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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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