Sample Report

Clinical EBI Report

EXPOSURE BURDEN INDEX · ENVIRONMENTAL HEALTH ASSESSMENT

Generated: 03/04/2026
RPT-HK-2024-0731-03042026

Patient Information

Initials: J.M.
DOB: 03/15/1978
MRN: HK-2024-0731
ZIP: 30301

Ordering Provider

Provider: Dr. S. Williams, DO
NPI: 1234567890
Practice: Integrative Health Associates
58EBI SCORE

Overall Exposure Burden Index

Composite score derived from 5 environmental exposure vectors, weighted by symptom correlation and vulnerability factors.

Triage: ACTVulnerability Modifier: +15Symptoms improve away from home

Symptom duration: 6-12 months · CPT: 96160 (Health Risk Assessment Instrument)

Exposure Vector Analysis

Individual environmental exposure scores (0–100 scale). Scores above 60 trigger clinical decision pathways.

Water Contamination
HIGH78/100
Air Quality
MODERATE62/100
Moisture / Mold
MODERATE55/100
Chemical Exposure
LOW31/100
Heavy Metals
LOW28/100

Symptom Cluster Analysis

Aggregated symptom severity by clinical cluster. Higher scores indicate greater symptom burden in that system.

General / Constitutional14
  • Fatigue (Severe)
  • Headaches (Moderate)
  • Joint pain (Mild)
Respiratory9
  • Sinus congestion (Moderate)
  • Shortness of breath (Mild)
  • Wheezing (Mild)
Neurological7
  • Brain fog (Moderate)
  • Memory problems (Mild)
Mood / Sleep6
  • Insomnia (Moderate)
  • Anxiety (Mild)
Gastrointestinal3
  • Nausea (Mild)

Environmental Profile Summary

Key environmental factors reported by the patient.

Home

Year Built1972
TypeSingle-family
BasementYes
Recent RenovationsNo

Water

SourceMunicipal
FiltrationNone
Pipe TypeUnknown (pre-1978)
Near ContaminationYes
IssuesDiscoloration, Metallic taste

Air / Indoor

Gas StoveYes
Attached GarageYes
Radon TestedNo
Water DamageYes
Visible MoldYes
CarpetingYes

Clinical Decision Pathways

4 pathway(s) generated based on exposure-symptom correlation analysis. These are suggestions to support clinical decision-making; all ordering and interpretation is at the clinician's discretion.

HIGH Water Contamination Score (78/100)
PRIORITY

Well-water exposure with unknown pipe age (pre-1978), proximity to contamination site, and visible water quality issues indicate elevated risk for PFAS, lead, and other waterborne contaminants.

Suggested Lab Panels

  • PFAS Blood Panel
  • Heavy Metal Panel (Blood)
  • Thyroid Panel (TSH, Free T3, Free T4)

CPT Codes

835198301884439

ICD-10 Codes

Z77.098Z58.6
HIGH Mold Score + Respiratory Symptoms
PRIORITY

Confirmed water damage and visible mold in a carpeted home, combined with respiratory symptoms (sinus congestion, shortness of breath, wheezing) that improve when leaving the home.

Suggested Lab Panels

  • IgE Panel
  • C4a
  • TGF-beta 1
  • MMP-9
  • MSH

CPT Codes

827858623583519

ICD-10 Codes

Z77.120J68.0T78.40XA
Elevated Air Quality Score (62/100)
ROUTINE

Gas stove, attached garage, no radon testing, and pre-1978 construction contribute to elevated indoor air quality risk. Radon testing is recommended as a priority.

Suggested Lab Panels

  • Pulmonary Function Test
  • IgE Total
  • Consider Radon Testing

CPT Codes

9401082785

ICD-10 Codes

Z77.110
Elevated Heavy Metal Exposure Risk (28/100) + Pre-1978 Home
ROUTINE

Pre-1978 home with unknown pipe material and proximity to contamination site. While the score is below the priority threshold, the combination of factors warrants baseline heavy metal screening.

Suggested Lab Panels

  • Blood Lead Level
  • Mercury (Blood)
  • Arsenic (Urine)

CPT Codes

836558382582175

ICD-10 Codes

Z77.011T56.0X1A

Recommended Next Steps

Based on the exposure profile, the following additional testing tiers may provide actionable data.

Tier 3: EBI + Water Testing

Tap Score Advanced City Water Test (111 analytes) including PFAS, lead, pesticides, and other contaminants. EPA-certified lab analysis.

Strongly Recommended

Tier 4: EBI + Mold Testing

EnviroBiomics ERMI mold analysis. 36-species mold panel using EPA-developed gold standard methodology for CIRS evaluation.

Strongly Recommended

Quick Reference: EBI-Related Billing Codes

ICD-10 Codes

Z77.010Contact with lead
Z77.011Contact with lead in water
Z77.098Contact with other hazardous substances
Z77.110Contact with air pollutants
Z77.120Contact with mold
Z58.6Inadequate drinking water supply
Z13.88Encounter for screening, other

CPT Codes

96160Health risk assessment instrument
99381–97E/M with environmental focus
99457Remote monitoring (device data)
83655Blood lead level
82108Aluminum (blood)
83519Immunoassay (TGF-beta, C4a)

Disclaimers & Compliance

This report is generated by the HomeKnown Exposure Burden Index (EBI) scoring engine based on patient-reported environmental and symptom data. It is intended to support clinical decision-making and does not constitute a medical diagnosis, treatment recommendation, or guarantee of any outcome.

All lab ordering, interpretation, and clinical decisions remain the responsibility of the ordering physician. HomeKnown does not order, perform, or interpret medical laboratory tests. Suggested lab panels and billing codes are provided as reference material to support medical necessity documentation.

Insurance coverage for environmental health assessments varies by plan and payer. Patients should verify coverage with their insurance provider. Environmental monitoring and testing services may be HSA/FSA eligible with a Letter of Medical Necessity (LMN).

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