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 #4|Office Visit #1 for Susan Ellerby

{| border="1"|
!colspan="6"|Patient
|----
!scope="col"|Name
!scope="col"|Date/Time of Birth
!scope="col"|Gender
!scope="col"|Identification Number
!scope="col"|Identification Number Type
!scope="col"|Address/Phone
|----
|Susan Ellerby
|12/08/1963 21:54:24
|Female
|925377799
|Medical Record Number
|483 Powell Street,<br>Shawville,<br>Pennsylvania 16873<br>814-645-9475
|----
|}

“Source” for all data for this patient: Dorcas Wayne, MD

{| border="1"|
!colspan="6"|Problem List
|----
!scope="col"|Type
!scope="col"|ICD-9 Code
!scope="col"|Patient Problem
!scope="col"|Status
!scope="col"|Date Diagnosed
|----
|Condition
|272.4
|Hyperlipidemia
|Active
|07/06/2010
|----
|----
!scope="col"|Type
!scope="col"|SNOMED Code*
!scope="col"|Patient Problem
!scope="col"|Status
!scope="col"|Date Diagnosed
|----
|Disorder
|55822004
|Hyperlipidemia
|Active
|07/06/2010
|----
|}

{| border="1"|
!colspan="10"|Medication List
|----
!scope="col"|RxNorm Code
!scope="col"|Product
!scope="col"|Generic Name
!scope="col"|Brand Name
!scope="col"|Strength
!scope="col"|Dose
!scope="col"|Route
!scope="col"|Frequency
!scope="col"|Date Started
!scope="col"|Status
|----
|617314
|Medication
|atorvastatin calcium
|Lipitor
|10 mg
|1 Tablet
|PO
|Q Day
|07/06/2010
|Active
|----
|}

{| border="1"|
!colspan="5"|Medication Allergy List
|----
!scope="col"|Type
!scope="col"|SNOMED Code
!scope="col"|Medication/Agent
!scope="col"|Reaction
!scope="col"|Date Recorded
|----
|Drug Allergy
|91936005
|Penicillin
|Rash and anaphylaxis
|05/22/1998
|----
|Drug Allergy
|293597001
|Codeine
|Hives
|02/17/1992
|----
|}


{| border="1"|
!colspan="5"|Diagnostic Test Results
|----
!scope="col"|Type
!scope="col"|LOINC Code
!scope="col"|Test (Normal Range)
!scope="col"|Result
!scope="col"|Date Performed
|----
|Chemistry
|14647-2
|Total cholesterol (<200 mg/dl)
|279 mg/dl
|07/06/2010
|----
|Chemistry
|14646-4
|HDL cholesterol (?40 mg/dl)
|89 mg/dl
|07/06/2010
|----
|Chemistry
|2089-1
|LDL cholesterol (<100 mg/dl)
|190 mg/dl
|07/06/2010
|----
|Chemistry
|14927-8
|Triglycerides (<150 mg/dl)
|187 mg/dl
|07/06/2010
|----