source: hData/trunk/test-patients/NIST-Inpatient-test-patient-2-wiki.txt@ 1154

Last change on this file since 1154 was 1024, checked in by George Lilly, 14 years ago

wiki conversion of NIST Inpatient test cases completed

File size: 4.5 KB
RevLine 
[1024]1Patient Summary Record Test Data – Set #2
2
3{| border="1"|
4!colspan="6"|Patient
5|----
6!scope="col"|Name
7!scope="col"|Date/Time of Birth
8!scope="col"|Gender
9!scope="col"|Identification Number
10!scope="col"|Identification Number Type
11!scope="col"|Address/Phone
12|----
13|Ruth Warholde
14|05/20/1954<br>23:59:45
15|Female
16|9836469798
17|Medical Record Number
18|225 Park Street <br>Morton, <br>Illinois 61550<br>309-354-9385
19|----
20|----
21|}
22
23“Source” for all data for this patient: Jackson Shoals, MD
24
25{| border="1"|
26!colspan="6"|Problem List
27|----
28!scope="col"|Type
29!scope="col"|ICD-9 Code
30!scope="col"|Patient Problem
31!scope="col"|Status
32!scope="col"|Date Diagnosed
33|----
34|Diagnosis
35|780.2
36|Syncope and collapse, vasovagal attack
37|Active
38|02/15/2010
39|----
40|Diagnosis
41|434.91
42|Cerebrovascular Accident (Stroke)
43|Resolved
44|07/09/2009
45|----
46|Diagnosis
47|599.0
48|Urinary tract infection
49|Recurrent
50|09/22/2008
51|----
52|Diagnosis
53|496.0
54|Chronic Obstructive Pulmonary Disease
55|Chronic
56|08/12/2007
57|----
58|Symptom
59|401.9
60|Hypertension, essential
61|Chronic
62|05/16/2006
63|----
64|----
65!scope="col"|Type
66!scope="col"|SNOMED Code*
67!scope="col"|Patient Problem
68!scope="col"|Status
69!scope="col"|Date Diagnosed
70|----
71|Disorder
72|398665005
73|Vasovagal syncope
74|Active
75|02/15/2010
76|----
77|Disorder
78|230690007
79|Cerebrovascular Accident (Stroke)
80|Resolved
81|07/09/2009
82|----
83|Disorder
84|197927001
85|Recurrent urinary tract infection
86|Recurrent
87|09/22/2008
88|----
89|Disorder
90|13645005
91|Chronic Obstructive Lung Disease
92|Chronic
93|08/12/2007
94|----
95|Disorder
96|59621000
97|Essential Hypertension
98|Chronic
99|05/16/2006
100|----
101|}
102
103{| border="1"|
104!colspan="10"|Medication List
105|----
106!scope="col"|RxNorm Code
107!scope="col"|Product
108!scope="col"|Generic Name
109!scope="col"|Brand Name
110!scope="col"|Strength
111!scope="col"|Dose
112!scope="col"|Route
113!scope="col"|Frequency
114!scope="col"|Date Started
115!scope="col"|Status
116|----
117|209834
118|Medication
119|docusate
120|Colace
121|100 mg
122|1 Capsule
123|PO
124|BID
125|02/16/2010
126|Active
127|----
128|205326
129|Medication
130|lisinopril
131|Zestril
132|30 mg
133|1 Tablet
134|PO
135|QD
136|07/15/2009
137|Active
138|----
139|309362
140|Medication
141|clopidogrel
142|Plavix
143|75 mg
144|1 Tablet
145|PO
146|QD
147|07/15/2009
148|Active
149|----
150|197361
151|Medication
152|amlodipine
153|Norvasc
154|5 mg
155|1 Tablet
156|PO
157|QD
158|07/15/2009
159|Active
160|----
161|539712
162|Medication
163|nitrofurantoin
164|Macrobid
165|100 mg
166|1 Capsule
167|PO
168|QD
169|09/22/2008
170|No Longer Active
171|----
172|836370
173|Medication
174|ipratropium bromide monhydrate
175|Atrovent inhaler
176|18 mcg/puff
177|2 puffs
178|By oral inhalation
179|QID
180|08/14/2007
181|Active
182|----
183|884175
184|Medication
185|clonidine hydrochloride
186|Catapres
187|0.1 mg
188|1 Tablet
189|PO
190|BID
191|05/16/2006
192|Active
193|----
194|}
195
196{| border="1"|
197!colspan="5"|Medication Allergy List
198|----
199!scope="col"|Type
200!scope="col"|SNOMED Code
201!scope="col"|Medication/Agent
202!scope="col"|Reaction
203!scope="col"|Date Recorded
204|----
205|Drug Allergy
206|293620004
207|Indomethacin
208|Nausea, vomiting, rash, dizziness, headache
209|03/25/2003
210|----
211|Drug Allergy
212|91939003
213|Sulfonamides
214|Hives, photosensitivity
215|07/26/1999
216|----
217|}
218
219{| border="1"|
220!colspan="5"|Diagnostic Test Results
221|----
222!scope="col"|Type
223!scope="col"|LOINC Code
224!scope="col"|Test (Normal Range)
225!scope="col"|Result
226!scope="col"|Date Performed
227|----
228|Imaging
229|11539-4
230|CT, head
231|Small high right occipital lobe <br>contusion. No evidence of <br>extra-axial blood. Significant <br>sinus disease.
232|02/24/2010
233|----
234|Hematology
235|718-7
236|Hemoglobin (male: 14-18 g/dl female: 12-16 g/dl)
237|13 g/dl
238|02/17/2010
239|----
240|Hematology
241|4544-3
242|Hematocrit (male: 40-54% female: 36-48%)
243|38%
244|02/17/2010
245|----
246|Chemistry
247|2951-2
248|Sodium (135–146 mg/dl)
249|136 mg/dl
250|02/17/2010
251|----
252|Chemistry
253|2823-3
254|Potassium (3.5–5.3 mg/dl)
255|3.9 mg/dl
256|02/17/2010
257|----
258|Imaging
259|34534-8
260|Electrocardiogram
261|Normal Sinus Rhythm
262|02/15/2010
263|----
264|Microbiology
265|630-4
266|Urine culture, routine <br>(Negative: No growth Positive: >10,000 CFU/ml)
267|Negative: No growth
268|10/02/2008
269|----
270|}
271
272{| border="1"|
273!colspan="5"|Procedure List
274|----
275!scope="col"|Type
276!scope="col"|ICD-9 Code
277!scope="col"|Procedure
278!scope="col"|Status
279!scope="col"|Date Performed
280|----
281|Surgical
282|66.39
283|Bilateral tubal ligation
284|Completed
285|06/14/1990
286|----
287|----
288!scope="col"|Type
289!scope="col"|CPT Code*
290!scope="col"|Procedure
291!scope="col"|Status
292!scope="col"|Date Performed
293|----
294|Surgical
295|58600
296|Bilateral tubal ligation
297|----
Note: See TracBrowser for help on using the repository browser.