Encounter Type (SBC182):  Arterial Leg W/Stress (Vasospasm Eval)-Single Level

Clinical Template ID: 53, Name: Presentation of Lower Limb Arterial Study Narrative (VarID=3846)(Recent Data=0) Brachial Blood Pressure Right Systolic (mm hg) (VarID=101)(Recent Data=0) Diastolic (mm hg) (VarID=104)(Recent Data=0) Left Systolic (mm hg) (VarID=102)(Recent Data=0) Diastolic (mm hg) (VarID=105)(Recent Data=0) Right Lower Limb Claudication (VarID=3851)(Recent Data=0) Lookup ID=2000007 Lookup Name=claudi Buttock Calf Hip Thigh Pulse Examination Femoral (VarID=93)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Popliteal (VarID=95)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Posterior Tibial (VarID=99)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Dorsalis Pedis (VarID=97)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Trophic Changes Muscle Atrophy (VarID=301)(Recent Data=0) Loss of Hair (VarID=302)(Recent Data=0) Brittle Nails (VarID=303)(Recent Data=0) Foot Callus (VarID=304)(Recent Data=0) Foot Ulceration (VarID=305)(Recent Data=0) Foot Infection (VarID=306)(Recent Data=0) Trash Foot (VarID=307)(Recent Data=0) Toe(s) Gangrene (VarID=308)(Recent Data=0) Left Lower Limb Claudication (VarID=3852)(Recent Data=0) Lookup ID=2000007 Lookup Name=claudi Buttock Calf Hip Thigh Pulse Examination Femoral (VarID=94)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Popliteal (VarID=96)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Posterior Tibial (VarID=100)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Dorsalis Pedis (VarID=98)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Trophic Changes Muscle Atrophy (VarID=309)(Recent Data=0) Loss of Hair (VarID=310)(Recent Data=0) Brittle Nails (VarID=311)(Recent Data=0) Foot Callus (VarID=312)(Recent Data=0) Foot Ulceration (VarID=313)(Recent Data=0) Foot Infection (VarID=314)(Recent Data=0) Trash Foot (VarID=315)(Recent Data=0) Toe(s) Gangrene (VarID=316)(Recent Data=0) Graft 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 Graft Date (VarID=3853)(Recent Data=0) 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 Graft Date (VarID=3854)(Recent Data=0) RiskFactorStatement (VarID=2000034)(Recent Data=0)

Conclusion Template ID: 137, Name: Lab Next Followup 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 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