| 1 | TD170.306.f.: Exchange clinical information and patient summary record
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| 2 |
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| 3 | * indicates alternative standard code per certification criteria
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| 4 |
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| 5 | Patient Summary Record Test Data Set #1
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| 6 |
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| 7 | Patient
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| 8 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone
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| 9 | Ann Toliver|07/16/1950<br>14:15:12|Female|989285998|Medical Record Number|353 Wine Street <br>Flint, <br>Michigan 48503 <br> 810-673-8378
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| 10 |
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| 11 | Source for all data for this patient: Fatima Goyal, MD
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| 12 |
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| 13 | Problem List
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| 14 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
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| 15 | Diagnosis|428.0|Congestive Heart Failure|Active|02/22/2010
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| 16 | Diagnosis|410.90|Acute Myocardial Infarction|Resolved|09/16/2007
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| 17 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 18 | Disorder|42343007|Congestive Heart Failure|Active|02/22/2010
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| 19 | Disorder|57054005|Acute Myocardial Infarction|Resolved|09/16/2007
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| 20 |
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| 21 | Medication List
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| 22 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 23 | 201372|Medication|captopril|Capoten|25 mg|Tablet|PO|TID|02/25/2010|Active
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| 24 | 200820|Medication|spironolactone|Aldactone|25 mg|Tablet|PO|QID|02/25/2010|Active 309888|Medication|digoxin|Lanoxin|125 mcg|Tablet|PO|QD|02/25/2010|Active
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| 25 | 628958|Medication|potassium chloride|Klor-Con|10 mEq|1 Tablet|PO|BID|02/25/2010|Active
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| 26 | 198039|Medication|nitroglycerin|Nitroglycerin|400 mcg|1 Tablet|SL|As needed|09/20/2007|Active
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| 27 |
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| 28 | Medication Allergy List
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| 29 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
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| 30 | Drug Allergy|293586001|Aspirin|Wheezing|03/02/2007
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| 31 | Drug Allergy|294506009|Ampicillin|Diarrhea, nausea, vomiting|04/25/1994
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| 32 |
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| 33 | Diagnostic Test Results
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| 34 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
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| 35 | Imaging|24648-8|Chest X-ray, PA|Enlarged cardiac silhouette, <br>lung fields clear |02/24/2010
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| 36 | Chemistry|2951-2|Sodium (135146 mg/dl)|138 mg/dl|02/24/2010
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| 37 | Chemistry|2823-3|Potassium (3.55.3 mg/dl)|4.3 mg/dl|02/24/2010
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| 38 | Chemistry|2075-0|Chloride (95-107 mEq/L)|98 mEq/L|02/24/2010
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| 39 | Imaging|24648-8|Chest X-ray, PA|Enlarged cardiac silhouette, <br>horizontal lines in the periphery<br>of lower posterior lung fields |02/22/2010
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| 40 | Chemistry|2951-2|Sodium (135146 mg/dl)|126 mg/dl|02/22/2010
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| 41 | Chemistry|2823-3|Potassium (3.55.3 mg/dl)|3.0 mg/dl|02/22/2010
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| 42 | Chemistry|2075-0|Chloride (95-107 mEq/L)|94 mEq/L|02/22/2010
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| 43 |
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| 44 | Procedure List
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| 45 | Type|ICD-9 Code|Procedure|Status|Date Performed
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| 46 | Cardiac|00.66|Percutaneous transluminal coronary angioplasty|Completed|09/17/2007
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| 47 | Cardiac|37.21|Cardiac catheterization|Completed|10/01/2006
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| 48 | Type|CPT Code*|Procedure|Status|Date Performed
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| 49 | Cardiac|92982|Percutaneous transluminal coronary angioplasty|Completed|09/17/2007
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| 50 | Cardiac|93501|Cardiac catheterization|Completed|10/01/2006
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