Encounter Type (SBF31):  Duplex Veins For Hemo Access-Bilateral

Clinical Template ID: 55, Name: Presentation of Upper Limb Hemodialysis Study Narrative (VarID=3846)(Recent Data=0) Right Limb Brachial Pressure: Systolic (mm hg) (VarID=101)(Recent Data=0) Diastolic (mm hg) (VarID=104)(Recent Data=0) Pulse Axillary (VarID=84)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Brachial (VarID=83)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Radial (VarID=81)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Ulnar (VarID=82)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Allen Test (VarID=255)(Recent Data=0) Lookup ID=265 Lookup Name=Allen Test [AV ACCESS] Negative (Normal) Positive Fistula (VarID=317)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Partial Thrill Pulse Thrill Distal Steal (VarID=319)(Recent Data=0) Left Limb Brachial Pressure Systolic (mm hg) (VarID=102)(Recent Data=0) Diastolic (mm hg) (VarID=105)(Recent Data=0) Pulse Axillary Pulse (VarID=88)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Brachial Pulse (VarID=87)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Radial (VarID=85)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Ulnar (VarID=86)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade 0 1 2 3 4 Allen Test (VarID=256)(Recent Data=0) Lookup ID=265 Lookup Name=Allen Test [AV ACCESS] Negative (Normal) Positive Fistula (VarID=318)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Partial Thrill Pulse Thrill Distal Steal (VarID=320)(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