Call the clinic at (509) 638-0808 to verify your insurance benefits and to schedule your initial visit. Welcome to Bethesda! Changes in the nail, such as discolocation or thickening, can signal health problems including liver and kidney diseases, heart and lung conditions, anemia and diabetes. James G. Corasanti, MD, PhD. Dr. Skinner Learn More. Seizures may also occur. Patients who visit MedStar Health Cardiology Associates at Annapolis can receive expert heart care in an office designed with the patient experience in mind.
The mite is only 1/60 inch long, and is almost impossible to see. Physicians' Group of The Woodlands is proudly part of Privia Health. Dermatitis Medicamentosa is a term used to describe any of the group of those skin eruptions or changes which may occur as a result of the ingestion or parenteral administration, or contact with, virtually any drug. Covering the newest trends and treatments in pain care, as well as the pain treatment strategies that have been successfully employed in the past, Pain Care Essentials and Innovations brings you fully up to date with effective treatments ...
All Rights Reserved. Patients often ask about removal of benign skin growths or cosmetic type procedures in dermatology. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. I can’t say enough about her staff either. They resemble pimples at first. Your skin is an organ that is expected to be not only healthy, but also lovely and touchable. Hives are an allergic response of the skin causing crops of raised, red, itching areas, which may come and go. DLE is one of a large number of conditions occurring in a rare disease called systemic lupus erythematosus (SLE). She’s always responded quickly to my needs most often personally. Jeffrey Jacobs, MD, is a gastroenterologist and specializes in the care of patients with inflammatory bowel disease. Unguis Incarnatum--otherwise commonly known as an "ingrowing nail" is a relatively common condition in which the nail (most frequently that of the great toe) pierces the lateral nailfold and enters the dermis of the skin, where it initiates a foreign body reaction and possible infection. This 27 year old male patient has a ten-year history of a hyperpigmented, scaly, non-itchy skin condition, which began on his chest and has slowly spread to involve his back, neck, and face.. Calluses can be advantageous to some but painful to others, while corns are characteristically painful to all. Bethesda Community Clinic is a Christ-centered 501 (c)3 nonprofit dedicated to providing quality, affordable health care services to the uninsured and under-insured. They can also grow on the face, and the eyelids. Think about it, you never hear anyone say, “My, she has an attractive liver.” But, you will hear, “That lady has the most beautiful skin!” This is what true dermatology is all about: Healthy skin that is also lovely to behold, comfortable to live in, and a pleasure to touch. Get to Know Dr. Ilanna Loeffel. Access your medical records online Patient Portal Online medical records. She is deeply grateful to have the great joy of working with children and their families. NextMD is a secure, simple way to see and use your personal health records and communicate with your doctor online. One study has shown that unemployment rates are higher in both women and men with acne... Alopecia areata (al-oh-PEE-shah air-ee-AH-tah) is a common condition that results in the loss of hair on the scalp and elsewhere. Skin cancer is the most common cancer. This detailed reference supplies the latest and most comprehensive information available on new and innovative methods and techniques of cutaneous scar revision and removal. Written by more than 40 contributors Pseudofolliculitis barbae is one of the most common skin complaints of black men, occurring in 45 to 80 percent of those men who shave. Dr. Jerry R. Jacobs is a Family Medicine Doctor in Brooksville, FL. In The Anti-Inflammation Cookbook, professional cook and inflammation sufferer Amanda Haas joins forces with Dr. Bradly Jacobs to explain which foods are beneficial and why and to share 65 delicious, simple inflammation-busting recipes. Dr. Jacob then furthered her medical education by completing a residency in internal medicine and a general cardiology fellowship at Winthrop University Hospital in Mineola, New York. This is a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or from an emotional upset. The Center proudly brings you some of the best surgeons in South Florida, Emery M. Salom, MD, and Jacob Tangir, MD and Jonathan Black, MD, MPH. Porokeratosis is a chronic progressive skin condition in which there are multiple abnormal skin patches with dry, atrophic center and elevated warty border in circumscription of each lesion, like a collar... DSAP is an unusual inherited skin condition causing dry patches on the arms and legs. Jacob Swartz, MD. About Our PracticeWe appreciate the opportunity to care for your child. Chondrodermatitis nodularis helicis is a painful inflammatory condition affecting the ear. While most skin diseases have the same clinical appearance in Black, White, and Oriental populations, there are some exceptions. The average human walks 70,000 miles in a lifetime! "I consent to having scheduling and non-medical information sent to my email address." Seborrheic keratoses (SK's) are harmless, common skin growths that first appear during adult life. She is so kind and caring and I love seeing her every time. The skill for healing, the art for beauty, & the love for caring. Super friendly and efficient staff! With more than 19 years of experience in obstetrics and gynecology, Dr. Jacome has been very successful in his medical field. Intertrigo is type of inflammation of the top layers of skin caused by moisture and bacteria in skin fold areas. Patient Forms & Payments. Dr. Jacobs is the most knowledgeable and persistent doctor you could possibly hope for in the fertility world. High school students were interviewed and asked what was most important to their appearance. Since 1995, Minnesota Oncology has defined a new standard of cancer treatment in the Twin Cities. Jacob Whipple, DDS and William Parilla, DDS, practice a full scope of general and cosmetic dentistry with expertise ranging from porcelain veneers to dental implants, crowns and bridges. In this revelatory book, Edward Glaeser, a leading urban economist, declares that cities are actually the healthiest, greenest, and richest (in both cultural and economic terms) places to live. diameter) multiple usually located on the arms, legs, or ... Perioral dermatitis has been defined as a persistent erythematous (reddish color) eruption of the skin composed of tiny papules and little papulopustules, distributed primarily around the mouth. Dry Skin Anatomy & Physiology: What is The Human Skin Barrier? Purchase of this book includes access to an online video introduction, online banks of GRE practice problems, and the GRE Challenge Problem Archive. "A groundbreaking program by one of the nation's leading experts on acid reflux to help the millions of diagnosed and undiagnosed sufferers identify the silent, potentially deadly symptoms and provide them with a proven 28-day eating plan ... IMPORTANT INFORMATION REGARDING COVID-19. - "Affiliation" is the local physician organization to which the doctor belongs. Be sure to call ahead with Dr. Jacob to book an appointment. The syringoma, a benign sweat duct tumor, belongs to the classification of skin neoplasms known as the "skin appendage tumors"--thus called because they display certain structural similarities to the hair follicle, the sebaceous gland, the epidermis, the apocrine gland, or the eccrine gland. The head louse is one variety of a number of different lice. Your most important goal: Prevent infection. They pose a diagnostic challenge to even the most experienced physician because of the diversity of their clinical presentations. Quite simply, dry skin is skin that has lost its moisture. Dr. Some skin conditions, such as keloids, "flash moles," and ingrown hairs due to shaving, are ... Non-cancerous red or purple growths of blood vessels that mainly grow on the trunk.
Jacob Parnell MD, Internal Medicine | TriStar Medical Group Healthy hair grows in a cycle, and, it is normal to lose hair and grow it back during this cycle. ChARM patient portal. Privia connects us with leading doctors in the community to transform healthcare by delivering high-quality, coordinated care that is centered on our patients. It usually manifests as an intensely pruritic ( itchy ) lesion at the bite site. Itching is common. Vasculitis (pronounced vaa-skew-lite-iss) is inflammation of the blood vessels. Squamous Cell Carcinoma: The Second Most Common Cancer in Man. When you sign up, you will receive an email with instructions for logging in. The Pocket Guru: Guidance and mantras for spiritual ... - Page 1 He is accepting new patients. Sound confusing? Dr. Jacob Godwin, Specializing in Pain Management for Musculoskeletal & Neurological Conditions. She earned her Doctor of Nursing Practice degree from Columbia University. Center for Rheumatic - The Field of Allergy, Internal ... Herpes virus has the peculiar ability to go into a latent stage, lying dormant in the body. Dr. Spencer Sechler. If you are already signed up, log into your portal below. - A primary care provider (or PCP) is a doctor or in some cases, a nurse practitioner or physician assistant, who sees patients for everyday medical issues, such as colds and annual wellness visits. Communicate with your doctor, manage appointments, access test results and more in one convenient location with the TPMG Patient Portal. A message from Dr. Jacobs: The following are photos of Actinic Keratoses of the scalp, lip, ear, and nose. These are mostly white blood cells which circulate and are our major defense against infection. Dr. Spencer Sechler is a native of Warren, Ohio. Pediatric Rheumatology for the Practitioner Dr Jacob is the best. Amazing clinic. Highlights of this edition include updated JNC 7 findings regarding special population therapy and clinical management. More than a century after its initial description, sarcoidosis remains a biological and clinical enigma. Infection is not thought to be the primary cause, as the lesions do not clear with antibiotics alone. 2. This is a very practical guide to the recognition, diagnosis and treatment of the various forms of chronic arthritis in children.
In vitiligo, the patient's own immune system is responsible for "attacking" the skin's own pigment cells. Our orthopedic surgeons use state-of-the-art technology and advanced surgical tools. Acne keloidalis (also spelled "cheloidalis") nuchae is an unusual skin condition affecting the nape of the neck. Melanoma usually starts in a mole, and other skin cancers usually begin in untreated precancers. " #New England Journal of Medicine#1 "This is a book that one can pick up and read sections of and go back to again and again, and as such should be readily available wherever people are caring for children with joint complaints. Our physicians perform outpatient endoscopies in hospitals and ambulatory endoscopy centers. Exposure to someone who has it will almost always result in the exposed child "catching it". He realizes that each patient is different, and a tailored approach is critical to the successful care of his . Pseudofolliculitis barbae is the response of the skin to an ingrown hair. It occurs occasionally in some people and again and again in others. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. Definitely recommend! One of the functions of healthy skin is to protect your body from bacteria like staph or strep. Dr. Jana Jacobs, DO is a Family Medicine Specialist in Parker, CO and has over 29 years of experience in the medical field. Found inside – Page 175Anorectal varices--their frequency in cirrhotic and noncirrhotic portal hypertension.Gut, Mar, Vol.32, Nos.3, pp.309-311. (ISSN 0017-5749) Chen, LS; Lin, HC; Lee, FY; Hou, MC & Lee SD. (1996). Portal hypertensive colopathy in patients ... Grover's disease is an itchy skin condition on the chest and back. Only a few people with DLE also have SLE. Patient Portal Access your personal health information and test results, securely message your care team, and manage payments, all from one spot and at your convenience, 24/7. Your itchy face and scalp may be due to seborrheic dermatitis. Patient Portal PAY BILL NOW . The fibroblast cells (the cells that produce collagen and elastic skin tissue) are damaged. There are many different ways to treat Actinic Keratoses. There are five million sweat glands throughout the body and about 2/3 of these gland are located in the hands. Patients seeking medical information, please use the Patient Portal to contact your physician directly or contact our office over the phone. Interests. Alopecia is the medical word for hair loss. Diaper rash usually occurs in two stages: First there is irritation of the skin in the diaper area caused from a combination of the moisture under the diaper from the skin, the urine, and the stool. This book is about organisational development from a systemic perspective.
, MD.
Actinic Keratoses are precancerous, and to prevent skin cancer from developing on your skin, I believe they should be treated. For this reason, the condition may be mistaken for ring worm. Cancer Symptom Science is the first interdisciplinary compilation of research on the mechanisms underlying the expression of cancer-related symptoms. In particular, diabetic feet need extra special care.
Pityriasis Lichenoides can occur in two forms: acute and chronic, but there is an overlap between them. Three to six women are affected for each man with erythema nodosum (EN). It has been a true pleasure being a patient of Dr. Uhler. Your Specialists - WellMed Medical Group So many patients ask, “What is Lupus?” Really, lupus is a very complicated diseaes, so, for educational purposes, I am giving you this written information. PRIMARY CARE - Caring for our communities, one patient at ... Never any issues with the service in this office. Fine scales or thick sheets of desquamation follow the erythrodermic stage. Simply speaking, it is a whitish thickening of the tissues that line such areas as the mouth, anus, or vagina. We use cookies and other tools to enhance your experience on our website and to analyze our web traffic. Ascension Via Christi is the largest provider of health care services throughout Wichita and central Kansas including hospitals, doctors, and specialty clinics. Also, highlighted in the book is the product, Squatty Potty due to its unique ability to aide and assist the pooping process naturally. Free, fast and easy way find a job of 769.000+ postings in Hanover, MD and other big cities in USA. The secretion of sweat is controlled by the sympathetic or (vegetative) nervous system. 1150 Youngs Road, Suite 203 Williamsville, NY 14221. The first complete guide to the rapidly expanding field of telehealth From email to videoconferencing, telehealth puts real-time healthcare solutions at patients’ and clinicians’ fingertips. Wound Care Instructions After Biopsy or Skin Procedures Follow these instructions for best healing. It is a foreign body response. So, eye areas need extra avoidance of allergic agents. It''s great to have your book smarts and fancy law degree but how do you pay the bills every Friday when your staff wants their paycheck? You pull your hair out wondering how you got yourself into this mess. This book was written for you. She graduated from University Hospital Of Health Sciences medical school in 1992. Smoking cigarettes or working with vibrating machinery also can cause these episodes. We are currently accepting new patients. The skin barrier does not function as normal, and thus, the skin loses vital moisture and also becomes easily penetrated by allergens, toxins, and irritants. Contact.
Staff is welcoming and doctors are great! Vascular Disease in Women: An Overview of the Literature and ... High school students were interviewed and asked what was most. Displayed ratings and reviews are displayed for Providers who have received at least 30 returned surveys over a 12-month period and are related to all Care Provider related survey questions. Office locations. It appears that this virus stays with us for life. Bullous pemphigoid is a blistering skin disease which usually affects middle aged or elderly persons. Our orthopedic surgeons and doctors provide specialized orthopedic care for every patient. Founded and led by Fredesvinda Jacobs-Alvarez, MD, a board-certified child, adolescent, and adult psychiatrist, the practice was established in 2006, to help patients create pathways to wellness, enabling them to obtain their full potential and lead healthy, fulfilling lives. Grover's disease most often affects men over 50. A thin body, muscles, the right hair, or clear skin. Our recently remodelled office is located on the campus of Anne Arundel Medical Center. Dr. Swartz has clinical interests in mood and anxiety disorders, developmental disorders, autism spectrum disorders, trauma, substance use disorders, and global mental health. Contact Us. She worked for NeighborCare Professional Pharmacies for 11 years. This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. Sclerotherapy, a simple technique performed in Dr. Jacobs' office, is a fairly safe and relatively effective treatment for nearly all unwanted varicose veins with diameters of less than one millimeter. A recent TV documentary on the biology of human sexuality indicated that... Acanthosis nigricans is a disorder that causes light-brown-to-black, velvety, rough areas or increased skin markings usually on the back and sides of the neck. Piedmont Family Practice Cryosurgery is an office surgical procedure used to remove growths without cutting the skin... Darier's Diseases is a slowly progressive inherited disorder of keratinization of the skin. Dr. Heagle Haller joined Pediatrics on Hudson in December 2020. Our comprehensive approach to the management of cardiovascular disease with meticulous attention to detail has served our patients for over 30 years. Annapolis Rheumatology - 2021 - Home We are proud to provide our patients with access to top-quality Pediatric, Women's, Adult Internal Medicine and Medical Weight Loss care all under one roof. Simply, patients with nostalgia paresthetica experience a frustratingly resistant itch on their back. Measles is caused by paramyxovirus RNA virus. As devices, technologies, and imaging techniques continue to evolve, today’s endovascular surgical techniques have increased in both number and complexity. Oh no, zits! Competitive salary. These lesions are small benign growths, they tend to form in areas where the skin forms creases, such as the neck, armpit, and groin. WellMed has a network of on-staff and . Simply stated, dermatology is the fine medical art of attaining beautiful skin. Access to the latest evidence-based treatments, technology and trials . Rescheduling You can go online to the patient portal and reschedule your appointment. Certain types of HPV have been linked with a variety of premalignant and malignant conditions. Text. Patient Portal. Note: This provider may accept more insurance plans than shown. Dawn Jacobs graduated from Morgan State University in 1993 with a Bachelor of Science degree in chemistry. Pityriasis alba is a common mild dermatitis inflammation of round or oval slightly scaly patches which leave pale hypopigmented marks after the inflammation has faded. Meet Our Doctors. Paronychia is an inflammatory reaction involving the folds of skin surrounding the fingernail. Map/Directions. Home / For Patients / Patient Portal. - A primary care provider (or PCP) is a doctor or in some cases, a nurse practitioner or physician assistant, who sees patients for everyday medical issues, such as colds and annual wellness visits. Featuring full-color illustrations, schematic diagrams, and diagnostic algorithms, Atlas of Cardiac Innervation is a valuable resource for cardiologists, radiologists, nuclear medicine physicians, and electrophysiologists. Vitiligo is an auto immune condition which results in depigmentation: various sized, white, sharply demarcated macules and patches of the skin. He was born and raised in the Kansas City metro area. at greatest risk for skin cancer. Pityriasis rubra pilaris can occur at any age but it's more common in people between the ages of 10 and 50 years. A Skin Tag is also known as an achrocordon. Inflammation is a condition in which tissue is damaged by blood cells which enter it. Accepted Insurance Plans. In The Compensations of Plunder, Justin M. Jacobs brings to light the historical context of the exodus of cultural treasures from northwestern China. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut a... OBGYN clinic serving Dallas, Denton and Tarrant Counties: Allen, Arlington, Bedford, Dallas, Euless, Frisco, Flower Mound, Garland, Grand Prairie, Irving, Lewisville, McKinney and Plano TX. We partner with leading publishers around the globe. Our goal is to have accessible editions simultaneously released with publishers' new books so that all readers can have access to the books they want to read. They also provide hormone replacement therapy and medical weight-loss plans. The #1 New York Times best-selling series. Bonus features • Q&A with author Ransom Riggs • Eight pages of color stills from the film • Sneak preview of Hollow City, the next novel in the series A mysterious island. The nails are usually involved. Grover's disease often starts quite suddenly. We are also firm believers in fostering a healthy parent-child relationship with the hope that parenthood is a rewarding and fulfilling experience. Dr. Parnell is Board Certified in Internal Medicine and has extensive teaching experience. PCPs often are your first point of contact for your general health concerns.
In today's complex medical environment, our internists like to keep […] Ted Jacobs, a young doctor in Laramie, Wyo., treats a dying Native American who tells him of being wounded by white settlers in wagons and having to escape through a spirit opening in the back of a cave. Our experienced staff of physicians and physician assistants deliver high quality, comprehensive primary care to infants, children, and adolescents. "My goal is to develop a collaborative relationship with my patients. Find A Doctor. The Final Rule of the 21st Century Cures Act, which took effect in April 2021, implements information-blocking provisions that expand the types of data available to patients within the online patient portal. Dr. Ashok Jacob M.D, FACR. Committed to providing high quality medical care . The staff and surgeons at Twin Cities Spine Center warmly welcome Dr. Bayard C. Carlson. The extensive content of this book provides the readers with a thorough understanding of the subject. Different approaches, evaluations and advanced studies have been included in this text. This includes poor heart function and any type of blockage to the circulation. TO REACH YOUR DOCTOR'S NURSE PLEASE USE THE EXTENSIONS BELOW: Dr. Julie DaVolio- Ext 113; Dr. Arlene Jacobs - Ext 110; Dr. Heather Bellanger - Ext 127; Dr. Amy Mos - Ext 151; Dr Jacquelyn Means . Biography. Herpes simplex is a virus infection. Found inside – Page 2023... requiring instead “massively parallel software running on tens, hundreds, or even thousands of servers” (Jacobs, ... pace with ever-changing technology while preserving the doctor–patient relationship in the context of technology ... Dr. Bayard C. Carlson. It gets its name from its appearance on the skin. Getting Started. Athlete's foot is a very common skin condition--many people will develop it at least once in their lives. Ringworm is a fungal (dermatophyte) infection of the skin, hair, or nails. Dr. The cause of erosive pustular dermatosis of the scalp is unknown. Found inside – Page 115Improving Safety, Quality and Value Juan A. Sanchez, Paul Barach, Julie K. Johnson, Jeffrey P. Jacobs. 37. 38. 39. 40. ... Patient portal benefits patient care and provider workflow. ... Katz J. The silent world of doctor and patient. Remember, the eyelid skin is very thin and is highly susceptible to allergens and irritants. "Near-term availability" is subject to change. Keratosis pilaris consists of small clustered, firm, white papules approximately one millimeter in diameter. Erythema multiforme is the name given to a short-lasting illness, which sometimes recurs. Dr Jacobs is amazing and if your lucky enough to have her your physician then your truly blessed. Yet psychological research has shown that acne can lower self-esteem and is extremely stressful. Schamberg's disease is a condition in which there is multifocal extravasation (leakage) of blood in a distinctive pinhead pattern on the skin of the lower or upper extremities (legs and sometimes arms). Our practice is open to newborns and transfer patients. He has been married to his wife, Amanda Chandler Parnell . One in six Americans will develop skin cancer in his or her lifetime. You may need a referral from your primary care provider to schedule an appointment. Symptoms: Bullae (large blisters, thin walled sacs filled with clear fluid, greater than 1 cm. The book will serve as an essential reference for both clinicians and researchers, discussing the disease prevalence, treatment options, and treatment outcomes for vascular disease in women and explores the need for future research in ... She takes a personal interest in the care of each of her patients. of Neurology, Jacobs School of Medicine and Biomedical Sciences, Univ. Our practitioners have offices in Farmington Hills, Warren, Novi, Southfield, Royal Oak, Howell, and Brighton. Dr. Jacob Skinner & Dr. Kevin Hsiung About Doctors. Dr. Whipple and Dr. Parilla, seek to provide the highest level of care in all aspects of general, cosmetic, and family dentistry and can literally redesign . The signs of photoaging are thin, wrinkled, discolored, leathery skin, as well as precancerous and cancerous growths. Lichen planus is characterized by distinctive papules which may be as small as a pinhead or larger. She then attended the University of Maryland School of Pharmacy and graduated with a Doctor of Pharmacy degree in 1998. Classic Cherry Angiomas are harmless... Chickenpox is usually mild, but it is a highly contagious disease. They can also occur on the esophagus and genitalia. Our Ob-Gyn clinic serves patients from Plano, Dallas, McKinney, & Frisco and the surrounding areas. Melanoma is often preventable, but in the USA, melanoma kills about one person every hour. Sometimes there is a psychological factor involved as either the principle or contributing cause of the problem. He is affiliated with medical facilities such as HCA Houston Healthcare Kingwood and Memorial Hermann - Texas Medical Center. Plano Women’s Healthcare is a full-service Obstetrics & Gynecology practice dedicated to providing the highest quality care in North Texas and surrounding areas. Stasis Dermatitis is a chronic rash stemming from poor circulation (low oxygen) of the legs due to internal varicose veins or poor circulation for other reasons. Dr. Jacobs lives in Cary with his wife Kimmie and their five children since adopting a 14 year old from Ukraine in 2015. Liquid Nitrogen Spray was used today to treat skin growths. It usually starts with one or more small, round, smooth patches. Is It A Melanoma | Is It Skin Cancer | Are You At Risk | Patient Testimonials | Contact fair skin and have sunburned. Sweating is a natural body function needed for the regulation of body-temperature. Our expertise includes personalized and attentive prenatal care, well-woman exams, hormone optimization, infertility, and minimally-invasive gynecologic procedures using the most advanced technology and techniques. We will take the most comprehensive evaluation possible given your history, and provide a detailed plan tailored specifically to tackle the . Papular urticaria is a skin reaction to flea bites and is a result of an immunologically mediated reaction.
What is best for you and your own skin problem? Dr. Travis Sifers is the most recent addition to The Center for Allergy and Immunology. A community of care — dedicated to you. The growths may have been benign, malignant, and/or pre-cancerous, depending on your diagnosis. Gentle paring with a scalpel can differentiate corns and calluses, which may be confused with plantar warts. Established in 1960, innovative medical and surgical eye care remain the hallmarks of our group. Whether the treatment requires nonsurgical or surgical care, I look forward to working with each patient to develop a treatment strategy specific to their needs." If you are new to the Patient Portal, please use the "New User" link. Events & Classes. Dr. Hsiung Learn More. Warts may grow on any part of the skin.
Why Was Dark Matter Cancelled, Long Term Car Rental Auckland, Battery Operated Halloween Projector, What's Prize Set In Love Nikki Anniversary Event, Svetlana Romashina Husband,
dr jacobs patient portalNo Comments