# Patient Test Record: SUDEpisodeTwoTelephoneVisitsMeetsInitiation2 NUMER1PassStrat1

Patient
SUDEpisodeTwoTelephoneVisitsMeetsInitiation2 NUMER1PassStrat1
Sex
248153007
Date of birth
2014-01-01T00:00:00+00:00
Date of expiration
None
Race
1002-5
Ethnicity
2186-5
Insurance Providers
1
Patient IDs
0
Address
Telecom
(HP) 555-555-2003

### QDM::Diagnosis

Description
Codes
Time
Fields/Results
Diagnosis: Substance Use Disorder
Codes:
ICD10CM: F10.129
Time Elements:
Prevalence Period Start: 2027-03-16T09:15:00.000+00:00
Other Fields:
Diagnosis: Substance Use Disorder
Codes:
ICD10CM: F10.24
Time Elements:
Prevalence Period Start: 2027-03-09T09:15:00.000+00:00
Other Fields:

### QDM::EncounterPerformed

Description
Codes
Time
Fields/Results
Encounter, Performed: Telephone Visits
Codes:
SNOMEDCT: 386473003
Time Elements:
Relevant Period Start: 2027-03-16T09:15:00.000+00:00
Relevant Period End: 2027-03-16T10:00:00.000+00:00
Other Fields:
Encounter, Performed: Telephone Visits
Codes:
Time Elements:
Relevant Period Start: 2027-03-16T09:15:00.000+00:00
Other Fields:
Encounter, Performed: Office Visit
Codes:
CPT: 99215
Time Elements:
Relevant Period Start: 2027-03-09T09:15:00.000+00:00
Other Fields:

### QDM::InterventionPerformed

Description
Codes
Time
Fields/Results
Intervention, Performed: Substance Use Disorder Treatment
Codes:
SNOMEDCT: 408935001
Time Elements:
Relevant Period Start: 2027-03-16T10:00:00.000+00:00
Other Fields:

### QDM::PatientCharacteristicSex

Description
Codes
Time
Fields/Results
Patient Characteristic Sex: FederalAdministrativeSex
Codes:
SNOMEDCT: 248153007
Time Elements:
Other Fields:

### QDM::PatientCharacteristicBirthdate

Description
Codes
Time
Fields/Results
Codes:
Time Elements:
Birth Date/Time: 2014-01-01T00:00:00.000+00:00
Other Fields:

### QDM::PatientCharacteristicRace

Description
Codes
Time
Fields/Results
Patient Characteristic Race: Race
Codes:
CDCREC: 1002-5
Time Elements:
Other Fields:

### QDM::PatientCharacteristicEthnicity

Description
Codes
Time
Fields/Results
Patient Characteristic Ethnicity: Ethnicity
Codes:
CDCREC: 2186-5
Time Elements:
Other Fields:

### QDM::PatientCharacteristicPayer

Description
Codes
Time
Fields/Results
Codes:
Source of Payment Typology: 1
Time Elements:
Relevant Period Start: 2014-01-01T00:00:00.000+00:00
Other Fields: