NIST-EP-Patient-5-Visit-1

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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 #5|Office Visit #1 for Johnathan Stone

Patient
Name Date/Time of Birth Gender Identification Number Identification Number Type Address/Phone
Johnathan Stone 11/12/1966 08:18:08 Male 988772587 Medical Record Number 937 Sutter Street
Aurora,
Colorado 80011
303-544-9988

“Source” for all data for this patient: Samuel Johnston, MD

Problem List
Type ICD-9 Code Patient Problem Status Date Diagnosed
Diagnosis 250.02 Diabetes Mellitus, Type 2 Active 07/17/2010
Type SNOMED Code* Patient Problem Status Date Diagnosed
Disorder 44054006 Diabetes Mellitus, Type 2 Active 07/17/2010
Medication List
RxNorm Code Product Generic Name Brand Name Strength Dose Route Frequency Date Started Status
205875 Medication glyburide Diabeta 2.5 mg 1 Tablet PO Q AM 07/17/2010 Active
Medication Allergy List
Type SNOMED Code Medication/Agent Reaction Date Recorded
Drug Allergy 294506009 Ampicillin Diarrhea, nausea, vomiting 03/25/1997
Drug Allergy 91939003 Sulfonamides Hives, photosensitivity 04/25/1989
Diagnostic Test Results
Type LOINC Code Test (Normal Range) Result Date Performed
Chemistry 14771-0 LOINC Fasting Blood Glucose (70–100 mg/dl) 120 mg/dl 07/17/2010

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