1 | Patient Summary Record Test Data Set #5
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2 |
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3 | {| border="1"|
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4 | !colspan="6"|Patient
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5 | |----
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6 | !scope="col"|Name
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7 | !scope="col"|Date/Time of Birth
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8 | !scope="col"|Gender
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9 | !scope="col"|Identification Number
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10 | !scope="col"|Identification Number Type
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11 | !scope="col"|Address/Phone
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12 | |----
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13 | |Matthew Brown
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14 | |09/22/1965 16:48:25
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15 | |Male
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16 | |988730987
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17 | |Medical Record Number
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18 | |754 Sharp Street<br>Aurora,<br>Colorado 80011<br>303-544-9988
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19 | |----
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20 | |}
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21 |
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22 | Source for all data for this patient: Pamela Jones, MD
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23 |
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24 | {| border="1"|
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25 | !colspan="6"|Problem List
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26 | |----
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27 | !scope="col"|Type
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28 | !scope="col"|ICD-9 Code
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29 | !scope="col"|Patient Problem
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30 | !scope="col"|Status
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31 | !scope="col"|Date Diagnosed
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32 | |----
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33 | |Diagnosis
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34 | |250.02
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35 | |Diabetes Mellitus, Type 2
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36 | |Active
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37 | |07/17/2009
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38 | |----
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39 | |Symptom
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40 | |401.9
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41 | |Hypertension, Essential
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42 | |Active
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43 | |06/05/2008
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44 | |----
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45 | |----
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46 | !scope="col"|Type
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47 | !scope="col"|SNOMED Code*
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48 | !scope="col"|Patient Problem
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49 | !scope="col"|Status
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50 | !scope="col"|Date Diagnosed
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51 | |----
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52 | |Disorder
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53 | |44054006
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54 | |Diabetes Mellitus, Type 2
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55 | |Active
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56 | |07/17/2009
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57 | |----
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58 | |Disorder
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59 | |59621000
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60 | |Essential Hypertension
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61 | |Active
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62 | |06/05/2008
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63 | |----
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64 | |}
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65 |
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66 | {| border="1"|
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67 | !colspan="10"|Medication List
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68 | |----
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69 | !scope="col"|RxNorm Code
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70 | |----
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71 | |
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72 | |Product
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73 | |Generic Name
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74 | |Brand Name
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75 | |Strength
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76 | |Dose
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77 | |Route
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78 | |Frequency
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79 | |Date Started
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80 | |Status
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81 | |----
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82 | |205875
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83 | |Medication
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84 | |glyburide
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85 | |Diabeta
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86 | |2.5 mg
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87 | |1 Tablet
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88 | |PO
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89 | |Q AM
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90 | |07/17/2009
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91 | |Active
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92 | |----
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93 | |200801
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94 | |Medication
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95 | |furosemide
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96 | |Lasix
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97 | |20 mg
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98 | |1 Tablet
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99 | |PO
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100 | |BID
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101 | |06/05/2008
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102 | |Active
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103 | |----
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104 | |628958
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105 | |Medication
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106 | |potassium chloride
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107 | |Klor-Con
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108 | |10 mEq
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109 | |1 Tablet
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110 | |PO
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111 | |BID
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112 | |06/05/2008
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113 | |Active
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114 | |----
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115 | |}
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116 |
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117 | {| border="1"|
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118 | !colspan="5"|Medication Allergy List
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119 | |----
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120 | !scope="col"|Type
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121 | !scope="col"|SNOMED Code
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122 | !scope="col"|Medication/Agent
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123 | !scope="col"|Reaction
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124 | !scope="col"|Date Recorded
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125 | |----
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126 | |Drug Allergy
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127 | |294506009
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128 | |Ampicillin
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129 | |Diarrhea, nausea, vomiting
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130 | |03/25/1997
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131 | |----
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132 | |Drug Allergy
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133 | |91939003
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134 | |Sulfonamides
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135 | |Hives, photosensitivity
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136 | |04/25/1989
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137 | |----
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138 | |}
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139 |
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140 | {| border="1"|
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141 | !colspan="5"|Diagnostic Test Results
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142 | |----
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143 | !scope="col"|Type
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144 | !scope="col"|LOINC Code
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145 | !scope="col"|Test (Normal Range)
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146 | !scope="col"|Result
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147 | !scope="col"|Date Performed
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148 | |----
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149 | |Chemistry
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150 | |14771-0
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151 | |Fasting Blood Glucose (70100 mg/dl)
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152 | |145 mg/dl
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153 | |07/17/2009
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154 | |----
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155 | |Hemistry
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156 | |2823-3
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157 | |Potassium (3.55.3 mg/dl)
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158 | |4.5 mg/dl
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159 | |07/17/2009
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160 | |----
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161 | |Chemistry
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162 | |14927-8
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163 | |Triglycerides (<150 mg/dl)
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164 | |187 mg/dl
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165 | |07/17/2009
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166 | |----
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167 | |42272-5
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168 | |Imaging
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169 | |Chest X-ray, PA & Lateral
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170 | |The heart outline is normal<br>and the hilar and<br>mediastinal vessels are of<br>normal appearance
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171 | |07/17/2009
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172 | |----
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