Patient Care Coordination (PCC) Implementation Guide
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Patient Care Coordination (PCC) Implementation Guide - Local Development build (v0.1.1-current) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Bundle: Bundle `Document` - GP Connect Patient Summary

Document Details

Document Subject

version: 1521806400000; Last updated: 2018-03-23 12:00:00+0000

Mike MEAKIN Male, DoB: 1927-06-19 ( https://fhir.nhs.uk/Id/nhs-number#9658218873)

Contact Detail
  • ph: 01454587554(Home)
  • 1 KNIGHTS COURT, DN16 3PL(home)

Document Content

Problems

Problems and Issues

Active Problems and Issues

Date filter not applied

Start DateEntrySignificanceDetails
25-Apr-2018Lower back painMinor
01-May-2015Type II Diabetes mellitusMajorDiabetes type II blood glucose management

Major Inactive Problems and Issues

For the period '24-Jul-2015' to '24-Jul-2025'

No 'Major Inactive Problems and Issues' data is recorded for this patient.

Other Inactive Problems and Issues

For the period '24-Jul-2015' to '24-Jul-2025'

No 'Other Inactive Problems and Issues' data is recorded for this patient.

Allergy

Allergies and Adverse Reactions

Current Allergies and Adverse Reactions

Start DateDetails
15-Mar-2016Allergy to Penicillin, Patient experienced rash, nausea and vomiting

Historical Allergies and Adverse Reactions

Start DateEnd DateDetails
02-Jun-1963Hayfever, allergy to pollen

Medication

Medications

Acute Medication (Last 12 Months)

Date filter not applied

TypeStart DateMedication ItemDosage InstructionQuantityScheduled End DateDays DurationAdditional Information
NHS Medication25-Jan-2025Tramadol 50mg capsulesone tablet every 4 to 6 hours28 days28Take 1 or 2 tablets as directed up to 4 times per day

Current Repeat Medication

Date filter not applied

TypeStart DateMedication ItemDosage InstructionQuantityLast Issued DateNumber of Prescriptions IssuedMax IssuesReview DateAdditional Information
Repeat01-Feb-2022Metformin 500mg tabletsone tablet 2 to 3 times daily28 days28-Dec-20243615-Jul-2025Take one tablet three times daily
Repeat01-Dec-2012Lercanidipine 20mg tabletsone tablet daily28 days20-Dec-20243615-Jul-2025Take one tablet daily

Discontinued Repeat Medication

All repeat medication ended by a clinician action

Date filter not applied

TypeLast Issued DateMedication ItemDosage InstructionQuantityDiscontinued DateDiscontinuation ReasonAdditional Information
Repeat01-Feb-2012Metformin 500mg tabletsone tablet 2 to 3 times per day28 days01-Feb-201260 tablet pack discontinuedTake with food and water

All Medication

For the period '24-Jul-2015' to '24-Jul-2025'

TypeStart DateMedication ItemDosage InstructionQuantityLast Issued DateNumber of Prescriptions IssuedDiscontinuation DetailsAdditional Information
Lercanidipine 20mg tablets
Repeat01-Dec-2012Lercanidipine 20mg tabletsone tablet daily28 days01-Dec-20121Take one tablet daily
Metformin 500mg tablets
Repeat01-Feb-2022Metformin 500mg tabletsone tablet 2 to 3 times daily28 days01-Feb-20221Take one tablet three times daily
Repeat01-Feb-2012Metformin 500mg tabletsone tablet 2 to 3 times per day28 days01-Feb-20121DISCONTINUED:
01-Feb-2012
60 tablet pack discontinued		Take with food and water
Tramadol 50mg capsules
NHS Medication25-Jan-2025Tramadol 50mg capsulesone tablet every 4 to 6 hours28 days25-Jan-20251Take 1 or 2 tablets as directed up to 4 times per day

All Medication Issues

For the period '24-Jul-2015' to '24-Jul-2025'

TypeIssue DateMedication ItemDosage InstructionQuantityDays DurationAdditional Information
Lercanidipine 20mg tablets
Repeat01-Dec-2012Lercanidipine 20mg tabletsone tablet daily28 daysTake one tablet daily
Metformin 500mg tablets
Repeat01-Feb-2022Metformin 500mg tabletsone tablet 2 to 3 times daily28 daysTake one tablet three times daily
Repeat01-Feb-2012Metformin 500mg tabletsone tablet 2 to 3 times per day28 days4Take with food and water
Tramadol 50mg capsules
NHS Medication25-Jan-2025Tramadol 50mg capsulesone tablet every 4 to 6 hours28 days28Take 1 or 2 tablets as directed up to 4 times per day

Immunisations

Immunisations

DateVaccinationPartContentsDetails
30-Aug-2015Pneumovax II1Pneumoccocal
18-Jan-2013Influenza vaccine1Influenza
04-Oct-2010Influenza vaccine1Influenza

Referral

Referrals

For the period '24-Jul-2015' to '24-Jul-2025'

DateFromToPriorityDetails
02-Jul-2016Dr Johnson and PartnersCommunity Diabetic ClinicRoutineNeeds further support with dietary needs

History - Encounters

Encounters

All relevant items

DateTitleDetails
01-Feb-2018Care navigationReception signposting regarding exercise classes

Observation

Clinical Items

For the period '24-Jul-2015' to '24-Jul-2025'

No 'Clinical Items' data is recorded for this patient.

Observations

For the period '24-Jul-2015' to '24-Jul-2025'

DateEntryValueRangeDetails
07-May-2017Foot Risk ClassificationLeft diabetic foot at low riskLow to High RiskAnnual review
07-May-2017Foot Risk ClassificationRight diabetic foot at low riskLow to High RiskAnnual review

Administrative Items

All relevant items

DateEntryDetails
02-May-2015Appointment LetterCommunity diabetes clinic

Additional Resources Included in Document

Entry 2 - fullUrl = urn:uuid:44b7ff18-5c26-414e-8f53-d8a9515ea243

Resource Practitioner:

version: 1469444400000; Last updated: 2016-07-25 12:00:00+0100

identifier: http://fhir.nhs.net/Id/sds-user-id/G13579135, http://fhir.nhs.net/Id/sds-role-profile-id/PT1234

name: Nichole Gilbert

gender: Female

communication: No display for Practitioner.communication (language: English)

Entry 3 - fullUrl = urn:uuid:83521388-6fd3-4e2f-bda6-6fb889190c61

Resource Organization:

version: 1548849600000; Last updated: 2019-01-30 12:00:00+0000

identifier: http://fhir.nhs.net/Id/ods-organization-code/A20047

name: Dr Legg's Surgery

Contacts

-TelecomAddress
*ph: 12345678(Work)NHS NPFIT Test Data Manager Princes Exchange Leeds LS1 4HY (work)

Entry 4 - fullUrl = urn:uuid:2da4ef7b-c18e-4d95-b91e-2406317d4477

Resource Patient:

version: 1521806400000; Last updated: 2018-03-23 12:00:00+0000

Mike MEAKIN Male, DoB: 1927-06-19 ( https://fhir.nhs.uk/Id/nhs-number#9658218873)

Contact Detail
  • ph: 01454587554(Home)
  • 1 KNIGHTS COURT, DN16 3PL(home)