| Rev | Line | |
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| [1021] | 1 | Clinical Summaries Test Data Set #5 Office Visit #1 for Johnathan Stone
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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 | Johnathan 11/12/1966 Male 988772587 Medical Record Number 937 Sutter Street, Aurora,
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| 6 | Stone 08:18:08 Colorado 80011
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| 7 | 303-544-9988
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| 8 |
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| 9 | Source for all data for this patient: Samuel Johnston, MD
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| 10 |
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| 11 | Problem List
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| 12 | Type ICD-9 Code Patient Problem Status Date Diagnosed
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| 13 | Diagnosis 250.02 Diabetes Mellitus, Type 2 Active 07/17/2010
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| 14 |
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| 15 | Type SNOMED Code* Patient Problem Status Date Diagnosed
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| 16 | Disorder 44054006 Diabetes Mellitus, Type 2 Active 07/17/2010
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| 17 |
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| 18 | Medication List
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| 19 | RxNorm
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| 20 | Product Generic Name Brand Name Strength Dose Route Frequency Date Started Status
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| 21 | Code
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| 22 | 205875 Medication glyburide Diabeta 2.5 mg 1 Tablet PO Q AM 07/17/2010 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 294506009 Ampicillin Diarrhea, nausea, vomiting 03/25/1997
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| 27 | Drug Allergy 91939003 Sulfonamides Hives, photosensitivity 04/25/1989
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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 | Chemistry 14771-0 LOINC Fasting Blood Glucose (70100 mg/dl) 120 mg/dl 07/17/2010
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