| [1029] | 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 #4|Office Visit #2 for Susan Ellerby
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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 | Susan Ellerby|12/08/1963 21:54:24|Female|925377799|Medical Record Number|483 Powell Street,<br>Shawville,<br>Pennsylvania 16873<br>814-645-9475
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| 13 |
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| 14 | Source for all data for this patient: Dorcas Wayne, 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 | Symptom|401.9|Hypertension, Essential|Active|02/05/2010
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| 19 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 20 | Disorder|59621000|Essential Hypertension|Active|02/05/2010
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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 | 200801|Medication|furosemide|Lasix|20 mg|1 Tablet|PO|BID|02/05/2010|Active
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| 25 | 628958|Medication|potassium chloride|Klor-Con|10 mEq|1 Tablet|PO|BID|02/05/2010|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|05/22/1998
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| 30 | Drug Allergy|293597001|Codeine|Hives|02/17/1992
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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 | Chemistry|2823-3|Potassium (3.55.3 mg/dl)|4.5 mg/dl|02/05/2010
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| 35 | Imaging|42272-5|Chest X-ray, PA & Lateral|The heart outline is normal and the hilar and mediastinal vessels are of normal appearance|02/05/2010
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