 12% 10% 9% 8% 6% 4% 4% 3%
Adjusted Ranking
0%
50%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
357
A cost breakdown is provided for your convenience
Supplements - Costs and Quantities (for a 1 day supply)
Supplement A-F Betafood速 Catalyn速 Symplex速 F Zypan速
Product Code 0775 2140 7780 8475
Daily ---------------Costs Per-------------# of Dosage Day Week Month Bottles 6 6 3 6
$0.83 $0.70 $0.57 $0.83
$5.83 $4.90 $3.97 $5.83
$25.00 $21.00 $17.00 $25.00
1 1 1 1
21
$2.93
$20.53
$88.00
4
Bottle Size 90 90 90 90
Unit Price
Total Price
$12.50 $10.50 $17.00 $12.50
$12.50 $10.50 $17.00 $12.50 $52.50
This is a whole food based suggested protocol using whole food concentrate products that have been used in clinical nutrition practices for decades. These products have a long track record of use. These are foundational products for supporting function and repleting deficiency in the body. However, this is but one Report created by Systems Survey Maestro v6.51 - Copyright (c) 2002-2011 Greene Software. All rights reserved. Printed on: 2/20/2012 approach. Licensed to: E. Ward Hale WE offer other approaches as well based on European remedies and much more. We can further personalize a great wellness protocol designed to suit your personal tastes! Please contact us for more information and further consultation.
Findings on your survey that should be brought to the attention of your family doctor Page 1 of 1 .
Clinician Warnings iPlanet Health 11701 Lake Victoria Gardens Ave Suite 7108 Palm Beach Gardens, FL 33410 561-337-9435 iplanethealth@gmail.com www.iplanethealthoffice.com
1st priority
For Patient: .Codio, Mirlene
Survey Date: 2/3/2012
Doctor: Ward Hale, AP
Next Visit (4 Weeks):
The following questions, answered by the patient, need to be reviewed by the family Clinician for possible medical conditions: . Question
Answer
54
3
Question Text
physician
Please consult with your family doctor about this finding.
Moods of depression - "blues" or melancholy
The following recommended supplements have cautions and/or contraindications: Note: This is not necessarily a complete and exhaustive report of all potential cautions and contraindications. Please use all reference materials available for the products being recommended regarding cautions, potential adverse reactions and interactions with drugs. Supplement
Cautions and Contraindications
Zypan速
Special Information: Chewing this product is not recommended.
Report created by Systems Survey Maestro v6.51 - Copyright (c) 2002-2011 Greene Software. All rights reserved. Licensed to: E. Ward Hale
Printed on:
2/20/2012