NIST-EP-Patient-4-Visit-1

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

Patient
Name	Date/Time of Birth	Gender	Identification Number	Identification Number Type	Address/Phone
Susan Ellerby	12/08/1963 21:54:24	Female	925377799	Medical Record Number	483 Powell Street, Shawville, Pennsylvania 16873 814-645-9475

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

Problem List
Type	ICD-9 Code	Patient Problem	Status	Date Diagnosed
Condition	272.4	Hyperlipidemia	Active	07/06/2010
Type	SNOMED Code*	Patient Problem	Status	Date Diagnosed
Disorder	55822004	Hyperlipidemia	Active	07/06/2010

Medication List
RxNorm Code	Product	Generic Name	Brand Name	Strength	Dose	Route	Frequency	Date Started	Status
617314	Medication	atorvastatin calcium	Lipitor	10 mg	1 Tablet	PO	Q Day	07/06/2010	Active

Medication Allergy List
Type	SNOMED Code	Medication/Agent	Reaction	Date Recorded
Drug Allergy	91936005	Penicillin	Rash and anaphylaxis	05/22/1998
Drug Allergy	293597001	Codeine	Hives	02/17/1992

Diagnostic Test Results
Type	LOINC Code	Test (Normal Range)	Result	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

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