Cypress Certification Patient Test Record: Kirk Foster

Patient
Kirk Foster
Sex
M - Male
Date of birth
2010-02-02 15:00:00 UTC
Date of expiration
None
Race
2076-8 - Native Hawaiian or Other Pacific Islander
Ethnicity
2135-2 - Hispanic or Latino
Insurance Providers
2 - Medicaid
Patient IDs
600b343f6362390375a97d53 Cypress
Address
91216 Margarita Terrace Lodge
East Idaborough, AK 99514
US
Telecom
(HP) (854) 524-1884

QDM::EncounterPerformed

Description
Codes
Time
Fields/Results
Preventive Care, Established Office Visit, 0 to 17
Codes:
CPT: 99392 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years)
Time Elements:
Relevant Period Start: 2021-10-06T08:00:00.000Z
Relevant Period End: 2021-10-06T08:30:00.000Z
Other Fields:
Length Of Stay: 0 d

QDM::InterventionPerformed

Description
Codes
Time
Fields/Results
Counseling for Nutrition
Codes:
CPT: 97802 - Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
SNOMEDCT: 11816003 - Diet education (procedure)
Time Elements:
Relevant Period Start: 2021-10-06T08:15:00.000Z
Relevant Period End: 2021-10-06T08:30:00.000Z
Other Fields:
Counseling for Physical Activity
Codes:
SNOMEDCT: 304507003 - Exercise education (procedure)
Time Elements:
Relevant Date/Time: 2021-10-06T08:15:00.000+00:00
Other Fields:

QDM::PhysicalExamPerformed

Description
Codes
Time
Fields/Results
BMI percentile
Codes:
LOINC: 59574-4 - Body mass index (BMI) [Percentile]
Time Elements:
Relevant Date/Time: 2021-10-06T08:15:00.000+00:00
Other Fields:
Result: 18.6 %
Height
Codes:
LOINC: 3137-7 - Body height Measured
Time Elements:
Relevant Date/Time: 2021-10-06T08:15:00.000+00:00
Other Fields:
Result: 5.0
Weight
Codes:
LOINC: 18833-4 - First Body weight
Time Elements:
Relevant Date/Time: 2021-10-06T08:15:00.000+00:00
Other Fields:
Result: 100.0

QDM::PatientCharacteristicPayer

Description
Codes
Time
Fields/Results
Codes:
Source of Payment Typology: 2 - Medicaid
Time Elements:
Relevant Period Start: 2010-02-02T15:00:00.000Z
Other Fields:

QDM::PatientCharacteristicBirthdate

Description
Codes
Time
Fields/Results
Codes:
LOINC: 21112-8 - Birth date
Time Elements:
Birth Date/Time: 2010-02-02T15:00:00.000+00:00
Other Fields:

QDM::PatientCharacteristicSex

Description
Codes
Time
Fields/Results
Codes:
AdministrativeGender: M - Male
Time Elements:
Other Fields:

QDM::PatientCharacteristicRace

Description
Codes
Time
Fields/Results
Codes:
CDCREC: 2076-8 - Native Hawaiian or Other Pacific Islander
Time Elements:
Other Fields:

QDM::PatientCharacteristicEthnicity

Description
Codes
Time
Fields/Results
Codes:
CDCREC: 2135-2 - Hispanic or Latino
Time Elements:
Other Fields: