| 1 | Test Procedure for §170.304.h Clinical Summaries
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| 2 | APPROVED (Pending) Version 1.0 July 21, 2010
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| 3 |
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| 4 | TD170.304.h.: Clinical summaries
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| 5 |
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| 6 | * indicates alternative standard code per certification criteria
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| 7 |
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| 8 | Clinical Summaries Test Data Set #3|Office Visit #2 for Barbara Simpson
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| 9 |
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| 10 | Patient
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| 11 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone
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| 12 | Barbara Simpson|10/12/1956 19:47:01|Female|9688675266|Medical Record Number|996 Dalton Street,<br>Fargo,<br>North Dakota 54102<br>701-366-5534
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| 13 |
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| 14 | Source for all data for this patient: Robert James, MD
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| 15 |
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| 16 | Problem List
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| 17 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
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| 18 | Diagnosis|496.0|Chronic Obstructive Pulmonary Disease|Chronic|02/10/2010
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| 19 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 20 | Disorder|13645005|Chronic Obstructive Lung Disease|Chronic|02/10/2010
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| 21 |
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| 22 | Medication List
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| 23 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 24 | 836370|Medication|ipratropium bromide monohydrate|Atrovent Inhaler|18 mcg/puff|2 Puffs|Inhaled|QID|02/10/2010|Active
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| 25 | 630208|Medication|albuterol sulfate|Albuterol Inhaler|2.5 mg/3ml|2 Puffs|Inhaled|Q 4 hours as needed|02/10/2010|Active
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| 26 |
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| 27 | Medication Allergy List
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| 28 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
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| 29 | Drug Allergy|91936005|Penicillin|Rash and anaphylaxis|06/10/2009
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| 30 | Drug Allergy|91939003|Sulfonamides|Hives, photosensitivity|04/25/1988
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| 31 |
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| 32 | Diagnostic Test Results
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| 33 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
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| 34 | Imaging|42272-5|Chest X-ray, PA & Lateral|Hyperinflated lungs with flattened diaphragm and central pulmonary artery enlargement|02/10/2010
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| 35 | Hematology|718-7|Hemoglobin (male: 14-18 g/dl female: 12-16 g/dl)|16 g/dl|02/10/2010
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| 36 | Hematology|4544-3|Hematocrit (male: 40-54% female: 36-48%)|45%|02/10/2010
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