Encounter Type (SBE214):  Unilateral Upper Limb Vein Mapping

Clinical Template ID: 623, Name: 0_Presentation of Upper Limb Venous 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) History of DVT (VarID=40)(Recent Data=0) Lookup ID=66 Lookup Name=DVTHistory Yes Multiple None Proven Suspected Immobilization (VarID=38)(Recent Data=0) Lookup ID=118 Lookup Name=Immobilization Acute quadriplegia Acute hemiplegia Acute monoplegia Yes > 3 days 1 - 3 days Acute paraplegia No Post Operative State (VarID=41)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes History of Malignancy (VarID=35)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Adenocarcinoma (VarID=36)(Recent Data=0) Lookup ID=8 Lookup Name=Adenocarcinoma Adenocarcinoma Not adenocarcinoma Cardiac Status (NYHA) (VarID=259)(Recent Data=0) Limb Trauma (VarID=39)(Recent Data=0) Lookup ID=207 Lookup Name=Trauma [DVT RF] Fracture femur Fracture hip or pelvis Fracture leg bone(s) None Soft tissue trauma Pregnancy (VarID=34)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Obesity (VarID=42)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Hormonal Treatment (VarID=298)(Recent Data=0) Hypercoagulable State (VarID=12)(Recent Data=0) Lookup ID=112 Lookup Name=Hypercoagulation No Proven, treated Proven, untreated Suspected Yes Peripheral Arterial Disease (VarID=14)(Recent Data=0) Lookup ID=132 Lookup Name=Lower Limb Ischemia Mild Moderate None Severe Yes Hypertension (VarID=3)(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 BMI (VarID=4079)(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) Right Upper Limb Pain (VarID=321)(Recent Data=0) Edema (VarID=322)(Recent Data=0) Tenderness (VarID=323)(Recent Data=0) Inflammation (VarID=324)(Recent Data=0) Pigmentation (VarID=326)(Recent Data=0) Circumference Upper Arm (cm) (VarID=356)(Recent Data=0) Arm (cm) (VarID=357)(Recent Data=0) Wrist (cm) (VarID=358)(Recent Data=0) Previous Venous Surgeries (VarID=5401)(Recent Data=0) Lookup ID=2233 Lookup Name=Venous Surgery Types (UMMC) GSV stripping SSV stripping GSV ablation SSV ablation Left Upper Limb Pain (VarID=359)(Recent Data=0) Edema (VarID=360)(Recent Data=0) Tenderness (VarID=361)(Recent Data=0) Inflammation (VarID=362)(Recent Data=0) Pigmentation (VarID=363)(Recent Data=0) Circumference Upper Arm (cm) (VarID=364)(Recent Data=0) Wrist (cm) (VarID=366)(Recent Data=0) Arm (cm) (VarID=365)(Recent Data=0) Previous Venous Surgeries (VarID=5402)(Recent Data=0) Lookup ID=2233 Lookup Name=Venous Surgery Types (UMMC) GSV stripping SSV stripping GSV ablation SSV ablation 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) Right Upper Limb Venous Title (VarID=5669)(Recent Data=0) Right Upper Limb Venous Presentation (VarID=4646)(Recent Data=0) Left Upper Limb Venous Title (VarID=5670)(Recent Data=0) Left Upper Limb Venous Presentation (VarID=4647)(Recent Data=0)

Conclusion Template ID: 654, Name: 0_UL Venous Outcome Findings Summary Right Upper Limb Useable Segments Right Cephalic (VarID=5324)(Recent Data=0) Right Cephalic Forearm (VarID=5325)(Recent Data=0) Right Basilic Arm (VarID=5326)(Recent Data=0) Right Basilic Forearm (VarID=5327)(Recent Data=0) Positive Results (VarID=589)(Recent Data=0) Conclusion (VarID=778)(Recent Data=0) Left Upper Limb Useable Segments Left Cephalic Arm (VarID=5328)(Recent Data=0) Left Cephalic Forearm (VarID=5329)(Recent Data=0) Left Basilic Forearm (VarID=5331)(Recent Data=0) Left Basilic Arm (VarID=5330)(Recent Data=0) Positive Results (VarID=590)(Recent Data=0) Conclusion (VarID=779)(Recent Data=0) Torniquet (VarID=5332)(Recent Data=0) The study was performed after warming the upper arm and forearm (VarID=5333)(Recent Data=0) The study was performed on (VarID=5323)(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: 27, Name: Risk Factors DVT Age (VarID=258)(Recent Data=0) History of DVT (VarID=40)(Recent Data=0) Lookup ID=66 Lookup Name=DVTHistory Yes Multiple None Proven Suspected Immobilization (VarID=38)(Recent Data=0) Lookup ID=118 Lookup Name=Immobilization Acute quadriplegia Acute hemiplegia Acute monoplegia Yes > 3 days 1 - 3 days Acute paraplegia No Post Operative State (VarID=41)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes History of Malignancy (VarID=35)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Adenocarcinoma (VarID=36)(Recent Data=0) Lookup ID=8 Lookup Name=Adenocarcinoma Adenocarcinoma Not adenocarcinoma Cardiac Status (NYHA) (VarID=259)(Recent Data=0) CHF (VarID=3487)(Recent Data=0) Lookup ID=1701 Lookup Name=CHF None Asymp, hx CHF Mild Severe Limb Trauma (VarID=39)(Recent Data=0) Lookup ID=207 Lookup Name=Trauma [DVT RF] Fracture femur Fracture hip or pelvis Fracture leg bone(s) None Soft tissue trauma Pregnancy (VarID=34)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Obesity (VarID=42)(Recent Data=0) Lookup ID=2000002 Lookup Name=Carotid Artery Disease VCU no yes Hormonal Treatment (VarID=298)(Recent Data=0) Hypercoagulable State (VarID=12)(Recent Data=0) Lookup ID=112 Lookup Name=Hypercoagulation No Proven, treated Proven, untreated Suspected Yes Peripheral Arterial Disease (VarID=14)(Recent Data=0) Lookup ID=132 Lookup Name=Lower Limb Ischemia Mild Moderate None Severe Yes