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Richard Smith Example
Richard Smith aged 60, is at home and has been feeling unwell with chest pain. His wife speaks to Peter, a neighbour, who offers to take them to the local A & E department. On arrival at A & E Richard, with the aid of his wife, checks in with the receptionist. The receptionist asks for his name, address and Date of Birth and does a PDS look-up to get his details. She confirms these are correct and checks Richard is on the A & E system. She then asks him to take a seat in the waiting area.
After a short wait, Richard starts to feel worse and his wife goes to speak to the receptionist, who asks a passing nurse to speak to Richard. Richard’s wife explains that she is concerned about the possibility of Richard suffering from a heart attack, as his symptoms are similar to Richard’s mother when she had a heart attack. The nurse feels that Richard needs to be seen urgently and asks him and his wife to follow her to the examination cubicle. After taking Richard’s vital signs, the nurse explains that she will go and get a doctor to examine Richard, leaves the cubicle and returns with Doctor Amanda Smith. She also takes Richard’s vital signs and does an ECG that shows inferior ischaemic changes. She explains that they are going to admit Richard onto a ward for further tests.
Richard is admitted to the ward on the 12th Feb where, during triage, the nurse asks if he has any allergies and what medication he is on. Richard’s wife has brought his medication with her, so is able to show the nurse the medication. Richard tells the nurse he has an allergy to Penicillin which causes a rash. The nurse asks if he gets any swelling, to which Richard replies “No”. Richard’s Summary Care Record confirms what he told the nurse. Richard is given a TIMI assessment and a full blood test.
During the course of his stay in hospital Richard is given another ECG. The coronary angiogram indicates a diseased RCA. Following consultation with Mr Abacus, the heart specialist, Richard consents to having an angioplasty procedure to place a drug eluting stent. The is done the next day and the procedure is successful.
When Richard’s wife visits him on the 15th, he tells her that the consultant Mr Abacus says he can go home the following day once he has spoken to someone from the Cardiac Rehabilitation Team. The following day Richard has a Cardiac Rehabilitation consultation with Dr Paul Rastall during which he is given information regarding the diagnosis and possible life style changes when he is discharged. Richard is concerned about whether he can drive and asks about this as he is a self employed electrician. Dr Paul Rastall advises him that he should not to drive for at least a week, but reassures him that he should be able to drive once recovered and says he will arrange for a community follow-up.
In the afternoon Dr Paul Rastall discharges Richard and completes and sends an eDischarge to Richard’s GP and the community nurse at the practice where Richard is registered.
Richard’s wife arrives with their neighbour Peter, who has kindly agreed to pick him up from the hospital and take him home.
The Inpatient Stay
The Inpatient stay is carried in the UKCore-Encounter profiled resource
Named Participants
- Patient - Richard Smith - UKCore-Patient profiled resource
- Patient's Wife - Joy Smith - UKCore-RelatedPerson profiled resource
- Consultant - Mr Abacus - UKCore-Practitioner / UKCore-PractitionerRole profiled resource
- Specialist Registrar - Dr Amanda Smith - UKCore-Practitioner / UKCore-PractitionerRole profiled resource
- Discharging clinician (Document Author) - Dr Paul Rastall - UKCore-Practitioner / UKCore-PractitionerRole profiled resource
- Patient’s GP (Document recipient) - Dr John Lorenzo - UKCore-Practitioner / UKCore-PractitionerRole profiled resource
- Community Nurse (Document recipient) - Mrs Angela Jones - UKCore-Practitioner / UKCore-PractitionerRole profiled resource
Named Organisations
- Patient’s GP Practice - MGP Medical Centre - UKCore-Organization profiled resource
- Discharging Hospital - Leeds Teaching Hospitals NHS Trust - UKCore-Organization profiled resource
Example Instance of Scenario
{ "resourceType": "Bundle", "id": "c06e13aa-8c3b-4e67-999b-6e07e399e741", "meta": { "lastUpdated": "2015-02-17T12:00:00+00:00", "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" ] }, "identifier": { "system": "https://tools.ietf.org/html/rfc4122", "value": "1ff370b6-fc5b-40a1-9721-2a942e301f65" }, "type": "document", "timestamp": "2023-01-28T22:12:21Z", "entry": [ { "fullUrl": "urn:uuid:fa2a75a7-4257-422d-92a4-cf537f078e13", "resource": { "resourceType": "Composition", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition" ] }, "extension": [ { "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CareSettingType", "valueCodeableConcept": { "coding": [ { "system": "http://snomed.info/sct", "code": "789718008", "display": "Cardiology service" } ] } } ], "status": "final", "type": { "coding": [ { "system": "http://snomed.info/sct", "code": "373942005", "display": "Discharge summary" } ] }, "subject": { "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" }, "encounter": { "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" }, "date": "2015-02-17T10:00:00+00:00", "author": [ { "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" } ], "title": "Cardiology Service Discharge Summary", "custodian": { "reference": "urn:uuid:12bba528-a08a-448b-946b-7e8008044025" }, "section": [ { "title": "Admission details", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "admission-details", "display": "Admission details" } ] }, "text": { "status": "extensions", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Reason for admission</th><td>ECG: inferior ischaemia</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>NHS other Hospital Provider - Ward for general Patients or the younger \nphysically disabled or A and E department</td></tr><tr><th>Date/time of admission</th><td>12-Feb-2015 09:00</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" } ] }, { "title": "Allergies and adverse reactions", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "allergies-and-adverse-reaction", "display": "Allergies and adverse reactions" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Causative agent</th><td>Penicillin -class of antibiotic-</td></tr><tr><th>Description of reaction</th><td>Eruption due to drug</td></tr><tr><th>Date recorded</th><td>12 February 2015</td></tr><tr><th>Severity</th><td>Mild</td></tr><tr><th>Certainty</th><td>Certain</td></tr><tr><th>Comment</th><td>No swelling</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:95e8f8d0-dfc3-4c72-a9dc-7ba1ccd1fab4" } ] }, { "title": "Assessment scales", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "assessment-scales", "display": "Assessment scales" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Assessment scale</th><td>TIMI assessment</td></tr></tbody></table></div>" } }, { "title": "Clinical summary", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "clinical-summary", "display": "Clinical summary" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Clinical Summary</th></tr><tr><td><p>60 year old man complaining of chest pain lasting around 2 hours.</p><p>Examination unremarkable.</p><p>Inferior ischaemic changes on ECGs.</p><p>Coronary angiogram demonstrated diseased RCA, drug eluting stent successfully placed.</p><p>Appropriate secondary prevention medications prescribed for follow up with Cardiac Rehabilitation team.</p></td></tr></tbody></table></div>" } }, { "title": "Diagnoses", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "diagnoses", "display": "Diagnoses" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Diagnosis name</th><td>Coronary arteriosclerosis</td></tr><tr><th>Comment</th><td>The coronary angiogram indicates a diseased RCA.</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:caf5f17d-e73d-4aaa-a406-dab1717da0c4" } ] }, { "title": "Discharge details", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "discharge-details", "display": "Discharge details" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Discharging consultant</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Discharging specialty/department</th><td>Cardiology</td></tr><tr><th>Discharge location</th><td><p>Name: Cramer ward</p><p>Identifier: RR8CRAM</p></td></tr><tr><th>Date/time of discharge</th><td>16-Feb-2015 15:00</td></tr><tr><th>Discharge method</th><td>Patient discharged on clinical advice or with clinical consent</td></tr><tr><th>Discharge type</th><td>Usual place of residence unless listed below, for example, a private dwelling \nwhether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. \nIt also includes Patients with no fixed abode.</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" }, { "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" } ] }, { "title": "Distribution list", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "distribution-list", "display": "Distribution list" } ] }, "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:8ece9986-9af0-4882-b0cf-23a96ea7b509" }, { "reference": "urn:uuid:5e414a77-d394-4248-a631-00e45ddb64a0" } ] }, { "title": "GP practice", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "general-practitioner-practice", "display": "GP practice" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>GP name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>GP practice details</th><td><p>Name: MGP Medical Centre</p><p>Address:</p><p>Address Line: 1 MGP House, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 7PA</p></td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:f9f24f89-646b-4a19-a6b1-cabfa3b612e1" } ] }, { "title": "Individual requirements", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "individual-requirements", "display": "Individual requirements" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Individual requirements</th><td>Hospital needs to arrange for transportation to the patient's home.</td></tr></tbody></table></div>" } }, { "title": "Information and advice given", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "information-and-advice-given", "display": "Information and advice given" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Information and advice given</th><td><p>Patient seen by Cardiac Rehab and information given regarding the diagnosis and possible \nlife style changes when he is discharged.</p><p>Richard is concerned about whether he can drive and asks about this as he is a self employed electrician.</p><p> Dr Paul Rastall advised him that he should not to drive for at least a week, \nbut reassured him that he should be able to drive once recovered and said he will arrange for a community follow-up.</p></td></tr></tbody></table></div>" } }, { "title": "Investigation results", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "investigation-results", "display": "Investigation results" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table><tbody><tr><th>Investigation result</th></tr><tr><td><pre>\nFull Blood Count \n \nTestValueUnitsReference Range\nWhite Cell Count11.1x10*9/L3.5 - 10.0\nRed Cell Count5.0x10*12/L4.25 - 5.75 \nHaemoglobin150g/L13.0 - 17.0\nHaematocrit0.2300.400 - 0.500\nMean Cell Volume90fL84 - 98\nMean Cell Hb33.0pg27.5 - 32.0\nMean Cell Hb Con34.0pg31.0 - 35.0\nRDW12.0%< 14.5\nPlatelet Count300x10*9/L150 - 400\n\nMachine Differential \n \nTest ValueUnits Reference Range\nNeutrophils7.0x10*9/L1.7 - 7.5\nLymphocytes3.5x10*9/L1.0 - 3.5 \nMonocytes0.3x10*9/L< 0.6 \nEosinophils0.4x10*9/L< 0.4 \nBasophils0.1x10*9/L< 0.1 \nLUCs0.2x10*9/L< 0.4 \n </pre></td></tr></tbody></table></div>" } }, { "title": "Medications and medical devices", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "medications-and-medical-devices", "display": "Medications and medical devices" } ] }, "text": { "status": "extensions", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Medication name</th><td>Ramipril 2.5mg tablets</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>One 2.5mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Medication name</th><td>Aspirin 75mg tablets (Sigma Pharmaceuticals Plc)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 75mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Medication name</th><td>Clopidogrel 75mg tablets (Almus Pharmaceuticals Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 75mg tablet daily for one year then stop.</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Medication name</th><td>Simvastatin 40mg tablets (Brown & Burk UK Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 40mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width=\"100%\"><tbody><tr><th>Medication name</th><td>Bisoprolol 5mg tablets (A A H Pharmaceuticals Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 5mg tablet daily.</td></tr><tr><th>Comment</th><td>Recommend Uptitrate according to BP and HR</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:d0710501-2e32-4cbd-bd63-a14354bbcd0f" } ] }, { "title": "Patient and carer concerns, expectations and wishes", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "patient-and-carer-concerns", "display": "Patient and carer concerns, expectations and wishes" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Patient and carer concerns, expectations and wishes</th><td>The carer is concerned about the possibility of the patient suffering from a heart attack, \n bearing a similarity to the illness of the mother of the patient. The patient is worried about the impact of their illness on their ability to work and drive.</td></tr></tbody></table></div>" } }, { "title": "Patient demographics", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "patient-demographics", "display": "Patient demographics" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Patient name</th><td><p>Prefix: Mr</p><p>Given Name: Richard</p><p>Family Name: Smith</p></td></tr><tr><th>Date of birth</th><td>1 January 1957</td></tr><tr><th>Gender</th><td>Male</td></tr><tr><th>NHS number</th><td>1352465790</td></tr><tr><th>Patient address</th><td><p>Address Line: 21, Grove Street, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 1PF</p></td></tr><tr><th>Relevant contacts</th><td>\n Name: Joy Smith \n \n <p>Relationship: Next of kin</p><p>Contact details: Tel. 0712345678 Email. mrssmith@mymail.com</p></td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" } ] }, { "title": "Person completing record", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "person-completing-record", "display": "Person completing record" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Role</th><td>Consultant</td></tr><tr><th>Specialty</th><td>Cardiology</td></tr><tr><th>Professional identifier</th><td>GMC: 6122477</td></tr><tr><th>Date and time completed</th><td>17 Feb 2015 10:00</td></tr><tr><th>Contact details</th><td>Phone: 0113 6323200 (Work)</td></tr><tr><th>Organisation</th><td><p>Name: Leeds Teaching Hospitals NHS Trust,</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" } ] }, { "title": "Plan and requested actions", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "plan-and-requested-actions", "display": "Plan and requested actions" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Actions for healthcare professionals</th><td>\n GP please continue secondary preventative medication. \n \n <p>Status: Requested</p><p>Doses will be uptitrated by Cardiac Rehab team.</p><p>Status: Requested</p></td></tr><tr><th>Actions for patient or their carer</th><td>Patient to attend community follow up after discharge.</td></tr><tr><th>Agreed with patient or legitimate patient representative</th><td>Patient agreed to avoid driving for one week on discharge.</td></tr></tbody></table></div>" } }, { "title": "Procedures", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "procedures", "display": "Procedures" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Procedure name</th><td>Percutaneous coronary intervention</td></tr><tr><th>Anatomical site</th><td>Right coronary artery structure</td></tr><tr><th>Comment</th><td>Patient successfully underwent angioplasty procedure to place a drug eluting stent.</td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:1e04ce96-6e52-4f82-bc26-93c89c5836a1" } ] }, { "title": "Referrer details", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "referrer-details", "display": "Referrer details" } ] }, "text": { "status": "generated", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Referrer details</th><td><p>Name:</p><p>Prefix: Dr.</p><p>Given name: Amanda</p><p>Family name: Smith</p><p>Role: Specialist Registrar</p><p>Tel: 0113 6323222 (work)</p><p>Organisation</p><p>Name: St. James's University Hospital Accident and Emergency Department</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div>" }, "entry": [ { "reference": "urn:uuid:d791b058-2624-436a-bc02-db38d65325b8" }, { "reference": "urn:uuid:5f76e146-3eaa-4f0e-aa3b-8d26b8b2febe" } ] }, { "title": "Social context", "code": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings", "code": "social-context", "display": "Social context" } ] }, "text": { "status": "additional", "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><th>Household composition</th><td>Lives with wife</td></tr><tr><th>Occupational history</th><td>Self employed electrician</td></tr></tbody></table></div>" } } ] } }, { "fullUrl": "urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a", "resource": { "resourceType": "Encounter", "meta": { "profile": [ "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter" ] }, "extension": [ { "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod", "valueCodeableConcept": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland", "code": "21", "display": "Accident and emergency or dental casualty department of the Health Care Provider" } ] } } ], "status": "finished", "class": { "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode", "code": "IMP", "display": "inpatient encounter" }, "type": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "185212007", "display": "Seen in hospital ward" } ] } ], "subject": { "reference": "urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" }, "participant": [ { "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType", "code": "DIS", "display": "discharger" } ] } ], "individual": { "reference": "urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" } } ], "period": { "start": "2015-02-12T09:00:00+00:00", "end": "2015-02-16T15:00:00+00:00" }, "reasonCode": [ { "coding": [ { "system": "http://snomed.info/sct", "code": "425419005", "display": "ECG: inferior ischaemia" } ] } ], "hospitalization": { "admitSource": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland", "code": "51", "display": "NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department" } ] }, "dischargeDisposition": { "coding": [ { "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland", "code": "19", "display": "Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. 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<Bundle xmlns="http://hl7.org/fhir"> <id value="c06e13aa-8c3b-4e67-999b-6e07e399e741" /> <meta> <lastUpdated value="2015-02-17T12:00:00+00:00" /> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Bundle" /> </meta> <identifier> <system value="https://tools.ietf.org/html/rfc4122" /> <value value="1ff370b6-fc5b-40a1-9721-2a942e301f65" /> </identifier> <type value="document" /> <timestamp value="2023-01-28T22:12:21Z" /> <entry> <fullUrl value="urn:uuid:fa2a75a7-4257-422d-92a4-cf537f078e13" /> <resource> <Composition> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Composition" /> </meta> <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CareSettingType"> <valueCodeableConcept> <coding> <system value="http://snomed.info/sct" /> <code value="789718008" /> <display value="Cardiology service" /> </coding> </valueCodeableConcept> </extension> <status value="final" /> <type> <coding> <system value="http://snomed.info/sct" /> <code value="373942005" /> <display value="Discharge summary" /> </coding> </type> <subject> <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" /> </subject> <encounter> <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" /> </encounter> <date value="2015-02-17T10:00:00+00:00" /> <author> <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" /> </author> <title value="Cardiology Service Discharge Summary" /> <custodian> <reference value="urn:uuid:12bba528-a08a-448b-946b-7e8008044025" /> </custodian> <section> <title value="Admission details" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="admission-details" /> <display value="Admission details" /> </coding> </code> <text> <status value="extensions" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Reason for admission</th><td>ECG: inferior ischaemia</td></tr><tr><th>Admission method</th><td>Accident and emergency or dental casualty department of the Health Care Provider</td></tr><tr><th>Source of admission</th><td>NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department</td></tr><tr><th>Date/time of admission</th><td>12-Feb-2015 09:00</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" /> </entry> </section> <section> <title value="Allergies and adverse reactions" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="allergies-and-adverse-reaction" /> <display value="Allergies and adverse reactions" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Causative agent</th><td>Penicillin -class of antibiotic-</td></tr><tr><th>Description of reaction</th><td>Eruption due to drug</td></tr><tr><th>Date recorded</th><td>12 February 2015</td></tr><tr><th>Severity</th><td>Mild</td></tr><tr><th>Certainty</th><td>Certain</td></tr><tr><th>Comment</th><td>No swelling</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:95e8f8d0-dfc3-4c72-a9dc-7ba1ccd1fab4" /> </entry> </section> <section> <title value="Assessment scales" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="assessment-scales" /> <display value="Assessment scales" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Assessment scale</th><td>TIMI assessment</td></tr></tbody></table></div> </text> </section> <section> <title value="Clinical summary" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="clinical-summary" /> <display value="Clinical summary" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Clinical Summary</th></tr><tr><td><p>60 year old man complaining of chest pain lasting around 2 hours.</p><p>Examination unremarkable.</p><p>Inferior ischaemic changes on ECGs.</p><p>Coronary angiogram demonstrated diseased RCA, drug eluting stent successfully placed.</p><p>Appropriate secondary prevention medications prescribed for follow up with Cardiac Rehabilitation team.</p></td></tr></tbody></table></div> </text> </section> <section> <title value="Diagnoses" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="diagnoses" /> <display value="Diagnoses" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Diagnosis name</th><td>Coronary arteriosclerosis</td></tr><tr><th>Comment</th><td>The coronary angiogram indicates a diseased RCA.</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:caf5f17d-e73d-4aaa-a406-dab1717da0c4" /> </entry> </section> <section> <title value="Discharge details" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="discharge-details" /> <display value="Discharge details" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Discharging consultant</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Discharging specialty/department</th><td>Cardiology</td></tr><tr><th>Discharge location</th><td><p>Name: Cramer ward</p><p>Identifier: RR8CRAM</p></td></tr><tr><th>Date/time of discharge</th><td>16-Feb-2015 15:00</td></tr><tr><th>Discharge method</th><td>Patient discharged on clinical advice or with clinical consent</td></tr><tr><th>Discharge type</th><td>Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. It also includes Patients with no fixed abode.</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" /> </entry> <entry> <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" /> </entry> </section> <section> <title value="Distribution list" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="distribution-list" /> <display value="Distribution list" /> </coding> </code> <text> <status value="generated" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Mrs</p><p>Given Name: Angela</p><p>Family Name: Jones</p></td></tr><tr><th>Role</th><td>Community Nurse</td></tr><tr><th>Organisation name</th><td>Leeds Community Healthcare NHS Trust</td></tr></tbody></table><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>Role</th><td>General Medical Practitioner</td></tr><tr><th>Organisation name</th><td>MGP Medical Centre</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:8ece9986-9af0-4882-b0cf-23a96ea7b509" /> </entry> <entry> <reference value="urn:uuid:5e414a77-d394-4248-a631-00e45ddb64a0" /> </entry> </section> <section> <title value="GP practice" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="general-practitioner-practice" /> <display value="GP practice" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>GP name</th><td><p>Prefix: Dr</p><p>Given Name: John</p><p>Family Name: Lorenzo</p></td></tr><tr><th>GP practice details</th><td><p>Name: MGP Medical Centre</p><p>Address:</p><p>Address Line: 1 MGP House, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 7PA</p></td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:f9f24f89-646b-4a19-a6b1-cabfa3b612e1" /> </entry> </section> <section> <title value="Individual requirements" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="individual-requirements" /> <display value="Individual requirements" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Individual requirements</th><td>Hospital needs to arrange for transportation to the patient's home.</td></tr></tbody></table></div> </text> </section> <section> <title value="Information and advice given" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="information-and-advice-given" /> <display value="Information and advice given" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Information and advice given</th><td><p>Patient seen by Cardiac Rehab and information given regarding the diagnosis and possible life style changes when he is discharged.</p><p>Richard is concerned about whether he can drive and asks about this as he is a self employed electrician.</p><p> Dr Paul Rastall advised him that he should not to drive for at least a week, but reassured him that he should be able to drive once recovered and said he will arrange for a community follow-up.</p></td></tr></tbody></table></div> </text> </section> <section> <title value="Investigation results" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="investigation-results" /> <display value="Investigation results" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table><tbody><tr><th>Investigation result</th></tr><tr><td><pre> Full Blood Count TestValueUnitsReference Range White Cell Count11.1x10*9/L3.5 - 10.0 Red Cell Count5.0x10*12/L4.25 - 5.75 Haemoglobin150g/L13.0 - 17.0 Haematocrit0.2300.400 - 0.500 Mean Cell Volume90fL84 - 98 Mean Cell Hb33.0pg27.5 - 32.0 Mean Cell Hb Con34.0pg31.0 - 35.0 RDW12.0%< 14.5 Platelet Count300x10*9/L150 - 400 Machine Differential Test ValueUnits Reference Range Neutrophils7.0x10*9/L1.7 - 7.5 Lymphocytes3.5x10*9/L1.0 - 3.5 Monocytes0.3x10*9/L< 0.6 Eosinophils0.4x10*9/L< 0.4 Basophils0.1x10*9/L< 0.1 LUCs0.2x10*9/L< 0.4 </pre></td></tr></tbody></table></div> </text> </section> <section> <title value="Medications and medical devices" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="medications-and-medical-devices" /> <display value="Medications and medical devices" /> </coding> </code> <text> <status value="extensions" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Medication name</th><td>Ramipril 2.5mg tablets</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>One 2.5mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><tbody><tr><th>Medication name</th><td>Aspirin 75mg tablets (Sigma Pharmaceuticals Plc)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 75mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><tbody><tr><th>Medication name</th><td>Clopidogrel 75mg tablets (Almus Pharmaceuticals Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 75mg tablet daily for one year then stop.</td></tr><tr><th>Status</th><td>Added</td></tr></tbody></table><table width="100%"><tbody><tr><th>Medication name</th><td>Simvastatin 40mg tablets (Brown & Burk UK Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 40mg tablet once a day.</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table><table width="100%"><tbody><tr><th>Medication name</th><td>Bisoprolol 5mg tablets (A A H Pharmaceuticals Ltd)</td></tr><tr><th>Form</th><td>Tablet</td></tr><tr><th>Route</th><td>Oral</td></tr><tr><th>Dose directions description</th><td>Take one 5mg tablet daily.</td></tr><tr><th>Comment</th><td>Recommend Uptitrate according to BP and HR</td></tr><tr><th>Status</th><td>Continued</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:d0710501-2e32-4cbd-bd63-a14354bbcd0f" /> </entry> </section> <section> <title value="Patient and carer concerns, expectations and wishes" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="patient-and-carer-concerns" /> <display value="Patient and carer concerns, expectations and wishes" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Patient and carer concerns, expectations and wishes</th><td>The carer is concerned about the possibility of the patient suffering from a heart attack, bearing a similarity to the illness of the mother of the patient. The patient is worried about the impact of their illness on their ability to work and drive.</td></tr></tbody></table></div> </text> </section> <section> <title value="Patient demographics" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="patient-demographics" /> <display value="Patient demographics" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Patient name</th><td><p>Prefix: Mr</p><p>Given Name: Richard</p><p>Family Name: Smith</p></td></tr><tr><th>Date of birth</th><td>1 January 1957</td></tr><tr><th>Gender</th><td>Male</td></tr><tr><th>NHS number</th><td>1352465790</td></tr><tr><th>Patient address</th><td><p>Address Line: 21, Grove Street, Overtown</p><p>City: Leeds</p><p>Post Code: LS21 1PF</p></td></tr><tr><th>Relevant contacts</th><td> Name: Joy Smith <p>Relationship: Next of kin</p><p>Contact details: Tel. 0712345678 Email. mrssmith@mymail.com</p></td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" /> </entry> </section> <section> <title value="Person completing record" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="person-completing-record" /> <display value="Person completing record" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Name</th><td><p>Prefix: Dr</p><p>Given Name: Paul</p><p>Family Name: Rastall</p></td></tr><tr><th>Role</th><td>Consultant</td></tr><tr><th>Specialty</th><td>Cardiology</td></tr><tr><th>Professional identifier</th><td>GMC: 6122477</td></tr><tr><th>Date and time completed</th><td>17 Feb 2015 10:00</td></tr><tr><th>Contact details</th><td>Phone: 0113 6323200 (Work)</td></tr><tr><th>Organisation</th><td><p>Name: Leeds Teaching Hospitals NHS Trust,</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" /> </entry> </section> <section> <title value="Plan and requested actions" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="plan-and-requested-actions" /> <display value="Plan and requested actions" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Actions for healthcare professionals</th><td> GP please continue secondary preventative medication. <p>Status: Requested</p><p>Doses will be uptitrated by Cardiac Rehab team.</p><p>Status: Requested</p></td></tr><tr><th>Actions for patient or their carer</th><td>Patient to attend community follow up after discharge.</td></tr><tr><th>Agreed with patient or legitimate patient representative</th><td>Patient agreed to avoid driving for one week on discharge.</td></tr></tbody></table></div> </text> </section> <section> <title value="Procedures" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="procedures" /> <display value="Procedures" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Procedure name</th><td>Percutaneous coronary intervention</td></tr><tr><th>Anatomical site</th><td>Right coronary artery structure</td></tr><tr><th>Comment</th><td>Patient successfully underwent angioplasty procedure to place a drug eluting stent.</td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:1e04ce96-6e52-4f82-bc26-93c89c5836a1" /> </entry> </section> <section> <title value="Referrer details" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="referrer-details" /> <display value="Referrer details" /> </coding> </code> <text> <status value="generated" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Referrer details</th><td><p>Name:</p><p>Prefix: Dr.</p><p>Given name: Amanda</p><p>Family name: Smith</p><p>Role: Specialist Registrar</p><p>Tel: 0113 6323222 (work)</p><p>Organisation</p><p>Name: St. James's University Hospital Accident and Emergency Department</p><p>Address Line: St James's University Hospital, Beckett Street</p><p>City: Leeds</p><p>Post Code: LS9 7TF</p></td></tr></tbody></table></div> </text> <entry> <reference value="urn:uuid:d791b058-2624-436a-bc02-db38d65325b8" /> </entry> <entry> <reference value="urn:uuid:5f76e146-3eaa-4f0e-aa3b-8d26b8b2febe" /> </entry> </section> <section> <title value="Social context" /> <code> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-RecordStandardHeadings" /> <code value="social-context" /> <display value="Social context" /> </coding> </code> <text> <status value="additional" /> <div xmlns="http://www.w3.org/1999/xhtml"><table width="100%"><tbody><tr><th>Household composition</th><td>Lives with wife</td></tr><tr><th>Occupational history</th><td>Self employed electrician</td></tr></tbody></table></div> </text> </section> </Composition> </resource> </entry> <entry> <fullUrl value="urn:uuid:4f36b35a-ad18-4ea9-a3fb-c893f709e88a" /> <resource> <Encounter> <meta> <profile value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter" /> </meta> <extension url="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod"> <valueCodeableConcept> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-AdmissionMethodEngland" /> <code value="21" /> <display value="Accident and emergency or dental casualty department of the Health Care Provider" /> </coding> </valueCodeableConcept> </extension> <status value="finished" /> <class> <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode" /> <code value="IMP" /> <display value="inpatient encounter" /> </class> <type> <coding> <system value="http://snomed.info/sct" /> <code value="185212007" /> <display value="Seen in hospital ward" /> </coding> </type> <subject> <reference value="urn:uuid:31686b67-9f20-4644-9a54-193d2f91de57" /> </subject> <participant> <type> <coding> <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType" /> <code value="DIS" /> <display value="discharger" /> </coding> </type> <individual> <reference value="urn:uuid:6239b7a7-380d-46ff-a1c5-7abc4e68f8bc" /> </individual> </participant> <period> <start value="2015-02-12T09:00:00+00:00" /> <end value="2015-02-16T15:00:00+00:00" /> </period> <reasonCode> <coding> <system value="http://snomed.info/sct" /> <code value="425419005" /> <display value="ECG: inferior ischaemia" /> </coding> </reasonCode> <hospitalization> <admitSource> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-SourceOfAdmissionEngland" /> <code value="51" /> <display value="NHS other Hospital Provider - Ward for general Patients or the younger physically disabled or A and E department" /> </coding> </admitSource> <dischargeDisposition> <coding> <system value="https://fhir.hl7.org.uk/CodeSystem/UKCore-DischargeDestinationEngland" /> <code value="19" /> <display value="Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes wardened accommodation but not residential accommodation where health care is provided. 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