source: hData/trunk/test-patients/NIST-Ambulatory-test-patient-2-wiki.txt@ 1731

Last change on this file since 1731 was 1030, checked in by mishpers@gmail.com, 14 years ago

Add ambulatory test patients 2-5

File size: 2.7 KB
Line 
1Test Procedure for §170.304.i Exchange Clinical Information and Patient Summary Record 
2APPROVED (Pending) Version 1.0  July 21, 2010  
3
4Patient Summary Record Test Data – Set #2
5
6{| border="1"|
7!colspan="6"|Patient
8|----
9!scope="col"|Name
10!scope="col"|Date/Time of Birth
11!scope="col"|Gender
12!scope="col"|Identification Number
13!scope="col"|Identification Number Type
14!scope="col"|Address/Phone
15|----
16|Ralph Johnson
17|06/28/1984 13:20:10
18|Male
19|9813466798
20|Medical Record Number
21|355 Elm Street<br>Morton,<br>Illinois 61550<br>309-377-8365
22|----
23|}
24
25“Source” for all data for this patient: Carl Roberts, MD
26
27{| border="1"|
28!colspan="6"|Problem List
29|----
30!scope="col"|Type
31!scope="col"|ICD-9 Code
32!scope="col"|Patient Problem
33!scope="col"|Status
34!scope="col"|Date Diagnosed
35|----
36|Diagnosis
37|493.00
38|Asthma, unspecified
39|Active
40|12/22/2009
41|----
42|Diagnosis
43|250.02
44|Diabetes Mellitus, Type 2
45|Active
46|08/10/2008
47|----
48|----
49!scope="col"|Type
50!scope="col"|SNOMED Code*
51!scope="col"|Patient Problem
52!scope="col"|Status
53!scope="col"|Date Diagnosed
54|----
55|Disorder
56|195967001
57|Asthma
58|Active
59|12/22/2009
60|----
61|Disorder
62|44054006
63|Diabetes Mellitus, Type 2
64|Active
65|08/10/2008
66|----
67|}
68
69{| border="1"|
70!colspan="10"|Medication List
71|----
72!scope="col"|RxNorm Code
73!scope="col"|Product
74!scope="col"|Generic Name
75!scope="col"|Brand Name
76!scope="col"|Strength
77!scope="col"|Dose
78!scope="col"|Route
79!scope="col"|Frequency
80!scope="col"|Date Started
81!scope="col"|Status
82|----
83|206833
84|Medication
85|metaproternol sulfate
86|Alupent Inhalation Aerosol
87|15 mg/ml
88|2 Puffs
89|Inhaled
90|Q4h
91|12/22/2009
92|Active
93|----
94|205875
95|Medication
96|glyburide
97|Diabeta
98|2.5 mg
99|1 Tablet
100|PO
101|Q AM
102|08/10/2008
103|Active
104|----
105|}
106
107{| border="1"|
108!colspan="5"|Medication Allergy List
109|----
110!scope="col"|Type
111!scope="col"|SNOMED Code
112!scope="col"|Medication/Agent
113!scope="col"|Reaction
114!scope="col"|Date Recorded
115|----
116|Drug Allergy
117|91936005
118|Penicillin
119|Rash and anaphylaxis
120|08/10/2008
121|----
122|Drug Allergy
123|293620004
124|Indomethacin
125|Nausea, vomiting, rash,<br>dizziness, headache
126|03/25/2003
127|----
128|}
129
130{| border="1"|
131!colspan="5"|Diagnostic Test Results
132|----
133!scope="col"|Type
134!scope="col"|LOINC Code
135!scope="col"|Test (Normal Range)
136!scope="col"|Result
137!scope="col"|Date Performed
138|----
139|Imaging
140|24648-8
141|Chest X-ray, PA
142|Increased bronchial wall<br>markings, patchy infiltrates
143|02/16/2010
144|----
145|Chemistry
146|14771-0
147|Fasting Blood Glucose (70–100 mg/dl)
148|70 mg/dl
149|12/22/2009
150|----
151|Hematology
152|26449-9
153|Eosinophil Count (1 – 3 %)
154|2%
155|12/22/2009
156|----
157|Imaging
158|24648-8
159|Chest X-ray, PA
160|Bronchial wall markings
161|12/22/2009
162|----
Note: See TracBrowser for help on using the repository browser.