NIST Ambulatory Test Patient 2

Test Procedure for §170.304.i Exchange Clinical Information and Patient Summary Record  APPROVED (Pending) Version 1.0  July 21, 2010  

Patient Summary Record Test Data – Set #2

Patient
Name	Date/Time of Birth	Gender	Identification Number	Identification Number Type	Address/Phone
Ralph Johnson	06/28/1984 13:20:10	Male	9813466798	Medical Record Number	355 Elm Street Morton, Illinois 61550 309-377-8365

“Source” for all data for this patient: Carl Roberts, MD

Problem List
Type	ICD-9 Code	Patient Problem	Status	Date Diagnosed
Diagnosis	493.00	Asthma, unspecified	Active	12/22/2009
Diagnosis	250.02	Diabetes Mellitus, Type 2	Active	08/10/2008
Type	SNOMED Code*	Patient Problem	Status	Date Diagnosed
Disorder	195967001	Asthma	Active	12/22/2009
Disorder	44054006	Diabetes Mellitus, Type 2	Active	08/10/2008

Medication List
RxNorm Code	Product	Generic Name	Brand Name	Strength	Dose	Route	Frequency	Date Started	Status
206833	Medication	metaproternol sulfate	Alupent Inhalation Aerosol	15 mg/ml	2 Puffs	Inhaled	Q4h	12/22/2009	Active
205875	Medication	glyburide	Diabeta	2.5 mg	1 Tablet	PO	Q AM	08/10/2008	Active

Medication Allergy List
Type	SNOMED Code	Medication/Agent	Reaction	Date Recorded
Drug Allergy	91936005	Penicillin	Rash and anaphylaxis	08/10/2008
Drug Allergy	293620004	Indomethacin	Nausea, vomiting, rash, dizziness, headache	03/25/2003

Diagnostic Test Results
Type	LOINC Code	Test (Normal Range)	Result	Date Performed
Imaging	24648-8	Chest X-ray, PA	Increased bronchial wall markings, patchy infiltrates	02/16/2010
Chemistry	14771-0	Fasting Blood Glucose (70–100 mg/dl)	70 mg/dl	12/22/2009
Hematology	26449-9	Eosinophil Count (1 – 3 %)	2%	12/22/2009
Imaging	24648-8	Chest X-ray, PA	Bronchial wall markings	12/22/2009

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