163 lines
2.7 KiB
Plaintext
163 lines
2.7 KiB
Plaintext
Test Procedure for §170.304.i Exchange Clinical Information and Patient Summary Record
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APPROVED (Pending) Version 1.0 July 21, 2010
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Patient Summary Record Test Data – Set #2
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{| border="1"|
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!colspan="6"|Patient
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|----
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!scope="col"|Name
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!scope="col"|Date/Time of Birth
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!scope="col"|Gender
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!scope="col"|Identification Number
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!scope="col"|Identification Number Type
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!scope="col"|Address/Phone
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|----
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|Ralph Johnson
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|06/28/1984 13:20:10
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|Male
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|9813466798
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|Medical Record Number
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|355 Elm Street<br>Morton,<br>Illinois 61550<br>309-377-8365
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|----
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|}
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“Source” for all data for this patient: Carl Roberts, MD
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{| border="1"|
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!colspan="6"|Problem List
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|----
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!scope="col"|Type
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!scope="col"|ICD-9 Code
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!scope="col"|Patient Problem
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!scope="col"|Status
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!scope="col"|Date Diagnosed
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|----
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|Diagnosis
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|493.00
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|Asthma, unspecified
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|Active
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|12/22/2009
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|----
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|Diagnosis
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|250.02
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|Diabetes Mellitus, Type 2
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|Active
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|08/10/2008
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|----
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|----
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!scope="col"|Type
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!scope="col"|SNOMED Code*
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!scope="col"|Patient Problem
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!scope="col"|Status
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!scope="col"|Date Diagnosed
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|----
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|Disorder
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|195967001
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|Asthma
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|Active
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|12/22/2009
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|----
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|Disorder
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|44054006
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|Diabetes Mellitus, Type 2
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|Active
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|08/10/2008
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|----
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|}
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{| border="1"|
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!colspan="10"|Medication List
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|----
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!scope="col"|RxNorm Code
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!scope="col"|Product
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!scope="col"|Generic Name
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!scope="col"|Brand Name
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!scope="col"|Strength
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!scope="col"|Dose
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!scope="col"|Route
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!scope="col"|Frequency
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!scope="col"|Date Started
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!scope="col"|Status
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|----
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|206833
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|Medication
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|metaproternol sulfate
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|Alupent Inhalation Aerosol
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|15 mg/ml
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|2 Puffs
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|Inhaled
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|Q4h
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|12/22/2009
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|Active
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|205875
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|Medication
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|glyburide
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|Diabeta
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|2.5 mg
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|1 Tablet
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|PO
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|Q AM
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|08/10/2008
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|Active
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|----
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|}
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{| border="1"|
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!colspan="5"|Medication Allergy List
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|----
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!scope="col"|Type
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!scope="col"|SNOMED Code
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!scope="col"|Medication/Agent
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!scope="col"|Reaction
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!scope="col"|Date Recorded
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|----
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|Drug Allergy
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|91936005
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|Penicillin
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|Rash and anaphylaxis
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|08/10/2008
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|----
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|Drug Allergy
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|293620004
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|Indomethacin
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|Nausea, vomiting, rash,<br>dizziness, headache
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|03/25/2003
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|----
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|}
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{| border="1"|
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!colspan="5"|Diagnostic Test Results
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|----
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!scope="col"|Type
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!scope="col"|LOINC Code
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!scope="col"|Test (Normal Range)
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!scope="col"|Result
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!scope="col"|Date Performed
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|----
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|Imaging
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|24648-8
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|Chest X-ray, PA
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|Increased bronchial wall<br>markings, patchy infiltrates
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|02/16/2010
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|----
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|Chemistry
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|14771-0
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|Fasting Blood Glucose (70–100 mg/dl)
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|70 mg/dl
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|12/22/2009
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|----
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|Hematology
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|26449-9
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|Eosinophil Count (1 – 3 %)
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|2%
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|12/22/2009
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|----
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|Imaging
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|24648-8
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|Chest X-ray, PA
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|Bronchial wall markings
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|12/22/2009
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|----
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