Encounter Type (SBF122):  Upper Pre-Op Dialysis, Left

Clinical Template ID: 627, Name: 0_Presentation of Lower Limb Hemodialysis 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 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 Brachial Pressure 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) Right Lower Limb Pulse Rt Femoral (VarID=93)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Popliteal (VarID=95)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Posterior Tibial (VarID=99)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Dorsalis Pedis (VarID=97)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Fistula (VarID=317)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Focal Thrill Partial Thrill Absent thrill Pulse Thrill Left Lower Limb Pulse Lt Femoral (VarID=94)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Popliteal (VarID=96)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Posterior Tibial (VarID=100)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Dorsalis Pedis (VarID=98)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Fistula (VarID=318)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Focal Thrill Partial Thrill Absent thrill Pulse Thrill 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 Lower Limb Hemodialysis Title (VarID=5674)(Recent Data=0) Right Pulse Examination (VarID=4659)(Recent Data=0) Right UL Fistula Examination (VarID=4667)(Recent Data=0) Left Lower Limb Hemodialysis Title (VarID=5676)(Recent Data=0) Left Pulse Examination (VarID=4660)(Recent Data=0) Left UL Fistula Examination (VarID=4668)(Recent Data=0)

Conclusion Template ID: 653, Name: 0_UL Vein Mapping Findings Summary 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) 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) 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)