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 #2 for Jonas Barnaby {| 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 |---- |Jonas Barnaby |07/14/1961 12:30:24 |Male |969988999 |Medical Record Number |478 Charles Street,
Williamsport,
Pennsylvania 17701
570-857-8593 |---- |} “Source” for all data for this patient: Marcus Welby, 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 |02/20/2010 |---- |---- !scope="col"|Type !scope="col"|SNOMED Code* !scope="col"|Patient Problem !scope="col"|Status !scope="col"|Date Diagnosed |---- |Disorder |55822004 |Hyperlipidemia |Active |02/20/2010 |---- |} {| 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 |02/20/2010 |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 |293597001 |Codeine |Hives |06/27/1996 |---- |Drug Allergy |294506009 |Ampicillin |Diarrhea, nausea, vomiting |03/15/1994 |---- |} {| 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) |262 mg/dl |02/20/2010 |---- |Chemistry |14646-4 |HDL cholesterol (?40 mg/dl) |78 mg/dl |02/20/2010 |---- |Chemistry |2089-1 |LDL cholesterol (<100 mg/dl) |184 mg/dl |02/20/2010 |---- |Chemistry |14927-8 |Triglycerides (<150 mg/dl) |177 mg/dl |02/20/2010 |----