Encounter Type (SBC11211):  Arterial Duplex Leg Graft-Right

Clinical Template ID: 2000002, Name: ll graft Narrative (VarID=3846)(Recent Data=0) Right Graft Type (VarID=3848)(Recent Data=0) Lookup ID=2000014 Lookup Name=GraftType Aorto-bifem Aorto-fem Ax Fem Cross Fem Fem to AT Fem to DP Fem to PT Insitu BK Popliteal Insitu Fem AK Popliteal PTFE Fem Pop Left Graft Type (VarID=3849)(Recent Data=0) Lookup ID=2000014 Lookup Name=GraftType Aorto-bifem Aorto-fem Ax Fem Cross Fem Fem to AT Fem to DP Fem to PT Insitu BK Popliteal Insitu Fem AK Popliteal PTFE Fem Pop RiskFactorStatement (VarID=2000034)(Recent Data=0)

Conclusion Template ID: 146, Name: Lower Limb Graft Surveillance Next Followup (VarID=730)(Recent Data=0) Lookup ID=657 Lookup Name=Lab Study Next Followup No follow-up is needed One Week Two Weeks Three Weeks One Month Two Months Three Months Six Months One Year Two Years Right Lower Limb Disease Location (VarID=367)(Recent Data=0) Lookup ID=416 Lookup Name=Lower Limb Disease Location No Disease AortoIliac Fem_Popliteal Tibio-Peroneal Multilevel Ankle Pressure (mm hg) (VarID=150)(Recent Data=0) Ankle Arm Index (VarID=152)(Recent Data=0) Graft [1] (VarID=735)(Recent Data=0) Patency Status (VarID=736)(Recent Data=0) Lookup ID=1001 Lookup Name=Vascular Lab Graft Patency Patent Stenosed < 60% Stenosed > 60% Occluded Stenosis (VarID=802)(Recent Data=0) Lookup ID=1023 Lookup Name=Graft Stenosis Location Distal Third Inflow anastomosis Inflow artery Mid Third Outflow anastomosis Outflow artery Proximal third Graft [2] (VarID=737)(Recent Data=0) Patency Status (VarID=738)(Recent Data=0) Lookup ID=1001 Lookup Name=Vascular Lab Graft Patency Patent Stenosed < 60% Stenosed > 60% Occluded Stenosis (VarID=803)(Recent Data=0) Lookup ID=1023 Lookup Name=Graft Stenosis Location Distal Third Inflow anastomosis Inflow artery Mid Third Outflow anastomosis Outflow artery Proximal third Conclusion (VarID=772)(Recent Data=0) Lookup ID=1009 Lookup Name=LL Graft Surveillance Conclusion Lesion causing > 60% diameter reduction, distal anastomosis Lesion causing > 60% diameter reduction, distal third Lesion causing > 60% diameter reduction, inflow anastomosis Lesion causing > 60% diameter reduction, middle third Lesion causing > 60% diameter reduction, proximal third No critical stenosis Total graft occlusion Widely patent graft through out its course. Left Lower Limb Disease Location (VarID=368)(Recent Data=0) Lookup ID=416 Lookup Name=Lower Limb Disease Location No Disease AortoIliac Fem_Popliteal Tibio-Peroneal Multilevel Ankle Pressure (mm hg) (VarID=151)(Recent Data=0) Ankle Arm Index (VarID=153)(Recent Data=0) Graft [1] (VarID=739)(Recent Data=0) Patency Status (VarID=740)(Recent Data=0) Lookup ID=1001 Lookup Name=Vascular Lab Graft Patency Patent Stenosed < 60% Stenosed > 60% Occluded Stenosis (VarID=804)(Recent Data=0) Lookup ID=1023 Lookup Name=Graft Stenosis Location Distal Third Inflow anastomosis Inflow artery Mid Third Outflow anastomosis Outflow artery Proximal third Graft [2] (VarID=741)(Recent Data=0) Patency Status (VarID=742)(Recent Data=0) Lookup ID=1001 Lookup Name=Vascular Lab Graft Patency Patent Stenosed < 60% Stenosed > 60% Occluded Stenosis (VarID=805)(Recent Data=0) Lookup ID=1023 Lookup Name=Graft Stenosis Location Distal Third Inflow anastomosis Inflow artery Mid Third Outflow anastomosis Outflow artery Proximal third Conclusion (VarID=773)(Recent Data=0) Lookup ID=1009 Lookup Name=LL Graft Surveillance Conclusion Lesion causing > 60% diameter reduction, distal anastomosis Lesion causing > 60% diameter reduction, distal third Lesion causing > 60% diameter reduction, inflow anastomosis Lesion causing > 60% diameter reduction, middle third Lesion causing > 60% diameter reduction, proximal third No critical stenosis Total graft occlusion Widely patent graft through out its course. Critical Findings: Reported to: (VarID=2000001)(Recent Data=0) Reported by: (VarID=2000002)(Recent Data=0) Found time/date: (VarID=2000003)(Recent Data=0) Report time/date: (VarID=2000004)(Recent Data=0) Critical Result (VarID=2000010)(Recent Data=0) Read Back Performed (VarID=2000008)(Recent Data=0)

Risk Factors Template ID: 26, Name: Risk Factors Arteriosclerosis Cardiac Status (VarID=259)(Recent Data=0) LVEF (VarID=709)(Recent Data=0) Unstable Angina (VarID=807)(Recent Data=0) Recent MI (within 30 days) (VarID=808)(Recent Data=0) Carotid Artery Disease (VarID=13)(Recent Data=0) Lookup ID=2000028 Lookup Name=carotid artery di Right .....Right: 1 - 49% .....Right: 50 - 79% .....Right: 80 - 99% .....Right: Occlusion Left .....Left: 1 - 49% .....Left: 50 - 79% .....Left: 80 - 99% .....Left: Occlusion Diabetes (VarID=4)(Recent Data=0) Lookup ID=61 Lookup Name=Diabetes IDDM adult IDDM juvenile NIDDM None Yes Embolization (VarID=297)(Recent Data=0) Lookup ID=403 Lookup Name=Arterial Emolization Multiple Incidents None Single Incident Yes Fibrinogen Level (mg/dl) (VarID=296)(Recent Data=0) Hyperlipidemia (VarID=9)(Recent Data=0) Lookup ID=113 Lookup Name=Hyperlipidemia Yes None Mild Moderate Severe Cholesterol (mg/dl) (VarID=28)(Recent Data=0) LDL (mg/dl) (VarID=26)(Recent Data=0) Triglycerides (mg/dl) (VarID=29)(Recent Data=0) HDL ((mg/dl) (VarID=27)(Recent Data=0) VLDL (%) (VarID=257)(Recent Data=0) History of Irradiation (VarID=382)(Recent Data=0) HIV (VarID=72)(Recent Data=0) Hypertension (VarID=3)(Recent Data=0) Lookup ID=114 Lookup Name=Hypertension Mild Moderate None Severe Yes Hypercoagulable State (VarID=12)(Recent Data=0) Lookup ID=112 Lookup Name=Hypercoagulation None Proven, treated Proven, untreated Suspected Yes Peripheral Arterial Disease (VarID=516)(Recent Data=0) Lookup ID=502 Lookup Name=PAD Amputation Claudication None Rest Pain/Tissue loss Yes Pulmonary Disease (VarID=11)(Recent Data=0) Lookup ID=169 Lookup Name=Pulmonary Status Mild Moderate None Severe Yes Renal Disease (VarID=10)(Recent Data=0) Lookup ID=178 Lookup Name=Renal Mild Moderate None Severe Yes Smoking (VarID=5)(Recent Data=0) Lookup ID=189 Lookup Name=Smoking Mild Moderate None Severe Yes Activity Level (VarID=15)(Recent Data=0) Lookup ID=6 Lookup Name=Activity Level Active Life Style Independent Dependent, Partial Dependent, Complete