| 1 | * indicates alternative standard code per certification criteria
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| 2 |
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| 3 | Patient Summary Record Test Data Set #1
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| 4 |
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| 5 | {| border="1"|
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| 6 | !colspan="6"|Patient
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| 7 | |----
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| 8 | !scope="col"|Name
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| 9 | !scope="col"|Date/Time of Birth
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| 10 | !scope="col"|Gender
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| 11 | !scope="col"|Identification Number
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| 12 | !scope="col"|Identification Number Type
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| 13 | !scope="col"|Address/Phone
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| 14 | |----
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| 15 | |John D. Smith
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| 16 | |07/04/1960 10:15:02
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| 17 | |Male
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| 18 | |999999999
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| 19 | |Medical Record Number
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| 20 | |355 Maple Street <br>Williamsport, <br>Pennsylvania 17701 <br>570-837-8364
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| 21 | |----
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| 22 | |}
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| 23 |
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| 24 | Source for all data for this patient: John Fitzgerald, MD
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| 25 |
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| 26 | {| border="1"|
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| 27 | !colspan="6"|Problem List
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| 28 | |----
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| 29 | !scope="col"|Type
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| 30 | !scope="col"|ICD-9 Code
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| 31 | !scope="col"|Patient Problem
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| 32 | !scope="col"|Status
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| 33 | !scope="col"|Date Diagnosed
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| 34 | |----
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| 35 | |Diagnosis
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| 36 | |250.02
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| 37 | |Diabetes Mellitus, Type 2
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| 38 | |Active
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| 39 | |09/16/2009
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| 40 | |----
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| 41 | |Condition
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| 42 | |272.4
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| 43 | |Hyperlipidemia
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| 44 | |Active
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| 45 | |05/05/2002
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| 46 | |----
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| 47 | |Finding
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| 48 | |414.01
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| 49 | |Coronary Artery Disease (CAD)
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| 50 | |Chronic
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| 51 | |05/05/2002
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| 52 | |----
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| 53 | |Symptom
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| 54 | |401.9
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| 55 | |Hypertension, Essential
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| 56 | |Active
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| 57 | |05/05/2002
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| 58 | |----
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| 59 | |----
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| 60 | !scope="col"|Type
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| 61 | !scope="col"|SNOMED Code*
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| 62 | !scope="col"|Patient Problem
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| 63 | !scope="col"|Status
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| 64 | !scope="col"|Date Diagnosed
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| 65 | |----
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| 66 | |Disorder
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| 67 | |44054006
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| 68 | |Diabetes Mellitus, Type 2
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| 69 | |Active
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| 70 | |09/16/2009
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| 71 | |----
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| 72 | |Disorder
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| 73 | |55822004
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| 74 | |Hyperlipidemia
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| 75 | |Active
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| 76 | |05/05/2002
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| 77 | |----
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| 78 | |Disorder
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| 79 | |53741008
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| 80 | |Coronary Arteriosclerosis
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| 81 | |Chronic
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| 82 | |05/05/2002
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| 83 | |----
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| 84 | |Disorder
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| 85 | |59621000
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| 86 | |Essential Hypertension
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| 87 | |Active
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| 88 | |05/05/2002
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| 89 | |----
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| 90 | |}
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| 91 |
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| 92 | {| border="1"|
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| 93 | !colspan="10"|Medication List
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| 94 | |----
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| 95 | !scope="col"|RxNorm Code
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| 96 | !scope="col"|Product
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| 97 | !scope="col"|Generic Name
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| 98 | !scope="col"|Brand Name
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| 99 | !scope="col"|Strength
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| 100 | !scope="col"|Dose
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| 101 | !scope="col"|Route
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| 102 | !scope="col"|Frequency
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| 103 | !scope="col"|Date Started
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| 104 | !scope="col"|Status
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| 105 | |----
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| 106 | |205875
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| 107 | |Medication
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| 108 | |glyburide
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| 109 | |Diabeta
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| 110 | |2.5 mg
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| 111 | |1 Tablet
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| 112 | |PO
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| 113 | |Q AM
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| 114 | |09/16/2009
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| 115 | |Active
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| 116 | |----
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| 117 | |617314
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| 118 | |Medication
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| 119 | |atorvastatin calcium
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| 120 | |Lipitor
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| 121 | |10 mg
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| 122 | |1 Tablet
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| 123 | |PO
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| 124 | |Q Day
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| 125 | |05/05/2002
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| 126 | |Active
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| 127 | |----
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| 128 | |200801
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| 129 | |Medication
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| 130 | |furosemide
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| 131 | |Lasix
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| 132 | |20 mg
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| 133 | |1 Tablet
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| 134 | |PO
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| 135 | |BID
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| 136 | |05/05/2002
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| 137 | |Active
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| 138 | |----
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| 139 | |628958
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| 140 | |Medication
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| 141 | |potassium chloride
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| 142 | |Klor-Con
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| 143 | |10 mEq
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| 144 | |1 Tablet
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| 145 | |PO
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| 146 | |BID
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| 147 | |05/05/2002
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| 148 | |Active
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| 149 | |----
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| 150 | |}
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| 151 |
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| 152 | {| border="1"|
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| 153 | !colspan="5"|Medication Allergy List
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| 154 | |----
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| 155 | !scope="col"|Type
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| 156 | !scope="col"|SNOMED Code
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| 157 | !scope="col"|Medication/Agent
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| 158 | !scope="col"|Reaction
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| 159 | !scope="col"|Date Recorded
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| 160 | |----
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| 161 | |Drug Allergy
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| 162 | |293597001
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| 163 | |Codeine
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| 164 | |Hives
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| 165 | |06/27/1996
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| 166 | |----
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| 167 | |Drug Allergy
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| 168 | |294506009
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| 169 | |Ampicillin
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| 170 | |Diarrhea, nausea, vomiting
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| 171 | |03/15/1994
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| 172 | |----
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| 173 | |}
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| 174 |
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| 175 | {| border="1"|
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| 176 | !colspan="5"|Diagnostic Test Results
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| 177 | |----
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| 178 | !scope="col"|Type
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| 179 | !scope="col"|LOINC Code
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| 180 | !scope="col"|Test (Normal Range)
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| 181 | !scope="col"|Result
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| 182 | !scope="col"|Date Performed
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| 183 | |----
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| 184 | |Chemistry
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| 185 | |14771-0
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| 186 | |Fasting Blood Glucose (70100 mg/dl)
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| 187 | |178 mg/dl
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| 188 | |09/16/2009
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| 189 | |----
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| 190 | |Chemistry
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| 191 | |14682-9
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| 192 | |Creatinine (0.51.4 mg/dl)
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| 193 | |1.0 mg/dl
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| 194 | |09/16/2009
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| 195 | |----
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| 196 | |Chemistry
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| 197 | |14937-7
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| 198 | |BUN (730 mg/dl)
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| 199 | |18 mg/dl
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| 200 | |09/16/2009
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| 201 | |----
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| 202 | |Chemistry
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| 203 | |2951-2
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| 204 | |Sodium (135146 mg/dl)
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| 205 | |141 mg/dl
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| 206 | |09/16/2009
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| 207 | |----
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| 208 | |Chemistry
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| 209 | |2823-3
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| 210 | |Potassium (3.55.3 mg/dl)
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| 211 | |4.3 mg/dl
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| 212 | |09/16/2009
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| 213 | |----
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| 214 | |Chemistry
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| 215 | |14647-2
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| 216 | |Total cholesterol (<200 mg/dl)
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| 217 | |162 mg/dl
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| 218 | |09/16/2009
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| 219 | |----
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| 220 | |Chemistry
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| 221 | |14646-4
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| 222 | |HDL cholesterol (?40 mg/dl)
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| 223 | |43 mg/dl
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| 224 | |09/16/2009
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| 225 | |----
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| 226 | |Chemistry
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| 227 | |2089-1
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| 228 | |LDL cholesterol (<100 mg/dl)
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| 229 | |84 mg/dl
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| 230 | |09/16/2009
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| 231 | |----
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| 232 | |Chemistry
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| 233 | |14927-8
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| 234 | |Triglycerides (<150 mg/dl)
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| 235 | |177 mg/dl
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| 236 | |09/16/2009
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| 237 | |----
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| 238 | |Imaging
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| 239 | |24648-8
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| 240 | |Chest X-ray, PA
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| 241 | |No disease is seen in the<br>lung fields or pleura
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| 242 | |09/16/2009
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| 243 | |----
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| 244 | |}
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| 245 |
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