source: hData/trunk/test-patients/NIST-Ambulatory-test-patient-2.csv@ 1217

Test Procedure for §170.304.i Exchange Clinical Information and Patient Summary Record  
APPROVED (Pending) Version 1.0  July 21, 2010   

Patient Summary Record Test Data – Set #2 

Patient 
Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone 
Ralph Johnson|06/28/1984 13:20:10|Male|9813466798|Medical Record Number|355 Elm Street<br>Morton,<br>Illinois 61550<br>309-377-8365 

“Source” for all data for this patient: Carl Roberts, MD 

Problem List 
Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed 
Diagnosis|493.00|Asthma, unspecified|Active|12/22/2009 
Diagnosis|250.02|Diabetes Mellitus, Type 2|Active|08/10/2008 
Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed 
Disorder|195967001|Asthma|Active|12/22/2009 
Disorder|44054006|Diabetes Mellitus, Type 2|Active|08/10/2008 

Medication List 
RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status 
206833|Medication|metaproternol sulfate|Alupent Inhalation Aerosol|15 mg/ml|2 Puffs|Inhaled|Q4h|12/22/2009|Active 
205875|Medication|glyburide|Diabeta|2.5 mg|1 Tablet|PO|Q AM|08/10/2008|Active 

Medication Allergy List 
Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded 
Drug Allergy|91936005|Penicillin|Rash and anaphylaxis|08/10/2008 
Drug Allergy|293620004|Indomethacin|Nausea, vomiting, rash,<br>dizziness, headache|03/25/2003 

Diagnostic Test Results 
Type|LOINC Code|Test (Normal Range)|Result|Date Performed 
Imaging|24648-8|Chest X-ray, PA|Increased bronchial wall<br>markings, patchy infiltrates|02/16/2010 
Chemistry|14771-0|Fasting Blood Glucose (70–100 mg/dl)|70 mg/dl|12/22/2009 
Hematology|26449-9|Eosinophil Count (1 – 3 %)|2%|12/22/2009 
Imaging|24648-8|Chest X-ray, PA|Bronchial wall markings|12/22/2009