Test Procedure for §170.304.h Clinical Summaries  
APPROVED (Pending) Version 1.0  July 21, 2010   

TD170.304.h.: Clinical summaries 

* indicates alternative standard code per certification criteria 

Clinical Summaries Test Data – Set #1  Office Visit #1 for Jonas Barnaby 

Patient 
        Name              Date/Time of Birth         Gender        Identification Number        Identification Number Type             Address/Phone 
Jonas Barnaby            07/14/1961               Male             969988999                   Medical Record Number               478 Charles Street, 
                         12:30:24                                                                                                  Williamsport, 
                                                                                                                                   Pennsylvania  17701 
                                                                                                                                   570-857-8593 

“Source” for all data for this patient: Marcus Welby, MD 

Problem List 
       Type                  ICD-9 Code                              Patient Problem                               Status              Date Diagnosed 
Diagnosis              250.02                     Diabetes Mellitus, Type 2                                  Active                07/20/2010 

       Type               SNOMED Code*                               Patient Problem                               Status              Date Diagnosed 
Disorder               44054006                   Diabetes Mellitus, Type 2                                  Active                07/20/2010 

Medication List 
  RxNorm 
                   Product        Generic Name         Brand Name        Strength        Dose        Route      Frequency        Date Started       Status 
    Code 
205875          Medication        glyburide           Diabeta            2.5 mg       1 Tablet       PO        Q AM             07/20/2010        Active 

Medication Allergy List 
          Type                      SNOMED Code                       Medication/Agent                        Reaction                   Date Recorded 
Drug Allergy                293597001                           Codeine                            Hives                             06/27/1996 
Drug Allergy                294506009                           Ampicillin                         Diarrhea, nausea, vomiting        03/15/1994 

                                                                                  
Diagnostic Test Results 
        Type                 LOINC Code                      Test (Normal Range)                              Result                   Date Performed 
Chemistry                14771-0                  Fasting Blood Glucose (70–100 mg/dl)            178 mg/dl                        07/20/2010