170.315_b1_toc_amb_ccd_r21_sample2 test data (July 22, 2015)

Patient Legal: Thomas V MANFRED jr Date of Birth: July 1, 1980 (35yr) Gender: Male Patient-ID:  112233334 (SSN)
Encounter ID: 9937012 (Examples) , Date/Time: July 22, 2015 2:00PM -0500 - 2:30PM -0500
Documentation Of Care provision, Annual Health Maintenance, History and Physical, Date/Time: July 22, 2015 2:00PM -0500 - 2:30PM -0500, Performer: Dr Albert DAVIS, Performer: Tracy DAVIS
Author Amb EMR v1.0, Organization: Neighborhood Physicians Practice, Authored On: July 22, 2015
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ALLERGIES AND ADVERSE REACTIONS

No Known Allergies

MEDICATIONS

No known Medications

PROBLEMS

No known problems

ENCOUNTERS

Encounter Location Date
Annual Health Maintenance, History and Physical Neighborhood Physicians Practice July 22, 2015 2pm EST

IMMUNIZATIONS

No known immunization history

VITAL SIGNS

Date / Time: July 22, 2015
Height 177 cm
Weight 88 kg
Blood Pressure 145/88 mm[Hg]

SOCIAL HISTORY

Social History Observation Description Dates Observed
Current Smoking Status Current every day July 22, 2015
Birth Sex Male July 22, 2015

PROCEDURES

No Procedure information

MEDICAL EQUIPMENT

Patient has no history of implantable devices

RESULTS

No Lab Test required. No Lab results.

FUNCTIONAL STATUS

No information

ASSESSMENTS

The patient was found to be healthy and advised to follow his current routine of exercise, work, sleep and quality of life.

TREATMENT PLAN

Hand-off Communication:

Planned Care Start Date
Schedule a visit for next year. July 22, 2016

Goals Section

No Goals Information

Health Concerns

No Health Concerns Information

MENTAL STATUS

No Mental Status information
Document
ID ToC_15 (2.16.840.1.113883.19.5.99999.1)
Version 1
Set‑ID sTT102 (2.16.840.1.113883.19.5.99999.19)
Created On July 22, 2015
Custodian Neighborhood Physicians Practice Contact Details Workplace: 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
 
Patient Legal: Thomas V MANFRED jr Contact Details Home Primary: 1002 Amber Dr
Beaverton, OR 97006
US
Tel Mobile: +1(555)-113-1234, Tel Home Primary: +1(555)-114-1544
Date of Birth July 1, 1980 (35yr) Gender Male
Race unknown Ethnicity unknown
Patient-IDs 112233334 (SSN) Language Communication
en-US, Expressed spoken, preferred: yes
Provider Organization
Neighborhood Physicians Practice
ID 99999999 (NPI)
Contact Details (Organization) 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-5000
 
Documentation Of - care provision Annual Health Maintenance, History and PhysicalJuly 22, 2015 2:00PM -0500 - 2:30PM -0500
Performer - Primary Care Provider - Primary Care Provider Dr Albert DAVIS of Neighborhood Physicians Practice Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Performer - Tracy DAVIS Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Encounter
ID 9937012 (Examples)
Encounter Date July 22, 2015 2:00PM -0500 - 2:30PM -0500
 
Author Amb EMR v1.0 - Code: Allopathic & Osteopathic Physicians, Organization: Neighborhood Physicians Practice Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Indirect target - personal relationship grandparent Mr. Richard MANFRED, grandparent Contact Details Home Primary: 1002 Amber Dr
Beaverton, OR 97006
US
Tel Home Primary: +1(555)-114-1544
Indirect target - personal relationship SPOUSE Ms Lisa MANFRED, SPOUSE Contact Details Home Primary: 1002 Amber Dr
Beaverton, OR 97006
US
Tel Home Primary: +1(555)-114-1544
Data Enterer Tracy DAVIS Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Informant Albert DAVIS Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Informant Lisa MANFRED
Information Recipient Dr Albert DAVIS
Organization
Neighborhood Physicians Practice
Contact Details (Organization)
Authenticator Dr Albert DAVIS signed at July 22, 2015 Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002
Legal Authenticator Dr Albert DAVIS signed at July 22, 2015 Contact Details 2472 Rocky place
Beaverton, OR 97006
US
Tel Workplace: +1(555)-555-1002