source: ccr2ccd-xslt/trunk/make/M1_100839_QRDA_V1_0_0Ver4.xml@ 999

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1<?xml version="1.0" encoding="utf-8"?>
2<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
3 <realmCode code="US"/>
4 <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
5 <templateId root="2.16.840.1.113883.10.20.12"/>
6 <templateId root="2.16.840.1.113883.3.249.11.100.1"/>
7 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-DOC@@@"/>
8 <code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
9 <title>QRDA Incidence Report</title>
10 <effectiveTime value="20100703"/>
11 <confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
12 <languageCode code="en-US"/>
13 <setId root="2.16.840.1.113883.3.543" extension="@@@UUID-SET@@@"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="002030004" root="SSN"/>
18 <addr use="H">
19 <streetAddressLine/>
20 <city/>
21 <state/>
22 <postalCode/>
23 </addr>
24 <telecom/>
25 <patient>
26 <name>
27 <given>JODY</given>
28 <given>JEAN</given>
29 <family>JONES</family>
30 </name>
31 <administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
32 <birthTime value="19450101120000"/>
33 </patient>
34 </patientRole>
35 </recordTarget>
36 <author>
37 <time value="20100703"/>
38 <assignedAuthor>
39 <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
40 <assignedPerson>
41 <name>
42 <given>Nancy</given>
43 <family>Anthracite</family>
44 <suffix>MD</suffix>
45 </name>
46 </assignedPerson>
47 <representedOrganization>
48 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
49 <name>WorldVistA Test Clinic</name>
50 </representedOrganization>
51 </assignedAuthor>
52 </author>
53 <informant>
54 <assignedEntity>
55 <id nullFlavor="NA"/>
56 <representedOrganization>
57 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
58 <name>World VistA Test Clinic</name>
59 </representedOrganization>
60 </assignedEntity>
61 </informant>
62 <custodian>
63 <assignedCustodian>
64 <representedCustodianOrganization>
65 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
66 <name>WorldVistA Test Clinic</name>
67 </representedCustodianOrganization>
68 </assignedCustodian>
69 </custodian>
70 <legalAuthenticator>
71 <time value="20100703"/>
72 <signatureCode code="S"/>
73 <assignedEntity>
74 <id root="2.16.840.1.113883.3.543" extension="111111"/>
75 <assignedPerson>
76 <name>
77 <given>Nancy</given>
78 <family>Anthracite</family>
79 <suffix>MD</suffix>
80 </name>
81 </assignedPerson>
82 <representedOrganization>
83 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
84 <name>WorldVistA Test Clinic</name>
85 </representedOrganization>
86 </assignedEntity>
87 </legalAuthenticator>
88 <participant typeCode="PRF">
89 <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
90 <associatedEntity classCode="PROV">
91 <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
92 <associatedPerson>
93 <name>
94 <prefix>Dr.</prefix>
95 <given>Nancy</given>
96 <family>Anthracite</family>
97 </name>
98 </associatedPerson>
99 </associatedEntity>
100 </participant>
101 <component>
102 <structuredBody>
103 <component>
104 <section>
105 <templateId root="2.16.840.1.113883.3.249.11.50"/>
106 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
107 <title>Measure set: CMS EHR Measure Set</title>
108 <text>2010 Measures Set Measures</text>
109 <component>
110 <section>
111 <templateId root="2.16.840.1.113883.3.249.11.2"/>
112 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
113 <title>Measure Section</title>
114 <text>
115 <list>
116 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
117 </list>
118 </text>
119 <entry typeCode="DRIV">
120 <act classCode="ACT" moodCode="DEF">
121 <id root="2.16.840.1.113883.3.249.11.2"/>
122 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
123 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
124 <statusCode code="completed"/>
125 </act>
126 </entry>
127 <component>
128 <section>
129 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
130 <title>Reporting Parameters</title>
131 <text>
132 <list>
133 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
134 </list>
135 </text>
136 <entry>
137 <act classCode="ACT" moodCode="EVN">
138 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
139 <effectiveTime>
140 <low value="20100101"/>
141 <high value="20101231"/>
142 </effectiveTime>
143 </act>
144 </entry>
145 </section>
146 </component>
147 <component>
148 <section>
149 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
150 <title>Patient Data</title>
151 </section>
152 </component>
153 <component>
154 <section>
155 <templateId root="2.16.840.1.113883.10.20.1.12"/>
156 <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
157 <title>Procedures</title>
158 <text>
159 <table>
160 <tbody>
161 <tr>
162 <th>Type</th>
163 <th>Date</th>
164 <th>Code</th>
165 <th>Description</th>
166 <th>Location</th>
167 <th>Substance</th>
168 <th>Method</th>
169 <th>Position</th>
170 <th>Site</th>
171 <th>Status</th>
172 <th>Source</th>
173 </tr>
174 <tr id="PROCEDURE_4056_27">
175 <td/>
176 <table>
177 <tbody>
178 <tr xmlns="">
179 <td>Procedure Date:
180 </td>
181 <td>Sep 04, 2010</td>
182 </tr>
183 </tbody>
184 </table>
185 <td>99213 (CPT-4)
186 </td>
187 <td>INTERMEDIATE (15min)</td>
188 <td/>
189 <td/>
190 <td/>
191 <td/>
192 <td/>
193 <td>Completed</td>
194 <td>SYSTEM MANAGER </td>
195 </tr>
196 <tr id="PROCEDURE_4055_24">
197 <td/>
198 <table>
199 <tbody>
200 <tr xmlns="">
201 <td>Procedure Date:
202 </td>
203 <td>Aug 28, 2010</td>
204 </tr>
205 </tbody>
206 </table>
207 <td>99202 (CPT-4)
208 </td>
209 <td>EXPANDED, HX &amp; EXAM</td>
210 <td/>
211 <td/>
212 <td/>
213 <td/>
214 <td/>
215 <td>Completed</td>
216 <td>SYSTEM MANAGER </td>
217 </tr>
218 <tr id="PROCEDURE_4047_14">
219 <td/>
220 <table>
221 <tbody>
222 <tr xmlns="">
223 <td>Procedure Date:
224 </td>
225 <td>Jul 31, 2010</td>
226 </tr>
227 </tbody>
228 </table>
229 <td>99213 (CPT-4)
230 </td>
231 <td>Office/Outpatient Visit of an Established Patient requiring (2 of 3) an Expanded History, an Exam and Medical Decision Making of Low Complexity (CPT-4 99213)</td>
232 <td/>
233 <td/>
234 <td/>
235 <td/>
236 <td/>
237 <td>Completed</td>
238 <td>SYSTEM MANAGER </td>
239 </tr>
240 <tr id="PROCEDURE_4046_7">
241 <td/>
242 <table>
243 <tbody>
244 <tr xmlns="">
245 <td>Procedure Date:
246 </td>
247 <td>Jul 05, 2010</td>
248 </tr>
249 </tbody>
250 </table>
251 <td>99214 (CPT-4)
252 </td>
253 <td>Office/Outpatient Visit of an Established Patient requiring (2 of 3) a Detailed History, an Exam and Medical Decision Making of Moderate Complexity (CPT-4 99214)</td>
254 <td/>
255 <td/>
256 <td/>
257 <td/>
258 <td/>
259 <td>Completed</td>
260 <td>EIGHT PROVIDER Scholar Extraordinaire </td>
261 </tr>
262 <tr id="PROCEDURE_4046_8">
263 <td/>
264 <table>
265 <tbody>
266 <tr xmlns="">
267 <td>Procedure Date:
268 </td>
269 <td>Jul 05, 2010</td>
270 </tr>
271 </tbody>
272 </table>
273 <td>83036 (CPT-4)
274 </td>
275 <td>Hemoglobin; Glycosylated (A1c) (CPT-4 83036)</td>
276 <td/>
277 <td/>
278 <td/>
279 <td/>
280 <td/>
281 <td>Completed</td>
282 <td>EIGHT PROVIDER Scholar Extraordinaire </td>
283 </tr>
284 <tr id="PROCEDURE_4046_9">
285 <td/>
286 <table>
287 <tbody>
288 <tr xmlns="">
289 <td>Procedure Date:
290 </td>
291 <td>Jul 05, 2010</td>
292 </tr>
293 </tbody>
294 </table>
295 <td>83704 (CPT-4)
296 </td>
297 <td>Lipoprotein, Blood; Quantitation of Lipoprotein particle Numbers and Lipoprotein particle Subclasses (Eg, by Nuclear Magnetic Resonance Spectroscopy) (CPT-4 83704)</td>
298 <td/>
299 <td/>
300 <td/>
301 <td/>
302 <td/>
303 <td>Completed</td>
304 <td>EIGHT PROVIDER Scholar Extraordinaire </td>
305 </tr>
306 <tr id="PROCEDURE_4046_10">
307 <td/>
308 <table>
309 <tbody>
310 <tr xmlns="">
311 <td>Procedure Date:
312 </td>
313 <td>Jul 05, 2010</td>
314 </tr>
315 </tbody>
316 </table>
317 <td>78414 (CPT-4)
318 </td>
319 <td>Determination of Central C-V Hemodynamics (Non-Imaging) (CPT-4 78414)</td>
320 <td/>
321 <td/>
322 <td/>
323 <td/>
324 <td/>
325 <td>Completed</td>
326 <td>EIGHT PROVIDER Scholar Extraordinaire </td>
327 </tr>
328 </tbody>
329 </table>
330 </text>
331 <entry typeCode="DRIV">
332 <procedure classCode="PROC" moodCode="EVN">
333 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
334 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
335 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
336 <id root="PROCEDURE_4056_27" extension="CCRObjectID"/>
337 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
338 <text>
339 <reference value="#PROCEDURE_4056_27"/>
340 </text>
341 <statusCode code="completed"/>
342 <effectiveTime>
343 <low value="20100904"/>
344 <high nullFlavor="UNK"/>
345 </effectiveTime>
346 </procedure>
347 </entry>
348 <entry typeCode="DRIV">
349 <procedure classCode="PROC" moodCode="EVN">
350 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
351 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
352 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
353 <id root="PROCEDURE_4055_24" extension="CCRObjectID"/>
354 <code displayName="EXPANDED, HX &amp; EXAM" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
355 <text>
356 <reference value="#PROCEDURE_4055_24"/>
357 </text>
358 <statusCode code="completed"/>
359 <effectiveTime>
360 <low value="20100828"/>
361 <high nullFlavor="UNK"/>
362 </effectiveTime>
363 </procedure>
364 </entry>
365 <entry typeCode="DRIV">
366 <procedure classCode="PROC" moodCode="EVN">
367 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
368 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
369 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
370 <id root="PROCEDURE_4047_14" extension="CCRObjectID"/>
371 <code displayName="Office/Outpatient Visit of an Established Patient requiring (2 of 3) an Expanded History, an Exam and Medical Decision Making of Low Complexity (CPT-4 99213)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
372 <text>
373 <reference value="#PROCEDURE_4047_14"/>
374 </text>
375 <statusCode code="completed"/>
376 <effectiveTime>
377 <low value="20100731"/>
378 <high nullFlavor="UNK"/>
379 </effectiveTime>
380 </procedure>
381 </entry>
382 <entry typeCode="DRIV">
383 <procedure classCode="PROC" moodCode="EVN">
384 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
385 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
386 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
387 <id root="PROCEDURE_4046_7" extension="CCRObjectID"/>
388 <code displayName="Office/Outpatient Visit of an Established Patient requiring (2 of 3) a Detailed History, an Exam and Medical Decision Making of Moderate Complexity (CPT-4 99214)" code="99214" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
389 <text>
390 <reference value="#PROCEDURE_4046_7"/>
391 </text>
392 <statusCode code="completed"/>
393 <effectiveTime>
394 <low value="20100705"/>
395 <high nullFlavor="UNK"/>
396 </effectiveTime>
397 </procedure>
398 </entry>
399 <entry typeCode="DRIV">
400 <procedure classCode="PROC" moodCode="EVN">
401 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
402 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
403 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
404 <id root="PROCEDURE_4046_8" extension="CCRObjectID"/>
405 <code displayName="Hemoglobin; Glycosylated (A1c) (CPT-4 83036)" code="83036" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
406 <text>
407 <reference value="#PROCEDURE_4046_8"/>
408 </text>
409 <statusCode code="completed"/>
410 <effectiveTime>
411 <low value="20100705"/>
412 <high nullFlavor="UNK"/>
413 </effectiveTime>
414 </procedure>
415 </entry>
416 <entry typeCode="DRIV">
417 <procedure classCode="PROC" moodCode="EVN">
418 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
419 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
420 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
421 <id root="PROCEDURE_4046_9" extension="CCRObjectID"/>
422 <code displayName="Lipoprotein, Blood; Quantitation of Lipoprotein particle Numbers and Lipoprotein particle Subclasses (Eg, by Nuclear Magnetic Resonance Spectroscopy) (CPT-4 83704)" code="83704" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
423 <text>
424 <reference value="#PROCEDURE_4046_9"/>
425 </text>
426 <statusCode code="completed"/>
427 <effectiveTime>
428 <low value="20100705"/>
429 <high nullFlavor="UNK"/>
430 </effectiveTime>
431 </procedure>
432 </entry>
433 <entry typeCode="DRIV">
434 <procedure classCode="PROC" moodCode="EVN">
435 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
436 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
437 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
438 <id root="PROCEDURE_4046_10" extension="CCRObjectID"/>
439 <code displayName="Determination of Central C-V Hemodynamics (Non-Imaging) (CPT-4 78414)" code="78414" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
440 <text>
441 <reference value="#PROCEDURE_4046_10"/>
442 </text>
443 <statusCode code="completed"/>
444 <effectiveTime>
445 <low value="20100705"/>
446 <high nullFlavor="UNK"/>
447 </effectiveTime>
448 </procedure>
449 </entry>
450 </section>
451 </component>
452 <component>
453 <section>
454 <templateId root="2.16.840.1.113883.10.20.1.9"/>
455 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
456 <title>Payers</title>
457 <text/>
458 <entry typeCode="DRIV">
459 <act classCode="ACT" moodCode="DEF">
460 <templateId root="2.16.840.1.113883.10.20.1.20"/>
461 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
462 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
463 <statusCode code="completed"/>
464 <entryRelationship typeCode="COMP">
465 <act classCode="ACT" moodCode="EVN">
466 <templateId root="2.16.840.1.113883.10.20.1.26"/>
467 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
468 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
469 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
470 <statusCode code="completed"/>
471 <performer typeCode="PRF">
472 <assignedEntity>
473 <id root="2.16.840.1.113883.12.86" extension="MC"/>
474 </assignedEntity>
475 </performer>
476 <participant typeCode="COV">
477 <participantRole>
478 <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
479 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
480 </participantRole>
481 </participant>
482 </act>
483 </entryRelationship>
484 </act>
485 </entry>
486 </section>
487 </component>
488 </section>
489 </component>
490 </section>
491 </component>
492 </structuredBody>
493 </component>
494</ClinicalDocument>
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