| 1 | Patient Summary Record Test Data Set #5
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| 2 |
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| 3 | Patient
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| 4 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone
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| 5 | Christine Taylor|09/22/1965 16:48:25|Female|9787478034|Medical Record Number|754 Angel Street Marshalltown Iowa 50158 641-544-9988
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| 6 |
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| 7 | Source for all data for this patient: Kathryn Thomson, MD
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| 8 |
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| 9 | Problem List
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| 10 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
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| 11 | Diagnosis|540.0|Acute Appendicitis|Resolved|01/09/2010
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| 12 | Diagnosis|434.91|Cerebrovascular Accident (Stroke)|Resolved|07/09/2009
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| 13 | Diagnosis|250.02|Diabetes Mellitus, Type 2|Active|03/30/2009
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| 14 | Symptom|401.9|Hypertension, Essential|Chronic|02/25/2008
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| 15 |
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| 16 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 17 | Disorder|74400008|Appendicitis|Resolved|01/09/2010
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| 18 | Disorder|230690007|Cerebrovascular Accident (Stroke)|Resolved|07/09/2009
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| 19 | Disorder|44054006|Diabetes Mellitus, Type 2|Active|03/30/2009
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| 20 | Disorder|59621000|Essential Hypertension|Chronic|02/25/2008
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| 21 |
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| 22 | Medication List
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| 23 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 24 | 309362|Medication|clopidogrel|Plavix|75 mg|1 Tablet|PO|QD|07/15/2009|Active
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| 25 | 205875|Medication|glyburide|Diabeta|2.5 mg|1 Tablet|PO|Q AM|03/30/2009|Active
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| 26 | 209834|Medication|docusate|Colace|100 mg|1 Capsule|PO|BID|03/30/2009|Active
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| 27 | 200801|Medication|furosemide|Lasix|20 mg|1 Tablet|PO|BID|02/25/2008|Active
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| 28 | 628958|Medication|potassium chloride|Klor-Con|10 mEq|1 Tablet|PO|BID|02/25/2008|Active
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| 29 |
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| 30 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 31 | 884175|Medication|clonidine hydrochloride|Catapres|0.1 mg|1 Tablet|PO|BID|02/25/2008|Active
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| 32 |
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| 33 | Medication Allergy List
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| 34 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
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| 35 | Drug Allergy|293620004|Indomethacin|Rash, dizziness, headache|06/05/2008
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| 36 | Drug Allergy|294506009|Ampicillin|Diarrhea, nausea, vomiting|05/25/1997
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| 37 | Drug Allergy|91939003|Sulfonamides|Hives, photosensitivity|08/25/1989
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| 38 |
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| 39 | Diagnostic Test Results
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| 40 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
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| 41 | Chemistry|14771-0|Fasting Blood Glucose (70100 mg/dl)|126 mg/dl|07/15/2010
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| 42 | Chemistry|2823-3|Potassium (3.55.3 mg/dl)|4.3 mg/dl|07/15/2010
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| 43 | Chemistry|14927-8|Triglycerides (<150 mg/dl)|178 mg/dl|07/15/2010
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| 44 | Imaging|42272-5|Chest X-ray, PA & Lateral|The heart outline is normal and the hilar and mediastinal vessels are of normal appearance|02/25/2008
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| 45 |
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| 46 | Procedure List
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| 47 | Type|ICD-9 Code|Procedure|Status|Date Performed
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| 48 | Surgical|47.09|Emergency Appendectomy|Completed|01/09/2010
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| 49 |
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| 50 | Type|CPT Code*|Procedure|Status|Date Performed
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| 51 | Surgical|44950|Emergency Appendectomy|Completed|01/09/2010
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| 52 |
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| 53 |
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