Encounter Type (SBD22):  Renal Artery Graft Duplex

Clinical Template ID: 625, Name: 0_Presentation of Abdominal Duplex 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) 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 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) Atrial Fibrillation (VarID=4548)(Recent Data=0) Carotid Artery Disease (VarID=13)(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 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 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 Liver Disease (VarID=5407)(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 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) Abdominal Bruit (VarID=527)(Recent Data=0) Lookup ID=208 Lookup Name=True False No Yes Abdominal Pain (VarID=548)(Recent Data=0) Lookup ID=208 Lookup Name=True False No Yes Enlarged liver (VarID=549)(Recent Data=0) Lookup ID=208 Lookup Name=True False No Yes Enlarged Spleen (VarID=550)(Recent Data=0) Lookup ID=208 Lookup Name=True False No Yes Pulsating mass (Aneurysm) (VarID=551)(Recent Data=0) Lookup ID=208 Lookup Name=True False No Yes Urea (VarID=3763)(Recent Data=0) Creatinine (mg/dl) (VarID=30)(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) Abdominal Presentation (VarID=4649)(Recent Data=0) Abdominal Urea and Creatinine Text (VarID=5673)(Recent Data=0)

Conclusion Template ID: 650, Name: 0_Renal Duplex Scan Findings Summary Right Side: Renal Artery (VarID=521)(Recent Data=0) Renal Plaque (VarID=792)(Recent Data=0) Lookup ID=153 Lookup Name=Plaque Severity None Mild Moderate Severe Stenosed Segment: (VarID=793)(Recent Data=0) Lookup ID=315 Lookup Name=Anatomical Segment Locator Artery .....Neck Artery ..........Neck, Right Side Artery ...............Innominate ....................Proximal Inominate ....................Distal Inominate ....................Inominate origin ...............Right Subclavian ....................Right Subclavian Origin ....................Right Proximal Subclavian ....................Right Distal Subclavian ...............Right Common Carotid ....................Right Proximal Common Carotid ....................Right Mid Common Carotid ....................Right Distal Common Carotid ....................Right Common Carotid Origin ...............Right Vertebral Artery ....................Right Proximal Vertebral ....................Right Middle Vertebral ....................Right Distal Vertebral ....................Right Vertebral Origin ...............Right Internal Carotid Artery ....................Right Carotid Bulb ....................Right Proximal Internal Carotid ....................Right Middle Internal Carotid ....................Right Distal Internal Carotid ...............Right External Carotid ...............Right Internal Mammary ...............Right Superficial Temporal Diameter reduction (VarID=794)(Recent Data=0) RAR (VarID=800)(Recent Data=0) RI (VarID=3470)(Recent Data=0) Renal Vein (VarID=786)(Recent Data=0) Lookup ID=2204 Lookup Name=Renal Vein (Maryland) Patent Thrombus Not Patent Not Visualized Kidney (VarID=787)(Recent Data=0) Lookup ID=1018 Lookup Name=Kidney Duplex Conclusion Absent kidney. Ectopic Horseshoe Hypertrophic Kidney Ischemic Kidney. Polycystic Kidney Renal dimensions within normal limits Severely atrophic Left Side: Renal Artery (VarID=522)(Recent Data=0) Renal Plaque (VarID=795)(Recent Data=0) Lookup ID=153 Lookup Name=Plaque Severity None Mild Moderate Severe Stenosed Segment: (VarID=796)(Recent Data=0) Lookup ID=315 Lookup Name=Anatomical Segment Locator Artery .....Neck Artery ..........Neck, Right Side Artery ...............Innominate ....................Proximal Inominate ....................Distal Inominate ....................Inominate origin ...............Right Subclavian ....................Right Subclavian Origin ....................Right Proximal Subclavian ....................Right Distal Subclavian ...............Right Common Carotid ....................Right Proximal Common Carotid ....................Right Mid Common Carotid ....................Right Distal Common Carotid ....................Right Common Carotid Origin ...............Right Vertebral Artery ....................Right Proximal Vertebral ....................Right Middle Vertebral ....................Right Distal Vertebral ....................Right Vertebral Origin ...............Right Internal Carotid Artery ....................Right Carotid Bulb ....................Right Proximal Internal Carotid ....................Right Middle Internal Carotid ....................Right Distal Internal Carotid ...............Right External Carotid ...............Right Internal Mammary ...............Right Superficial Temporal Diameter reduction (VarID=797)(Recent Data=0) RAR (VarID=801)(Recent Data=0) RI (VarID=3471)(Recent Data=0) Renal Vein (VarID=789)(Recent Data=0) Lookup ID=2204 Lookup Name=Renal Vein (Maryland) Patent Thrombus Not Patent Not Visualized Kidney (VarID=790)(Recent Data=0) Lookup ID=1018 Lookup Name=Kidney Duplex Conclusion Absent kidney. Ectopic Horseshoe Hypertrophic Kidney Ischemic Kidney. Polycystic Kidney Renal dimensions within normal limits Severely atrophic 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)