[1004] | 1 | <?xml version="1.0" encoding="utf-8"?>
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| 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">
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| 3 | <realmCode code="US"/>
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| 4 | <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
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| 5 | <templateId root="2.16.840.1.113883.10.20.12"/>
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| 6 | <templateId root="2.16.840.1.113883.3.249.11.100.1"/>
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| 7 | <id root="2.16.840.1.113883.3.543" extension="@@@UUID-DOC@@@"/>
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| 8 | <code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
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| 9 | <title>QRDA Incidence Report</title>
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| 10 | <effectiveTime value="20100703"/>
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| 11 | <confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
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| 12 | <languageCode code="en-US"/>
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| 13 | <setId root="2.16.840.1.113883.3.543" extension="@@@UUID-SET@@@"/>
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| 14 | <versionNumber value="1"/>
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| 15 | <recordTarget>
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| 16 | <patientRole>
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| 17 | <id extension="543453454" root="SSN"/>
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| 18 | <addr use="H">
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| 19 | <streetAddressLine/>
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| 20 | <city/>
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| 21 | <state/>
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| 22 | <postalCode/>
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| 23 | </addr>
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| 24 | <telecom/>
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| 25 | <patient>
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| 26 | <name>
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| 27 | <given>FEMALE-A</given>
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| 28 | <family>MEASURE-ONEONETWO</family>
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| 29 | </name>
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| 30 | <administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
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| 31 | <birthTime value="19600101120000"/>
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| 32 | </patient>
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| 33 | </patientRole>
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| 34 | </recordTarget>
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| 35 | <author>
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| 36 | <time value="20100703"/>
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| 37 | <assignedAuthor>
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| 38 | <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
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| 39 | <assignedPerson>
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| 40 | <name>
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| 41 | <given>Nancy</given>
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| 42 | <family>Anthracite</family>
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| 43 | <suffix>MD</suffix>
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| 44 | </name>
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| 45 | </assignedPerson>
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| 46 | <representedOrganization>
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| 47 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 48 | <name>WorldVistA Test Clinic</name>
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| 49 | </representedOrganization>
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| 50 | </assignedAuthor>
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| 51 | </author>
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| 52 | <informant>
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| 53 | <assignedEntity>
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| 54 | <id nullFlavor="NA"/>
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| 55 | <representedOrganization>
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| 56 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 57 | <name>World VistA Test Clinic</name>
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| 58 | </representedOrganization>
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| 59 | </assignedEntity>
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| 60 | </informant>
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| 61 | <custodian>
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| 62 | <assignedCustodian>
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| 63 | <representedCustodianOrganization>
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| 64 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 65 | <name>WorldVistA Test Clinic</name>
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| 66 | </representedCustodianOrganization>
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| 67 | </assignedCustodian>
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| 68 | </custodian>
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| 69 | <legalAuthenticator>
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| 70 | <time value="20100703"/>
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| 71 | <signatureCode code="S"/>
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| 72 | <assignedEntity>
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| 73 | <id root="2.16.840.1.113883.3.543" extension="111111"/>
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| 74 | <assignedPerson>
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| 75 | <name>
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| 76 | <given>Nancy</given>
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| 77 | <family>Anthracite</family>
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| 78 | <suffix>MD</suffix>
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| 79 | </name>
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| 80 | </assignedPerson>
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| 81 | <representedOrganization>
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| 82 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 83 | <name>WorldVistA Test Clinic</name>
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| 84 | </representedOrganization>
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| 85 | </assignedEntity>
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| 86 | </legalAuthenticator>
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| 87 | <participant typeCode="PRF">
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| 88 | <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
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| 89 | <associatedEntity classCode="PROV">
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| 90 | <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
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| 91 | <associatedPerson>
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| 92 | <name>
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| 93 | <prefix>Dr.</prefix>
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| 94 | <given>Nancy</given>
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| 95 | <family>Anthracite</family>
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| 96 | </name>
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| 97 | </associatedPerson>
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| 98 | </associatedEntity>
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| 99 | </participant>
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| 100 | <component>
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| 101 | <structuredBody>
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| 102 | <component>
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| 103 | <section>
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| 104 | <component>
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| 105 | <section>
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| 106 |
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| 107 | ********************************************************
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| 108 | Patient Data
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| 109 | ********************************************************
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| 110 | -->
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| 111 | <component>
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| 112 | <section>
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| 113 | <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
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| 114 | <title>Patient Data</title>
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| 115 | </section>
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| 116 | </component>
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| 117 | <component>
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| 118 | <section>
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| 119 | <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
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| 120 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
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| 121 | <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
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| 122 | <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
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| 123 | <title>Problems</title>
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| 124 | <text>
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| 125 | <table>
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| 126 | <tbody>
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| 127 | <tr>
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| 128 | <th>Type</th>
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| 129 | <th>Date</th>
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| 130 | <th>Code</th>
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| 131 | <th>Description</th>
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| 132 | <th>Status</th>
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| 133 | <th>Source</th>
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| 134 | </tr>
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| 135 | <tr>
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| 136 | <td>Problem</td>
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| 137 | <td>
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| 138 | <table>
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| 139 | <tbody>
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| 140 | <tr xmlns="">
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| 141 | <td>Oct 15, 2010</td>
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| 142 | </tr>
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| 143 | </tbody>
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| 144 | </table>
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| 145 | </td>
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| 146 | <td>401.9 (ICD9CM)
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| 147 | </td>
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| 148 | <td ID="PROBLEM1">Hypertension (ICD-9-CM 401.9)</td>
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| 149 | <td>Active</td>
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| 150 | <td>NANCY ANTHRACITE </td>
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| 151 | </tr>
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| 152 | </tbody>
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| 153 | </table>
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| 154 | </text>
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| 155 | <entry typeCode="DRIV">
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| 156 | <act classCode="ACT" moodCode="EVN">
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| 157 | <templateId root="2.16.840.1.113883.10.20.1.27"/>
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| 158 | <id root="PROBLEM1" extension="CCRObjectID"/>
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| 159 | <code nullFlavor="NA"/>
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| 160 | <performer typeCode="PRF">
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| 161 | <assignedEntity>
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| 162 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
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| 163 | <addr use="WP">
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| 164 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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| 165 | <city>ALBANY</city>
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| 166 | <state>NY</state>
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| 167 | <postalCode>12180</postalCode>
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| 168 | </addr>
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| 169 | <telecom/>
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| 170 | <assignedPerson>
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| 171 | <name>
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| 172 | <given>NANCY</given>
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| 173 | <family>ANTHRACITE</family>
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| 174 | </name>
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| 175 | </assignedPerson>
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| 176 | </assignedEntity>
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| 177 | </performer>
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| 178 | <entryRelationship typeCode="SUBJ">
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| 179 | <observation classCode="OBS" moodCode="EVN">
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| 180 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
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| 181 | <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
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| 182 | <id root="PROBLEM1" extension="CCRObjectID"/>
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| 183 | <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
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| 184 | <statusCode code="completed"/>
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| 185 | <effectiveTime>
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| 186 | <low value="20101015"/>
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| 187 | <high nullFlavor="UNK"/>
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| 188 | </effectiveTime>
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| 189 | <value displayName="Hypertension (ICD-9-CM 401.9)" code="401.9" codeSystemName="ICD9CM" codeSystem=""/>
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| 190 | <entryRelationship typeCode="REFR">
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| 191 | <observation classCode="OBS" moodCode="EVN">
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| 192 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
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| 193 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
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| 194 | <statusCode code="completed"/>
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| 195 | <value>
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| 196 | <originalText>Active</originalText>
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| 197 | </value>
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| 198 | </observation>
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| 199 | </entryRelationship>
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| 200 | </observation>
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| 201 | </entryRelationship>
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| 202 | </act>
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| 203 | </entry>
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| 204 | </section>
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| 205 | </component>
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| 206 | <component>
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| 207 | <section>
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| 208 | <templateId root="2.16.840.1.113883.10.20.1.12"/>
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| 209 | <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
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| 210 | <title>Procedures</title>
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| 211 | <text>
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| 212 | <table>
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| 213 | <tbody>
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| 214 | <tr>
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| 215 | <th>Type</th>
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| 216 | <th>Date</th>
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| 217 | <th>Code</th>
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| 218 | <th>Description</th>
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| 219 | <th>Location</th>
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| 220 | <th>Substance</th>
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| 221 | <th>Method</th>
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| 222 | <th>Position</th>
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| 223 | <th>Site</th>
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| 224 | <th>Status</th>
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| 225 | <th>Source</th>
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| 226 | </tr>
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| 227 | <tr id="PROCEDURE_4328_7">
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| 228 | <td/>
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| 229 | <table>
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| 230 | <tbody>
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| 231 | <tr xmlns="">
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| 232 | <td>Procedure Date:
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| 233 | </td>
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| 234 | <td>Oct 15, 2010</td>
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| 235 | </tr>
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| 236 | </tbody>
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| 237 | </table>
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| 238 | <td>99202 (CPT-4)
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| 239 | </td>
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| 240 | <td>INTERMEDIATE (20min)</td>
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| 241 | <td/>
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| 242 | <td/>
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| 243 | <td/>
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| 244 | <td/>
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| 245 | <td/>
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| 246 | <td>Completed</td>
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| 247 | <td>NANCY ANTHRACITE </td>
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| 248 | </tr>
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| 249 | </tbody>
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| 250 | </table>
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| 251 | </text>
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| 252 | <entry typeCode="DRIV">
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| 253 | <procedure classCode="PROC" moodCode="EVN">
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| 254 | <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
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| 255 | <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
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| 256 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
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| 257 | <id root="PROCEDURE_4328_7" extension="CCRObjectID"/>
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| 258 | <code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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| 259 | <text>
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| 260 | <reference value="#PROCEDURE_4328_7"/>
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| 261 | </text>
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| 262 | <statusCode code="completed"/>
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| 263 | <effectiveTime>
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| 264 | <low value="20101015"/>
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| 265 | <high nullFlavor="UNK"/>
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| 266 | </effectiveTime>
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| 267 | </procedure>
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| 268 | </entry>
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| 269 | </section>
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| 270 | </component>
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| 271 | <component>
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| 272 | <section>
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| 273 | <templateId root="2.16.840.1.113883.10.20.1.9"/>
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| 274 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
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| 275 | <title>Payers</title>
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| 276 | <text/>
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| 277 | <entry typeCode="DRIV">
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| 278 | <act classCode="ACT" moodCode="DEF">
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| 279 | <templateId root="2.16.840.1.113883.10.20.1.20"/>
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| 280 | <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
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| 281 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
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| 282 | <statusCode code="completed"/>
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| 283 | <entryRelationship typeCode="COMP">
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| 284 | <act classCode="ACT" moodCode="EVN">
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| 285 | <templateId root="2.16.840.1.113883.10.20.1.26"/>
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| 286 | <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
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| 287 | <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
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| 288 | <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
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| 289 | <statusCode code="completed"/>
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| 290 | <performer typeCode="PRF">
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| 291 | <assignedEntity>
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| 292 | <id root="2.16.840.1.113883.12.86" extension="MC"/>
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| 293 | </assignedEntity>
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| 294 | </performer>
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| 295 | <participant typeCode="COV">
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| 296 | <participantRole>
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| 297 | <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
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| 298 | <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
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| 299 | </participantRole>
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| 300 | </participant>
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| 301 | </act>
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| 302 | </entryRelationship>
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| 303 | </act>
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| 304 | </entry>
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| 305 | </section>
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| 306 | </component>
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| 307 | </section>
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| 308 | </component>
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| 309 | </section>
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| 310 | </component>
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| 311 | </structuredBody>
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| 312 | </component>
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| 313 | </ClinicalDocument>
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