Visualize HL7 Example and Test Instances (vi7eti), pronounced /viːˈsɛtiː/
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European Patient Summary

Patient
Name: Szczubełek, Stefan
DOB: 14-JUL-1971 (Age: 54)
Gender: male
ID: 2224-994199-2 (ECI)
Author
Dr. Ping, Hel
Patient summary Document
European Patient Summary
Report Date: 21-JUL-2025

Problem list

Condition Onset Date Status
Polyp of colon 21-Jul-2025 active
Osteoarthritis of knee 23-Jun-2024 active
Chronic kidney disease stage 2 06-Mar-2018 active
Microalbuminuria due to type 2 diabetes mellitus 06-Mar-2018 active
Disorder of kidney due to diabetes mellitus 02-Jan-2018 active
Chronic kidney disease stage 1 02-Jan-2018 active
Hyperlipidemia 04-Dec-2012 active
Chronic sinusitis 16-Nov-2006 active
Anemia 19-Oct-2004 active
Hyperglycemia 08-Oct-2002 active
Essential hypertension 02-Oct-2001 active
Metabolic syndrome X 26-Sep-1995 active
Hypertriglyceridemia 26-Sep-1995 active
Type 2 diabetes mellitus 25-Apr-1995 active
Prediabetes 22-Sep-1992 active

Medication list

No known medications

Immunizations list

Vaccine Date
Influenza virus antigen only vaccine product 28-Jan-2025
Clostridium tetani toxoid antigen adsorbed only vaccine product 19-Oct-2021
Live attenuated Human alphaherpesvirus 3 only vaccine product 22-Jun-2021
SARS-CoV-2 mRNA vaccine 09-Feb-2021

Procedure History list

Procedure Date Reason
Depression screening 08-Aug-2023 -
Medication reconciliation 08-Aug-2023 -
Assessment of health and social care needs 08-Aug-2023 -
Assessment of anxiety 08-Aug-2023 -
Screening for domestic abuse 08-Aug-2023 -
Depression screening using Patient Health Questionnaire Two-Item score (procedure) 08-Aug-2023 -
Screening for drug abuse 11-Oct-2022 -
Assessment of substance use 11-Oct-2022 -
Patient evaluation and management 30-Jul-2019 -
Urine specimen collection 30-Jul-2019 -
Patient discharge 30-Jul-2019 -
Taking patient vital signs 30-Jul-2019 -
History taking 30-Jul-2019 -
Discussion about signs and symptoms 30-Jul-2019 -
Antibiotic therapy 30-Jul-2019 -
Triage: emergency center 30-Jul-2019 -
Urinalysis with reflex to microscopy and culture 30-Jul-2019 -
Pre-discharge assessment 29-Jul-2019 -
Discharge from skilled nursing facility (procedure) 29-Jul-2019 -
Nursing care/supplementary surveillance 28-Jul-2019 -
Occupational therapy 26-Jul-2019 -
Physical therapy procedure 25-Jul-2019 -
History AND physical examination 23-Jul-2019 -
Initial patient assessment 23-Jul-2019 -
Development of individualized plan of care 23-Jul-2019 -
Suture open wound 28-Jun-2016 Facial laceration

Allergies and Intolerances

Allergy/Intolerance Onset Date Status Type Reaction
? active ?

Care Plan

Active Planned Care / Goals Start Date Reason
Musculoskeletal care 23-Jun-2024 Osteoarthritis of knee
  • Reduce knee pain severity to improve function and quality of life
  • Increase ability to perform daily activities without limitation from knee osteoarthritis
  • Increase knee flexion range of motion
  • Achieve recommended physical activity for joint health
Hyperlipidemia clinical management plan 25-Dec-2012 Hyperlipidemia
  • Achieve LDL cholesterol less than 1.8 mmol/L
  • Achieve total cholesterol less than 4.0 mmol/L
  • Achieve triglycerides less than 1.7 mmol/L
  • Achieve HDL cholesterol greater than 1.0 mmol/L
Lifestyle education regarding hypertension 02-Oct-2001 Essential hypertension (disorder)
  • Maintain blood pressure below 130/80 mmHg to reduce cardiovascular and renal risk.
  • Limit daily sodium intake to less than 2.3 grams to support blood pressure control.
  • Achieve at least 5% reduction in body weight to improve blood pressure control.
  • Engage in at least 150 minutes of moderate-intensity aerobic physical activity per week.
Diabetes self management plan 22-Sep-1992 Prediabetes
  • Maintain or achieve HbA1c at or below individualized target to support diabetes self-management.
  • Achieve and maintain weight loss as part of diabetes self-management plan.
  • Maintain blood pressure at or below target to reduce risk of diabetes complications.
  • Engage in at least 150 minutes of moderate-intensity physical activity per week as part of diabetes self-management.

Vital Signs

Vital Signs 2025-03-04 2025-02-11
Body Height 164.3 cm 164.3 cm
Pain severity - 0-10 verbal numeric rating [Score] - Reported 3 {score} 4 {score}
Body Weight 81.8 kg 81.8 kg
Body mass index (BMI) [Ratio] 30.3 kg/m2 30.3 kg/m2
Diastolic Blood Pressure 100 mm[Hg] 93 mm[Hg]
Systolic Blood Pressure 122 mm[Hg] 122 mm[Hg]
Heart rate 84 /min 79 /min
Respiratory rate 12 /min 15 /min

Relevant diagnostic tests/laboratory data

Recent Lab Observations 21-JUL-2025 Reference Range Unit
Polyp size greatest dimension 2.3 0 - 5 mm
Hemoglobin.gastrointestinal.lower [Presence] in Stool by Immunoassay --1st specimen 22.0 0 - 200 ng/mL

Device Use

Device Date (since)
Walker (physical object) 23-Jun-2024
Home nebulizer (physical object) 16-Nov-2006
Blood glucose meter (physical object) 22-Sep-1992