TD170.306.f.: Exchange clinical information and patient summary record * indicates alternative standard code per certification criteria Patient Summary Record Test Data – Set #1 Patient Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone Ann Toliver|07/16/1950
14:15:12|Female|989285998|Medical Record Number|353 Wine Street
Flint,
Michigan 48503
810-673-8378 “Source” for all data for this patient: Fatima Goyal, MD Problem List Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed Diagnosis|428.0|Congestive Heart Failure|Active|02/22/2010 Diagnosis|410.90|Acute Myocardial Infarction|Resolved|09/16/2007 Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed Disorder|42343007|Congestive Heart Failure|Active|02/22/2010 Disorder|57054005|Acute Myocardial Infarction|Resolved|09/16/2007 Medication List RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status 201372|Medication|captopril|Capoten|25 mg|Tablet|PO|TID|02/25/2010|Active 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 628958|Medication|potassium chloride|Klor-Con|10 mEq|1 Tablet|PO|BID|02/25/2010|Active 198039|Medication|nitroglycerin|Nitroglycerin|400 mcg|1 Tablet|SL|As needed|09/20/2007|Active Medication Allergy List Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded Drug Allergy|293586001|Aspirin|Wheezing|03/02/2007 Drug Allergy|294506009|Ampicillin|Diarrhea, nausea, vomiting|04/25/1994 Diagnostic Test Results Type|LOINC Code|Test (Normal Range)|Result|Date Performed Imaging|24648-8|Chest X-ray, PA|Enlarged cardiac silhouette,
lung fields clear |02/24/2010 Chemistry|2951-2|Sodium (135–146 mg/dl)|138 mg/dl|02/24/2010 Chemistry|2823-3|Potassium (3.5–5.3 mg/dl)|4.3 mg/dl|02/24/2010 Chemistry|2075-0|Chloride (95-107 mEq/L)|98 mEq/L|02/24/2010 Imaging|24648-8|Chest X-ray, PA|Enlarged cardiac silhouette,
horizontal lines in the periphery
of lower posterior lung fields |02/22/2010 Chemistry|2951-2|Sodium (135–146 mg/dl)|126 mg/dl|02/22/2010 Chemistry|2823-3|Potassium (3.5–5.3 mg/dl)|3.0 mg/dl|02/22/2010 Chemistry|2075-0|Chloride (95-107 mEq/L)|94 mEq/L|02/22/2010 Procedure List Type|ICD-9 Code|Procedure|Status|Date Performed Cardiac|00.66|Percutaneous transluminal coronary angioplasty|Completed|09/17/2007 Cardiac|37.21|Cardiac catheterization|Completed|10/01/2006 Type|CPT Code*|Procedure|Status|Date Performed Cardiac|92982|Percutaneous transluminal coronary angioplasty|Completed|09/17/2007 Cardiac|93501|Cardiac catheterization|Completed|10/01/2006