| 1 | Patient Summary Record Test Data Set #3
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| 2 |
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| 3 | Patient
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| 4 | Name|Date/Time of Birth|Gender|Identification Number|Identification Number Type|Address/Phone
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| 5 | Lorraine Blevins|04/16/1957<br>20:15:35|Female|967385998|Medical Record Number|1020 Stuart Street<br>Morton, <br>Illinois 61550<br> 309-374-8938
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| 6 |
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| 7 | Source for all data for this patient: Louis Randolph, MD
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| 8 |
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| 9 | Problem List
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| 10 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
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| 11 | Diagnosis|715.35|Right hip osteoarthritis|Resolved|02/12/2010
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| 12 | Finding|414.01|Coronary Artery Disease (CAD)|Chronic|05/05/2002
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| 13 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 14 | Disorder|239872002|Right hip osteoarthritis|Resolved|02/12/2010
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| 15 | Disorder|53741008|Coronary Arteriosclerosis|Chronic|05/05/2002
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| 16 |
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| 17 | Medication List
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| 18 | RxNorm Code|Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 19 | 855320|Medication|warfarin|Coumadin|3 mg|1 Tablet|PO|QD|02/15/2010|Active
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| 20 | 209613|Medication|bisacodyl|Dulcolax|5 mg|1 Tablet|PO|QD|02/15/2010|Active
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| 21 | 309362|Medication|clopidogrel|Plavix|75 mg|1 Tablet|PO|QD|05/15/2002|Active
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| 22 | 197361|Medication|amlodipine|Norvasc|5 mg|1 Tablet|PO|QD|07/15/2009|Active
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| 23 |
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| 24 | Medication Allergy List
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| 25 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
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| 26 | Drug Allergy|91939003|Sulfonamides|Hives, photosensitivity|06/06/1998
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| 27 | Drug Allergy|294506009|Ampicillin|Diarrhea, nausea, vomiting|04/25/1994
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| 28 |
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| 29 | Diagnostic Test Results
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| 30 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
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| 31 | Imaging|37721-8|X-ray, 2 views, Right Hip|Subchondral sclerosis,<br> increased density in<br>subchondral bone|02/12/2010
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| 32 | Imaging|24648-8|Chest X-ray, PA|No disease is seen in<br> the lung fields or pleura|06/05/2009
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| 33 | Hematology|718-7|Hemoglobin (male: 14-18 g/dl<br>female: 12-16 g/dl)|11.2 g/dl|06/05/2009
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| 34 | Hematology|4544-3|Hematocrit (male: 40-54% <br>female: 36-48%)|34%|06/05/2009
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| 35 | Coagulation|34714-6|Prothrombin Time/ International Normalized Ratio (PT/INR)<br>(2.5 3.5) |3.1|06/05/2009
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| 36 |
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| 37 | Procedure List
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| 38 | Type|ICD-9 Code|Procedure|Status|Date Performed
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| 39 | Surgical|81.51|Total Hip Replacement, Right|Completed|02/14/2010
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| 40 | Cardiac|37.21|Cardiac catheterization|Completed|05/05/2002
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| 41 | Type|CPT Code*|Procedure|Status|Date Performed
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| 42 | Surgical|27130|Total Hip Replacement, Right|Completed|02/14/2010
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| 43 | Cardiac|93501|Cardiac catheterization|Completed|05/05/2002
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