Encounter Type (SB):  Noninvasive Vascular Lab

Clinical Template ID: 632, Name: 0_Non-Invasive Lab Default Study Type (VarID=5668)(Recent Data=0) Lookup ID=2248 Lookup Name=Other Study Types Follow-up for Angio Intraoperative Study Non-billable On call - after hours Portable Research Teaching Operative History Procedure (VarID=5076)(Recent Data=0) Date (VarID=5077)(Recent Data=0) Side (VarID=5078)(Recent Data=0) Lookup ID=168 Lookup Name=Procedure Side N/A Right Left Bilateral Group (VarID=5691)(Recent Data=0) Clinical 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) Generate Note Options Include Operative History Note (VarID=5684)(Recent Data=0) Include Risk Factor Note (VarID=5679)(Recent Data=0) Clinical Note (VarID=5680)(Recent Data=0) Statements Procedure List Title (VarID=5632)(Recent Data=0) Procedure List All (VarID=5075)(Recent Data=0) Clinical Title (VarID=5634)(Recent Data=0) Blood Pressure (VarID=4651)(Recent Data=0)

Conclusion Template ID: 633, Name: 0_Non-Invasive Lab Default Critical results (VarID=4743)(Recent Data=0) Critical Result Type (VarID=5650)(Recent Data=0) Lookup ID=2243 Lookup Name=Lab Critical Result Type Arteriovenous fistula DVT Highest Limb ABI < .40 ICA Critical Stenosis Mesenteric artery critical stenosis Pseudoaneurysm Renal artery critical stenosis Reported To (VarID=3996)(Recent Data=0) Reported by (VarID=3995)(Recent Data=0) Found Time (VarID=3994)(Recent Data=0) Reported Time (VarID=3998)(Recent Data=0) Reporting Method (VarID=4544)(Recent Data=0) Lookup ID=1992 Lookup Name=Reporting Method email Fax Phone Publish to EMR Free-Text Note (VarID=5307)(Recent Data=0) 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

Risk Factors Template ID: 161, Name: Carotid Risk Factors Age (VarID=258)(Recent Data=0) Age Group (VarID=37)(Recent Data=0) Lookup ID=9 Lookup Name=Age >= 80 < 55 55 - 69 70 - 79 Weight (Kg) (VarID=33)(Recent Data=0) Height (cm) (VarID=623)(Recent Data=0) 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) Other Risk Factors (VarID=809)(Recent Data=0) Hypertension (VarID=3)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Diabetes (VarID=4)(Recent Data=0) Lookup ID=61 Lookup Name=Diabetes IDDM adult IDDM juvenile NIDDM No Yes Hyperlipidemia (VarID=9)(Recent Data=0) Lookup ID=113 Lookup Name=Hyperlipidemia None Mild Moderate Severe Yes 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) Pulmonary Status (VarID=11)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Renal Disease (VarID=10)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Smoking (VarID=5)(Recent Data=0) Lookup ID=189 Lookup Name=Smoking Yes No Active Former PPD yrs Fibrinogen Level (mg/dl) (VarID=296)(Recent Data=0) Peripheral Arterial Disease (VarID=516)(Recent Data=0) Lookup ID=502 Lookup Name=PAD Amputation Claudication No Rest Pain/Tissue loss Yes HIV (VarID=72)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Hypercoagulable State (VarID=12)(Recent Data=0) Lookup ID=112 Lookup Name=Hypercoagulation No Proven, treated Proven, untreated Suspected Yes Embolization (VarID=297)(Recent Data=0) Lookup ID=403 Lookup Name=Arterial Emolization Multiple Incidents No Single Incident Yes Cardiac Status (SVS) (VarID=2)(Recent Data=0) Lookup ID=23 Lookup Name=ASHD Mild Moderate None Severe Yes Peripheral Arterial Disease (VarID=14)(Recent Data=0) Lookup ID=132 Lookup Name=Lower Limb Ischemia Mild Moderate None Severe Yes Anatomic Risk Factors History of Irradiation (VarID=3982)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Contralateral Occlusion (VarID=810)(Recent Data=0) Contralateral Laryngeal Nerve Palsy (VarID=811)(Recent Data=0) High anatomic lesion (C2 or higher) (VarID=812)(Recent Data=0) Other anatomic risk factor (VarID=813)(Recent Data=0) Radical neck dissection (VarID=949)(Recent Data=0) Recurrent Stenosis (VarID=3856)(Recent Data=0) Tracheostomy Present (VarID=3857)(Recent Data=0) Prior Neck Surgery (VarID=3858)(Recent Data=0)