| [1029] | 1 | Test Procedure for §170.304.h Clinical Summaries
|
|---|
| 2 | APPROVED (Pending) Version 1.0 July 21, 2010
|
|---|
| 3 |
|
|---|
| 4 | TD170.304.h.: Clinical summaries
|
|---|
| 5 |
|
|---|
| 6 | * indicates alternative standard code per certification criteria
|
|---|
| 7 |
|
|---|
| 8 | Clinical Summaries Test Data Set #2|Office Visit #1 for Robert Flint
|
|---|
| 9 |
|
|---|
| 10 | Patient
|
|---|
| 11 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone
|
|---|
| 12 | Robert Flint|04/18/1983 20:18:04|Male|9813624798|Medical Record Number|747 Market Street,<br>Morton,<br>Illinois 61550<br>309-365-8298
|
|---|
| 13 |
|
|---|
| 14 | Source for all data for this patient: Carl Roberts, MD
|
|---|
| 15 |
|
|---|
| 16 | Problem List
|
|---|
| 17 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
|
|---|
| 18 | Diagnosis|493.00|Asthma, unspecified|Active|07/19/2009
|
|---|
| 19 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
|
|---|
| 20 | Disorder|195967001|Asthma|Active|07/19/2009
|
|---|
| 21 |
|
|---|
| 22 | Medication List
|
|---|
| 23 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
|
|---|
| 24 | 206833|Medication|metaproterenol sulfate|Alupent Inhalation Aerosol|15 mg/ml|2 Puffs|Inhaled|Q4h|07/19/2009|Active
|
|---|
| 25 |
|
|---|
| 26 | Medication Allergy List
|
|---|
| 27 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
|
|---|
| 28 | Drug Allergy|91936005|Penicillin|Rash and anaphylaxis|08/10/2008
|
|---|
| 29 | Drug Allergy|293620004|Indomethacin|Nausea, vomiting, rash, dizziness, headache|03/25/2003
|
|---|
| 30 |
|
|---|
| 31 | Diagnostic Test Results
|
|---|
| 32 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
|
|---|
| 33 | Imaging|24648-8|Chest X-ray, PA|Increased bronchial wall markings, patchy infiltrates|07/19/2009
|
|---|
