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 #3|Office Visit #1 for Barbara Simpson

{| 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
|----
|Barbara Simpson
|10/12/1956 19:47:01
|Female
|9688675266
|Medical Record Number
|996 Dalton Street,<br>Fargo,<br>North Dakota 54102<br>701-366-5534
|----
|}

“Source” for all data for this patient: Robert James, 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
|----
|Diagnosis
|486
|Pneumonia
|Active
|07/02/2010
|----
|----
!scope="col"|Type
!scope="col"|SNOMED Code*
!scope="col"|Patient Problem
!scope="col"|Status
!scope="col"|Date Diagnosed
|----
|Disorder
|233604007
|Pneumonia
|Active
|07/02/2010
|----
|}

{| 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
|----
|308460
|Medication
|azithromycin
|Azithromycin
|250 mg
|1 Tablet
|PO
|QD
|07/02/2010
|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
|06/10/2009
|----
|Drug Allergy
|91939003
|Sulfonamides
|Hives, photosensitivity
|04/25/1988
|----
|}

{| 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
|----
|Imaging
|42272-5
|Chest X-ray, PA & Lateral
|Bilateral Pneumonia
|07/02/2010
|----
|Cardiology
|34534-8
|Electrocardiogram
|Sinus Tachycardia
|07/02/2010
|----