Encounter Type (SBB1):  Transcranial Doppler, Complete Study

Clinical Template ID: 629, Name: 0_Presentation of TCD Choose appropriate criteria: Suspected Vasospasm (VarID=5369)(Recent Data=0) Sickle Cell Disease (VarID=5370)(Recent Data=0) Intracranial Stenosis (VarID=5371)(Recent Data=0) Suspected Brain Death (VarID=5373)(Recent Data=0) 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) 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 Risk Factors Age (VarID=258)(Recent Data=0) Activity Level (VarID=15)(Recent Data=0) Lookup ID=6 Lookup Name=Activity Level Active Life Style Dependent, Complete Dependent, Partial Independent Cardiac disease (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) Atrial Fibrillation (VarID=4548)(Recent Data=0) Diabetes (VarID=4)(Recent Data=0) Lookup ID=61 Lookup Name=Diabetes IDDM adult IDDM juvenile NIDDM No Yes Embolization (VarID=297)(Recent Data=0) Lookup ID=403 Lookup Name=Arterial Emolization Multiple Incidents No Single Incident Yes Hyperlipidemia (VarID=9)(Recent Data=0) Lookup ID=113 Lookup Name=Hyperlipidemia None Mild Moderate Severe Yes History of Irradiation (VarID=3982)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes HIV (VarID=72)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Hypertension (VarID=3)(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 Peripheral Arterial Disease (VarID=516)(Recent Data=0) Lookup ID=502 Lookup Name=PAD Amputation Claudication No Rest Pain/Tissue loss Yes Pulmonary Disease (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 Weight Loss (VarID=5306)(Recent Data=0) Hormonal Treatment (VarID=298)(Recent Data=0) Previous CVA (VarID=5311)(Recent Data=0) Clinical BP: Rt Systolic (mm hg) (VarID=101)(Recent Data=0) Rt Diastolic (mm hg) (VarID=104)(Recent Data=0) Lt Systolic (mm hg) (VarID=102)(Recent Data=0) Lt Diastolic (mm hg) (VarID=105)(Recent Data=0) Previous Carotid Intervention (VarID=4203)(Recent Data=0) Right CEA (VarID=3531)(Recent Data=0) Carotid Patch (VarID=4633)(Recent Data=0) Lookup ID=228 Lookup Name=Device Type Vascular graft .....Autogenous graft ..........Vein graft ...............Greater saphenous ...............Lesser saphenous ...............Arm veins ....................Cephalic vein ....................Basilic vein ....................Other arm vein ...............Internal jugular vein ...............Deep veins of lower limb ....................Superficial femoral vein ....................Deep femoral vein ....................Other lower limb deep vein ...............Mixed source vein graft ...............Other vein graft ..........Arterial graft ...............Internal iliac artery ...............Endarterectomised SFA ...............Splenic artery ...............Internal mammary arterial graft ...............Other arterial graft ...............Radial artery .....Non autogenous graft ..........Synthetic Graft ...............Dacron graft ....................Woven Dacron ....................Knitted Dacron ....................Other Dacron Left CEA (VarID=3532)(Recent Data=0) Carotid Patch (VarID=4634)(Recent Data=0) Lookup ID=228 Lookup Name=Device Type Vascular graft .....Autogenous graft ..........Vein graft ...............Greater saphenous ...............Lesser saphenous ...............Arm veins ....................Cephalic vein ....................Basilic vein ....................Other arm vein ...............Internal jugular vein ...............Deep veins of lower limb ....................Superficial femoral vein ....................Deep femoral vein ....................Other lower limb deep vein ...............Mixed source vein graft ...............Other vein graft ..........Arterial graft ...............Internal iliac artery ...............Endarterectomised SFA ...............Splenic artery ...............Internal mammary arterial graft ...............Other arterial graft ...............Radial artery .....Non autogenous graft ..........Synthetic Graft ...............Dacron graft ....................Woven Dacron ....................Knitted Dacron ....................Other Dacron Right CAS (VarID=3707)(Recent Data=0) Left CAS (VarID=3708)(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) Risk Factors Title (VarID=5633)(Recent Data=0) Risk Factors Note (VarID=5074)(Recent Data=0) Clinical Title (VarID=5634)(Recent Data=0) Blood Pressure (VarID=4651)(Recent Data=0) Previous Carotid Interventions (VarID=4645)(Recent Data=0)

Conclusion Template ID: 652, Name: 0_TCD Conclusion Findings Summary TCD Done By (VarID=300)(Recent Data=0) Lookup ID=404 Lookup Name=TCD Done By Both Teams Medical Staff Technical Staff TCD Technique (VarID=299)(Recent Data=0) Lookup ID=202 Lookup Name=TCD Methodology Conventional TCD Physiologic Testing Embolus Detecting Intraoperative Monitoring Nonoperative Monitoring Other Right Vasospasm Index (VarID=5334)(Recent Data=0) Left Vasospasm Index (VarID=5335)(Recent Data=0) 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: 26, Name: Risk Factors Arteriosclerosis 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 Carotid Artery Disease (VarID=13)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Cardiac Status (SVS) (VarID=2)(Recent Data=0) Lookup ID=23 Lookup Name=ASHD Mild Moderate None Severe Yes Diabetes (VarID=4)(Recent Data=0) Lookup ID=61 Lookup Name=Diabetes IDDM adult IDDM juvenile NIDDM No Yes Embolization (VarID=297)(Recent Data=0) Lookup ID=403 Lookup Name=Arterial Emolization Multiple Incidents No Single Incident Yes Fibrinogen Level (mg/dl) (VarID=296)(Recent Data=0) 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) History of Irradiation (VarID=3982)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes HIV (VarID=72)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Hypertension (VarID=3)(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 Peripheral Arterial Disease (VarID=516)(Recent Data=0) Lookup ID=502 Lookup Name=PAD Amputation Claudication No Rest Pain/Tissue loss Yes 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 Weight (Kg) (VarID=33)(Recent Data=0)