vault backup: 2026-04-05 17:16:38
This commit is contained in:
Yanxin Lu
BIN
documents/medical/covid/jiang_vaccine_3rd_shot.jpg
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documents/medical/covid/jiang_vaccine_3rd_shot.md
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---
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type: medical-record
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category: vaccination
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person: Jiang Xuewei (Erica)
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date: 2021-11-24
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source: jiang_vaccine_3rd_shot.jpg
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---
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# COVID-19 Vaccination Record Card — Jiang Erica (Xuewei)
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| Field | Value |
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|-------|-------|
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| Last Name | Jiang |
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| First Name | Erica (Xuewei) |
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| MI | — |
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| Date of Birth | 03/13/1993 |
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| Patient Number | — |
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## Vaccination Records
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| Dose | Vaccine | Product Name/Manufacturer | Lot Number | Date | Healthcare Professional or Clinic Site |
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|------|---------|--------------------------|------------|------|---------------------------------------|
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| 1st Dose COVID-19 | Pfizer | Pfizer | ER8729 | 4/6/21 | LAFD USC |
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| 2nd Dose COVID-19 | Pfizer | Pfizer | EW 0171 | 4/27/21 | LAFD - USC |
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| Other | Pfizer | Pfizer | FJ1620 | 11/24/21 | USC Pharmacy |
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| Other | — | — | — | — | — |
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Scanned by TapScanner.
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documents/medical/covid/lu_vaccine_2nd_shot.jpg
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documents/medical/covid/lu_vaccine_2nd_shot.md
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documents/medical/covid/lu_vaccine_2nd_shot.md
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---
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type: medical-record
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category: vaccination
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person: Lu Yanxin
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date: 2021-05-06
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source: lu_vaccine_2nd_shot.jpg
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---
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# COVID-19 Vaccination Record Card — Lu Yanxin
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Two cards are shown in this image (original and replacement/updated).
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## Card 1 (Top)
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| Field | Value |
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|-------|-------|
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| Last Name | Lu |
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| First Name | Yanxin |
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| MI | — |
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| Date of Birth | 10/17/1989 |
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| Patient Number | — |
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| Dose | Vaccine | Lot # | EXP | Date | Healthcare Professional or Clinic Site |
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|------|---------|-------|-----|------|---------------------------------------|
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| 1st Dose COVID-19 | PFIZER COVID-19 VACCINE | EW0161 | 07/31/2021 | 4/15/2021 | FORUM |
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| 2nd Dose COVID-19 | — | — | — | — | — |
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| Other | — | — | — | — | — |
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| Other | — | — | — | — | — |
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## Card 2 (Bottom)
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| Field | Value |
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|-------|-------|
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| Last Name | Lu |
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| First Name | Yanxin |
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| MI | — |
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| Date of Birth | 10-17-1989 |
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| Patient Number | — |
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| Dose | Vaccine | Product Name/Manufacturer | Lot Number | Date | Healthcare Professional or Clinic Site |
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|------|---------|--------------------------|------------|------|---------------------------------------|
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| 1st Dose COVID-19 | Pfizer | Pfizer | EW0161 | 4/15/21 | Forum |
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| 2nd Dose COVID-19 | PFIZER COVID-19 VACCINE | — | EW0173 | 5/6/2021 (EXP: 08/31/2021) | FORUM |
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| Other | — | — | — | — | — |
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Scanned by TapScanner.
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@@ -4,7 +4,7 @@ category: pre_authorization_chat
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person: Yanxin Lu
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date: 2026-02-02
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provider: Meritain Health / Progyny
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source: pre_auth_with_Meritain_Health.png
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source: meritain_ivf_pre_auth.png
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---
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# Benefits & Coverage Chat — Pre-Authorization with Meritain Health
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@@ -4,7 +4,7 @@ category: treatment_codes
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person:
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date:
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provider: Progyny
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source: Progyny Fertility Exclusive Treatment Codes List.pdf
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source: progyny_treatment_codes.pdf
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---
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# Progyny Fertility Exclusive Treatment Codes List
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@@ -4,7 +4,7 @@ category: oral surgery
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person: Xuewei Jiang
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date: 2016-10-18
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provider: Midtown Oral & Maxillofacial Surgery
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source: oral surgery form xuewei.pdf
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source: jiang_oral_surgery_form.pdf
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---
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# Midtown Oral & Maxillofacial Surgery
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person: Xuewei Jiang
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date: 2016-10-10
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provider: Midtown Oral & Maxillofacial Surgery
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source: 201610181224191000.jpg
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source: jiang_oral_surgery_intake_p1.jpg
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---
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# Midtown Oral & Maxillofacial Surgery
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@@ -4,7 +4,7 @@ category: oral surgery
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person: Xuewei Jiang
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date: 2016-10-18
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provider: Midtown Oral & Maxillofacial Surgery
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source: 201610181224191001.jpg
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source: jiang_oral_surgery_intake_p2.jpg
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---
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# HEALTH HISTORY
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---
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type: identification
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category: driver-license
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person: Jiang, Xuewei
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date: 2021-07-29
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source: jiang_dl_ca.jpg
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---
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# California Driver License - Xuewei Jiang
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| Field | Value |
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|-------|-------|
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| State | California, USA |
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| Document Type | DRIVER LICENSE |
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| DL Number | Y1661483 |
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| Class | C |
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| Type | LIMITED-TERM |
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| END NONE | |
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| EXP | 03/13/2026 |
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| Last Name (LN) | JIANG |
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| First Name (FN) | XUEWEI |
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| Address | 11950 IDAHO AVE APT 113, LOS ANGELES, CA 90025 |
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| DOB | 03/13/1993 |
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| RSTR | CORR LENS |
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| SEX | F |
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| HGT | 5'-06" |
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| HAIR | BLK |
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| WGT | 145 lb |
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| EYES | BRN |
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| DD | 07/29/2021616E8/ |
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| ISS | 03131993 |
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---
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type: insurance
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category: medical-insurance-card
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person: Jiang, Erica (Xuewei)
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provider: Aetna
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source: jiang_medical_insurance_card.png
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---
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# Medical Insurance Card - Erica Jiang (Xuewei)
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## Member and Network Information for Providers
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| Field | Value |
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|-------|-------|
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| Group # | 16426 |
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| Network | Aetna Network |
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| Member | YANXIN LU |
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| Member ID | 3928092626 |
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| Dependent | XUEWEI JIANG |
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| Network | Aetna Choice POS II |
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| Plan | EPO |
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| Claims Payor | Mertian Health |
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| | For Subscriber, see reverse |
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### Cost Share
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| Service | Cost |
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|---------|------|
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| Office Visit | $15 |
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| Specialist | $15 |
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| Urgent Care | $15 |
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| ER | $110 |
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| INV OOP $6,000/Family | |
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---
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## Pharmacy Plan
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| Field | Value |
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|-------|-------|
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| Logo | CVS Caremark |
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| RXPCN | ADV |
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| RXBIN | 004336 |
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| RXGRP | RX2543 |
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---
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## Providers Only
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| Field | Value |
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|-------|-------|
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| Provider Service | 888 632 3862 |
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| Precertification | 866 415 6831 |
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| Member | 844 246 4511 |
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| Pre-Certified Svc | 877 344 3256 |
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---
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## Member Support
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| Field | Value |
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|-------|-------|
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| Call Insurance Company Concerns at | 844 287 3866 |
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| www.aetna.com | |
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| if member accessible | |
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| Download Aetna Mobile to send a secure message with questions about eligibility, claims and plan benefits. | |
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| Available by phone 24/7 | |
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---
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## Claims Submission / Appeals
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**Mail All Claims & Correspondence to:**
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Mertian Health, PO Box 853921
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Richardson, TX 75085-3921
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**EDI:** AetnaMyMedAdv/EnvisionChange
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Healthcare 41124 or MedAdvantage/
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Health 17181
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**Mail All Appeal Correspondence to:**
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Mertian Health, PO Box 27881
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Philadelphia PA 19134-2881
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---
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## Precertification
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For a referral to see a specialist, a primary care doctor may require precertification. Without precertification, you may have a higher copay. For a list of services that require precertification and to request precertification, call 866.415.6831 or comply with your plan's precertification requirements. To determine if a service requires precertification, Call Progyny at 844.734.8586 to Pre-certify and enhance any fertility benefits.
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---
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## Elected into the NY Pool
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Aetna participating Doctors and Hospitals are independent providers and are neither agents nor employees of Aetna.
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**Network:** First Health Network
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---
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type: identification
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category: drivers-license
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person: Lu, Yanxin
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date: 2023-08-08
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source: lu_ca_dl_2023.pdf
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---
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# California Driver License - Yanxin Lu
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## Front
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| Field | Value |
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|-------|-------|
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| State | California, USA |
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| Document | DRIVER LICENSE |
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| DL# | Y5369348 |
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| Class | C |
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| Type | LIMITED-TERM |
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| EXP | 10/17/2028 |
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| END | NONE |
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| LN | LU |
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| FN | YANXIN |
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| Address | LOS ANGELES, CA 90066 |
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| DOB | 10/17/1989 |
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| RSTR | CORR LENS |
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| SEX | M |
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| HGT | 5-09" |
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| HAIR | BRN |
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| WGT | 125 lb |
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| EYES | BLK |
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| DD | 07/29/2021616R8/DDFD/28 |
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| ISS | 08/08/2023 |
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## Back
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| Field | Value |
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|-------|-------|
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| CLASS | C - Veh w/GVWR ≤26000, No WC |
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| ENDORSEMENTS | None |
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| RESTRICTIONS | 01-Must wear corrective lenses when driving |
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This license is issued as a license to drive a motor vehicle; it does not establish eligibility for employment, voter registration, or public benefits.
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Rev 08/28/2017
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---
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type: insurance-card
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category: medical
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person: Yanxin Lu
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source: lu_medical_card.png
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---
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# Yanxin Lu — Aetna Medical Insurance Card
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## Member and Network Information for Providers
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| Field | Value |
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|-------|-------|
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| Group # | 16424 |
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| Member | YANXIN LU |
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| Member ID | 3928092626 |
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| Network | Aetna Choice POS II |
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| Plan | EPO |
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### Copays
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| Service | Copay |
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|---------|-------|
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| Office Visit | $15 |
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| Specialist | $15 |
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| Urgent Care | $25 |
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| ER | $100 |
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| INN OOP | $3,000 |
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- **Claims Payer**: Meritain Health
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- For Submission, see reverse
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## Pharmacy Plan
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| Field | Value |
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|-------|-------|
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| RXBIN | 610014 |
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| RXPCN | ADV |
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| RXGRP | RX2336 |
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**Pharmacy**: CVS Caremark
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**Pharmacy Member**: 844.248.4511
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**Pharmacy Provider**: 800.364.6331
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## Providers Only
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| Field | Value |
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|-------|-------|
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| Provider Service | 866.761.3018 |
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| Precertification | 866.415.6831 |
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| Non-Physician | $42 |
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## Member Support
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| Field | Value |
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|-------|-------|
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| Call | 844.287.3866 |
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| Website | mymeritain.apcbcbs.com |
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Download Acrcolade Mobile to send a secure message with questions about eligibility, claims and plan benefits.
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Extras available by phone 24/7.
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## Claims Submission / Appeals
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**Mail All Claims & Correspondence to:**
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Meritain Health, PO Box 853921
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Richardson TX 75085-3921
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EDV: WidER/Endpoint/ChangeHealthcare
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at 47424 or MascoCapGroup/Health 1933
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**Mail All Appeal Correspondence to:**
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Meritain Health, PO Box 27651
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Golden Valley MN 55427
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## Precertification
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Pre-authorization is required before a primary care doctor may refer to another physician. Some services may require precertification. Without pre-approval, you may be responsible for some or all costs. Please review or comply with your plan's precertification requirements listed on the back of this card.
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Call Progyny at 844.734.8366 to pre-certify and enhance any fertility benefits.
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## Elected into the NY Pool
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The Plan Sponsor and Hospitals are independent providers and are neither agents nor employees of Aetna.
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**Network**: First Health Network
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