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| 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 #1|Office Visit #1 for Jonas Barnaby
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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 | Jonas Barnaby|07/14/1961|Male|969988999|Medical Record Number|478 Charles Street,
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| 13 | 12:30:24|Williamsport,
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| 14 | Pennsylvania|17701
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| 15 | 570-857-8593
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| 16 |
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| 17 | Source for all data for this patient: Marcus Welby, MD
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| 18 |
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| 19 | Problem List
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| 20 | Type|ICD-9 Code|Patient Problem|Status|Date Diagnosed
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| 21 | Diagnosis|250.02|Diabetes Mellitus, Type 2|Active|07/20/2010
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| 22 |
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| 23 | Type|SNOMED Code*|Patient Problem|Status|Date Diagnosed
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| 24 | Disorder|44054006|Diabetes Mellitus, Type 2|Active|07/20/2010
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| 25 |
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| 26 | Medication List
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| 27 | RxNorm
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| 28 | |Product|Generic Name|Brand Name|Strength|Dose|Route|Frequency|Date Started|Status
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| 29 | Code
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| 30 | 205875|Medication|glyburide|Diabeta|2.5 mg|1 Tablet|PO|Q AM|07/20/2010|Active
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| 31 |
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| 32 | Medication Allergy List
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| 33 | Type|SNOMED Code|Medication/Agent|Reaction|Date Recorded
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| 34 | Drug Allergy|293597001|Codeine|Hives|06/27/1996
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| 35 | Drug Allergy|294506009|Ampicillin|Diarrhea, nausea, vomiting|03/15/1994
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| 36 |
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| 37 |
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| 38 | Diagnostic Test Results
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| 39 | Type|LOINC Code|Test (Normal Range)|Result|Date Performed
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| 40 | Chemistry|14771-0|Fasting Blood Glucose (70100 mg/dl)|178 mg/dl|07/20/2010
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