Difference between revisions of "NIST-Inpatient-test-patient-2"

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Patient Summary Record Test Data – Set #2
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Patient Summary [[Record~|Record]] Test Data – Set #2
  
 
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|Female
 
|Female
 
|9836469798
 
|9836469798
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|Medical Record Number
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|Medical [[Record~|Record]] Number
 
|225 Park Street <br>Morton, <br>Illinois  61550<br>309-354-9385
 
|225 Park Street <br>Morton, <br>Illinois  61550<br>309-354-9385
 
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!colspan="5"|Medication Allergy List
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!colspan="5"|Medication [[Allergy~|Allergy]] List
 
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!scope="col"|Type
 
!scope="col"|Type
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!scope="col"|Medication/Agent
 
!scope="col"|Medication/Agent
 
!scope="col"|Reaction
 
!scope="col"|Reaction
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!scope="col"|Date Recorded
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!scope="col"|Date [[Record~|Record]]ed
 
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|Drug Allergy
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|Drug [[Allergy~|Allergy]]
 
|293620004
 
|293620004
 
|Indomethacin
 
|Indomethacin
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|03/25/2003
 
|03/25/2003
 
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|Drug Allergy
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|Drug [[Allergy~|Allergy]]
 
|91939003
 
|91939003
 
|Sulfonamides
 
|Sulfonamides
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|11539-4
 
|11539-4
 
|CT, head
 
|CT, head
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|Small high right occipital lobe <br>contusion. No evidence of <br>extra-axial blood. Significant <br>sinus disease.  
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|Small high right occipital lobe contusion. No evidence of extra-axial blood. Significant sinus disease.  
 
|02/24/2010
 
|02/24/2010
 
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|Microbiology
 
|Microbiology
 
|630-4
 
|630-4
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|Urine culture, routine <br>(Negative: No growth Positive: >10,000 CFU/ml)
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|Urine culture, routine (Negative: No growth Positive: >10,000 CFU/ml)
 
|Negative: No growth
 
|Negative: No growth
 
|10/02/2008
 
|10/02/2008
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|Bilateral tubal ligation
 
|Bilateral tubal ligation
 
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[https://trac.opensourcevista.net/browser/hData/trunk/test-patients/NIST-Inpatient-test-patient-2.csv CSV Format]
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--[[User:Glilly|Glilly]] 12:49, 22 Nov 2010 (PST)
 
--[[User:Glilly|Glilly]] 12:49, 22 Nov 2010 (PST)

Latest revision as of 14:05, 4 April 2012

Patient Summary Record Test Data – Set #2

Patient
Name Date/Time of Birth Gender Identification Number Identification Number Type Address/Phone
Ruth Warholde 05/20/1954
23:59:45 		Female 9836469798 Medical Record Number 225 Park Street
Morton,
Illinois 61550
309-354-9385

“Source” for all data for this patient: Jackson Shoals, MD

Problem List
Type ICD-9 Code Patient Problem Status Date Diagnosed
Diagnosis 780.2 Syncope and collapse, vasovagal attack Active 02/15/2010
Diagnosis 434.91 Cerebrovascular Accident (Stroke) Resolved 07/09/2009
Diagnosis 599.0 Urinary tract infection Recurrent 09/22/2008
Diagnosis 496.0 Chronic Obstructive Pulmonary Disease Chronic 08/12/2007
Symptom 401.9 Hypertension, essential Chronic 05/16/2006
Type SNOMED Code* Patient Problem Status Date Diagnosed
Disorder 398665005 Vasovagal syncope Active 02/15/2010
Disorder 230690007 Cerebrovascular Accident (Stroke) Resolved 07/09/2009
Disorder 197927001 Recurrent urinary tract infection Recurrent 09/22/2008
Disorder 13645005 Chronic Obstructive Lung Disease Chronic 08/12/2007
Disorder 59621000 Essential Hypertension Chronic 05/16/2006
Medication List
RxNorm Code Product Generic Name Brand Name Strength Dose Route Frequency Date Started Status
209834 Medication docusate Colace 100 mg 1 Capsule PO BID 02/16/2010 Active
205326 Medication lisinopril Zestril 30 mg 1 Tablet PO QD 07/15/2009 Active
309362 Medication clopidogrel Plavix 75 mg 1 Tablet PO QD 07/15/2009 Active
197361 Medication amlodipine Norvasc 5 mg 1 Tablet PO QD 07/15/2009 Active
539712 Medication nitrofurantoin Macrobid 100 mg 1 Capsule PO QD 09/22/2008 No Longer Active
836370 Medication ipratropium bromide monhydrate Atrovent inhaler 18 mcg/puff 2 puffs By oral inhalation QID 08/14/2007 Active
884175 Medication clonidine hydrochloride Catapres 0.1 mg 1 Tablet PO BID 05/16/2006 Active
Medication Allergy List
Type SNOMED Code Medication/Agent Reaction Date Recorded
Drug Allergy 293620004 Indomethacin Nausea, vomiting, rash, dizziness, headache 03/25/2003
Drug Allergy 91939003 Sulfonamides Hives, photosensitivity 07/26/1999
Diagnostic Test Results
Type LOINC Code Test (Normal Range) Result Date Performed
Imaging 11539-4 CT, head Small high right occipital lobe contusion. No evidence of extra-axial blood. Significant sinus disease. 02/24/2010
Hematology 718-7 Hemoglobin (male: 14-18 g/dl female: 12-16 g/dl) 13 g/dl 02/17/2010
Hematology 4544-3 Hematocrit (male: 40-54% female: 36-48%) 38% 02/17/2010
Chemistry 2951-2 Sodium (135–146 mg/dl) 136 mg/dl 02/17/2010
Chemistry 2823-3 Potassium (3.5–5.3 mg/dl) 3.9 mg/dl 02/17/2010
Imaging 34534-8 Electrocardiogram Normal Sinus Rhythm 02/15/2010
Microbiology 630-4 Urine culture, routine (Negative: No growth Positive: >10,000 CFU/ml) Negative: No growth 10/02/2008
Procedure List
Type ICD-9 Code Procedure Status Date Performed
Surgical 66.39 Bilateral tubal ligation Completed 06/14/1990
Type CPT Code* Procedure Status Date Performed
Surgical 58600 Bilateral tubal ligation

CSV Format

--Glilly 12:49, 22 Nov 2010 (PST)

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