1.7 KiB
1.7 KiB
| 1 | Test Procedure for §170.304.i Exchange Clinical Information and Patient Summary Record |
|---|---|
| 2 | APPROVED (Pending) Version 1.0 July 21, 2010 |
| 3 | Patient Summary Record Test Data – Set #2 |
| 4 | Patient |
| 5 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone |
| 6 | Ralph Johnson|06/28/1984 13:20:10|Male|9813466798|Medical Record Number|355 Elm Street<br>Morton,<br>Illinois 61550<br>309-377-8365 |
| 7 | “Source” for all data for this patient: Carl Roberts, MD |
| 8 | Problem List |
| 9 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed |
| 10 | Diagnosis|493.00|Asthma, unspecified|Active|12/22/2009 |
| 11 | Diagnosis|250.02|Diabetes Mellitus, Type 2|Active|08/10/2008 |
| 12 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed |
| 13 | Disorder|195967001|Asthma|Active|12/22/2009 |
| 14 | Disorder|44054006|Diabetes Mellitus, Type 2|Active|08/10/2008 |
| 15 | Medication List |
| 16 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status |
| 17 | 206833|Medication|metaproternol sulfate|Alupent Inhalation Aerosol|15 mg/ml|2 Puffs|Inhaled|Q4h|12/22/2009|Active |
| 18 | 205875|Medication|glyburide|Diabeta|2.5 mg|1 Tablet|PO|Q AM|08/10/2008|Active |
| 19 | Medication Allergy List |
| 20 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded |
| 21 | Drug Allergy|91936005|Penicillin|Rash and anaphylaxis|08/10/2008 |
| 22 | Drug Allergy|293620004|Indomethacin|Nausea, vomiting, rash,<br>dizziness, headache|03/25/2003 |
| 23 | Diagnostic Test Results |
| 24 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed |
| 25 | Imaging|24648-8|Chest X-ray, PA|Increased bronchial wall<br>markings, patchy infiltrates|02/16/2010 |
| 26 | Chemistry|14771-0|Fasting Blood Glucose (70–100 mg/dl)|70 mg/dl|12/22/2009 |
| 27 | Hematology|26449-9|Eosinophil Count (1 – 3 %)|2%|12/22/2009 |
| 28 | Imaging|24648-8|Chest X-ray, PA|Bronchial wall markings|12/22/2009 |