Initial Public Health Case Report
Jane Doe
Patient Identifiers
PT-470126 Meaningless identifier, not to be used for any actual entities. Examples only.
444-44-4444 United States Social Security Number
About
Date of Birth
10/2/1990
Sex
Female
Race
Native Hawaiian or other Pacific Islander
Ethnicity
Not Hispanic or Latino
Contact
Home
2222 Home Street
Houston, TX
77002, US
tel: (Primary Home) 555-555-2003
email: (Primary Home) janedoe@email.com
Emergency Contact
Mr Emer Contact
()
()
Contact
tel: (Mobile Contact) +1-334-304-2665
Author
Time:
05/5/2020, 15:00
OID: 2.16.840.1.113883.3.72.5.20
Contact
Work Place
1234 Facility Drive
Houston, TX
77002
tel: (Work Place) 555-777-0123
fax: (Work Place) 555-777-0987
Encounter
Identifier
9937015 OID: 2.16.840.1.113883.19
Type
Office outpatient visit 15 minutes
Date
From: 05/13/2020
To: 05/13/2020
Location
Outpatient Facility
Responsible Party
Assigned Amanda, of Houston Urgent Care
Clinic
Contact
Home
1234 Provider Street
Houston, TX
77002, US
tel: (Work Place) 555-777-0123
fax: (Work Place) 555-777-0987
Encounters
Encounter | Date(s) | Location |
---|---|---|
Office outpatient visit 15 minutes | 05/13/2020 | Houston Urgent Care Clinic |
|
History of Present Illness
No history of present illness
Medications Administered
No medications administered
Problem List
No problems reported
Reason for visit
Results
Results Panel | Date(s) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
SARS-like Coronavirus N gene [Presence] in Unspecified specimen by NAA with probe detection | ||||||||||||||
|
Plan of Treatment
*** In the table below, row entries with values under RCTC columns triggered this Electronic Initial Case Report (eICR)
Lab Test Order | Code | CodeSystem | RCTC OID *** | RCTC Version *** | Ordered Date |
---|---|---|---|---|---|
SARS-like Coronavirus N gene [Presence] in Unspecified specimen by NAA with probe detection | 94310-0 | LOINC | 05/13/2020 |
Social History
Birth Sex | Value | Date |
---|---|---|
Sex Assigned At Birth | Female | 10/02/1990 |
Social History Observation Type | Value | Dates(s) |
---|---|---|
Occupation / Employment details | Postsecondary teachers | |
Pregnancy Status | No |
Document maintained by
Houston Urgent Care Clinic
Contact
Work Place
1234 Facility Drive
Houston, TX
77002
tel: (Work Place) 555-777-0123
Document Information
Document Identifier | Document Created |
---|---|
OID: 10c13861-86a8-4a9a-aec6-b615921178df | 05/5/2020, 15:00 |