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,<br>Williamsport,<br>Pennsylvania 17701<br>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
|----