Encounter Type (SBF51):  Duplex, Right Lower Limb Arteriovenous Graft

Clinical Template ID: 626, Name: 0_Presentation of Upper Limb Hemodialysis Study 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 Upper Limb Pulse Rt Axillary (VarID=84)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Brachial (VarID=83)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Radial (VarID=81)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Ulnar (VarID=82)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Rt Allen Test (VarID=255)(Recent Data=0) Lookup ID=265 Lookup Name=Allen Test [AV ACCESS] Negative (Normal) Positive Rt Fistula (VarID=317)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Focal Thrill Partial Thrill Absent thrill Pulse Thrill Rt Distal Steal (VarID=319)(Recent Data=0) Left Upper Limb Pulse Lt Axillary Pulse (VarID=88)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Brachial Pulse (VarID=87)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Radial (VarID=85)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Ulnar (VarID=86)(Recent Data=0) Lookup ID=263 Lookup Name=Clinical Pulse Grade Diminished Healthy Absent Lt Allen Test (VarID=256)(Recent Data=0) Lookup ID=265 Lookup Name=Allen Test [AV ACCESS] Negative (Normal) Positive Lt Fistula (VarID=318)(Recent Data=0) Lookup ID=405 Lookup Name=Dialysis Access Assessment Focal Thrill Partial Thrill Absent thrill Pulse Thrill Lt Distal Steal (VarID=320)(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) Right Upper Limb Hemodialysis Title (VarID=5671)(Recent Data=0) Right Pulse Examination (VarID=4659)(Recent Data=0) Right Hand Allen Test (VarID=4669)(Recent Data=0) Right UL Fistula Examination (VarID=4667)(Recent Data=0) Right UL Steal (VarID=4671)(Recent Data=0) Left Upper Limb Hemodialysis Title (VarID=5672)(Recent Data=0) Left Pulse Examination (VarID=4660)(Recent Data=0) Left Hand Allen Test (VarID=4670)(Recent Data=0) Left UL Fistula Examination (VarID=4668)(Recent Data=0) Left UL Steal (VarID=4672)(Recent Data=0)

Conclusion Template ID: 642, Name: 0_Hemodialysis Access Duplex Study Findings Summary Fistula Location (VarID=3424)(Recent Data=0) Lookup ID=2146 Lookup Name=Dialysis Access Type Upper Limb Fistula .....Radiocephalic - Wrist (Brescia-Cimino) .....Posterior radial branch-cephalic - Snuff-box .....Ulnar-basilic forearm transposition .....Radial-cephalic forearm transposition .....Brachial-cephalic forearm looped transposition .....Brachial-cephalic upper arm direct access .....Brachial-basilic upper arm transposition Upper Limb Dialysis Graft .....Radial-brachial forearm indirect saphenous vein translocation .....Prosthetic brachial-antecubital forearm loop access .....Prosthetic radial-median cubital forearm straight access .....Prosthetic radial-basilic forearm loop access .....Brachial-axillary indirect greater saphenous .....Prosthetic brachial-axillary access Autogenous femoral-greater saphenous looped access transposition Prosthetic femoral-femoral looped inguinal hemodialysis access Other Prosthetic Dialysis Access Graft .....Prosthetic axillary-axillary chest access .....Prosthetic axillary-axillary chest loop access .....Prosthetic axillary-internal jugular chest loop access .....Prosthetic femoral-femoral suprainguinal access .....Prosthetic axillary-femoral body wall access Distance between brachial artery bifurcation and AC fossa (cm) (VarID=5378)(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)