source: ccr2ccd-xslt/trunk/make/PAT_100904_QRDA_V1_0_0-11-03-2010_20.xml@ 1065

Last change on this file since 1065 was 1004, checked in by George Lilly, 14 years ago

final PQRI files
File size: 15.8 KB
Line 
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="543453454" root="SSN"/>
18 <addr use="H">
19 <streetAddressLine/>
20 <city/>
21 <state/>
22 <postalCode/>
23 </addr>
24 <telecom/>
25 <patient>
26 <name>
27 <given>FEMALE-A</given>
28 <family>MEASURE-ONEONETWO</family>
29 </name>
30 <administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
31 <birthTime value="19600101120000"/>
32 </patient>
33 </patientRole>
34 </recordTarget>
35 <author>
36 <time value="20100703"/>
37 <assignedAuthor>
38 <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
39 <assignedPerson>
40 <name>
41 <given>Nancy</given>
42 <family>Anthracite</family>
43 <suffix>MD</suffix>
44 </name>
45 </assignedPerson>
46 <representedOrganization>
47 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
48 <name>WorldVistA Test Clinic</name>
49 </representedOrganization>
50 </assignedAuthor>
51 </author>
52 <informant>
53 <assignedEntity>
54 <id nullFlavor="NA"/>
55 <representedOrganization>
56 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
57 <name>World VistA Test Clinic</name>
58 </representedOrganization>
59 </assignedEntity>
60 </informant>
61 <custodian>
62 <assignedCustodian>
63 <representedCustodianOrganization>
64 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
65 <name>WorldVistA Test Clinic</name>
66 </representedCustodianOrganization>
67 </assignedCustodian>
68 </custodian>
69 <legalAuthenticator>
70 <time value="20100703"/>
71 <signatureCode code="S"/>
72 <assignedEntity>
73 <id root="2.16.840.1.113883.3.543" extension="111111"/>
74 <assignedPerson>
75 <name>
76 <given>Nancy</given>
77 <family>Anthracite</family>
78 <suffix>MD</suffix>
79 </name>
80 </assignedPerson>
81 <representedOrganization>
82 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
83 <name>WorldVistA Test Clinic</name>
84 </representedOrganization>
85 </assignedEntity>
86 </legalAuthenticator>
87 <participant typeCode="PRF">
88 <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
89 <associatedEntity classCode="PROV">
90 <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
91 <associatedPerson>
92 <name>
93 <prefix>Dr.</prefix>
94 <given>Nancy</given>
95 <family>Anthracite</family>
96 </name>
97 </associatedPerson>
98 </associatedEntity>
99 </participant>
100 <component>
101 <structuredBody>
102 <component>
103 <section>
104 <component>
105 <section>
106
107 ********************************************************
108 Patient Data
109 ********************************************************
110 --&gt;
111 <component>
112 <section>
113 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
114 <title>Patient Data</title>
115 </section>
116 </component>
117 <component>
118 <section>
119 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
120 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
121 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
122 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
123 <title>Problems</title>
124 <text>
125 <table>
126 <tbody>
127 <tr>
128 <th>Type</th>
129 <th>Date</th>
130 <th>Code</th>
131 <th>Description</th>
132 <th>Status</th>
133 <th>Source</th>
134 </tr>
135 <tr>
136 <td>Problem</td>
137 <td>
138 <table>
139 <tbody>
140 <tr xmlns="">
141 <td>Oct 15, 2010</td>
142 </tr>
143 </tbody>
144 </table>
145 </td>
146 <td>401.9 (ICD9CM)
147 </td>
148 <td ID="PROBLEM1">Hypertension (ICD-9-CM 401.9)</td>
149 <td>Active</td>
150 <td>NANCY ANTHRACITE </td>
151 </tr>
152 </tbody>
153 </table>
154 </text>
155 <entry typeCode="DRIV">
156 <act classCode="ACT" moodCode="EVN">
157 <templateId root="2.16.840.1.113883.10.20.1.27"/>
158 <id root="PROBLEM1" extension="CCRObjectID"/>
159 <code nullFlavor="NA"/>
160 <performer typeCode="PRF">
161 <assignedEntity>
162 <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
163 <addr use="WP">
164 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
165 <city>ALBANY</city>
166 <state>NY</state>
167 <postalCode>12180</postalCode>
168 </addr>
169 <telecom/>
170 <assignedPerson>
171 <name>
172 <given>NANCY</given>
173 <family>ANTHRACITE</family>
174 </name>
175 </assignedPerson>
176 </assignedEntity>
177 </performer>
178 <entryRelationship typeCode="SUBJ">
179 <observation classCode="OBS" moodCode="EVN">
180 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
181 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
182 <id root="PROBLEM1" extension="CCRObjectID"/>
183 <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
184 <statusCode code="completed"/>
185 <effectiveTime>
186 <low value="20101015"/>
187 <high nullFlavor="UNK"/>
188 </effectiveTime>
189 <value displayName="Hypertension (ICD-9-CM 401.9)" code="401.9" codeSystemName="ICD9CM" codeSystem=""/>
190 <entryRelationship typeCode="REFR">
191 <observation classCode="OBS" moodCode="EVN">
192 <templateId root="2.16.840.1.113883.10.20.1.50"/>
193 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
194 <statusCode code="completed"/>
195 <value>
196 <originalText>Active</originalText>
197 </value>
198 </observation>
199 </entryRelationship>
200 </observation>
201 </entryRelationship>
202 </act>
203 </entry>
204 </section>
205 </component>
206 <component>
207 <section>
208 <templateId root="2.16.840.1.113883.10.20.1.12"/>
209 <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
210 <title>Procedures</title>
211 <text>
212 <table>
213 <tbody>
214 <tr>
215 <th>Type</th>
216 <th>Date</th>
217 <th>Code</th>
218 <th>Description</th>
219 <th>Location</th>
220 <th>Substance</th>
221 <th>Method</th>
222 <th>Position</th>
223 <th>Site</th>
224 <th>Status</th>
225 <th>Source</th>
226 </tr>
227 <tr id="PROCEDURE_4328_7">
228 <td/>
229 <table>
230 <tbody>
231 <tr xmlns="">
232 <td>Procedure Date:
233 </td>
234 <td>Oct 15, 2010</td>
235 </tr>
236 </tbody>
237 </table>
238 <td>99202 (CPT-4)
239 </td>
240 <td>INTERMEDIATE (20min)</td>
241 <td/>
242 <td/>
243 <td/>
244 <td/>
245 <td/>
246 <td>Completed</td>
247 <td>NANCY ANTHRACITE </td>
248 </tr>
249 </tbody>
250 </table>
251 </text>
252 <entry typeCode="DRIV">
253 <procedure classCode="PROC" moodCode="EVN">
254 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
255 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
256 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
257 <id root="PROCEDURE_4328_7" extension="CCRObjectID"/>
258 <code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
259 <text>
260 <reference value="#PROCEDURE_4328_7"/>
261 </text>
262 <statusCode code="completed"/>
263 <effectiveTime>
264 <low value="20101015"/>
265 <high nullFlavor="UNK"/>
266 </effectiveTime>
267 </procedure>
268 </entry>
269 </section>
270 </component>
271 <component>
272 <section>
273 <templateId root="2.16.840.1.113883.10.20.1.9"/>
274 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
275 <title>Payers</title>
276 <text/>
277 <entry typeCode="DRIV">
278 <act classCode="ACT" moodCode="DEF">
279 <templateId root="2.16.840.1.113883.10.20.1.20"/>
280 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
281 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
282 <statusCode code="completed"/>
283 <entryRelationship typeCode="COMP">
284 <act classCode="ACT" moodCode="EVN">
285 <templateId root="2.16.840.1.113883.10.20.1.26"/>
286 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
287 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
288 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
289 <statusCode code="completed"/>
290 <performer typeCode="PRF">
291 <assignedEntity>
292 <id root="2.16.840.1.113883.12.86" extension="MC"/>
293 </assignedEntity>
294 </performer>
295 <participant typeCode="COV">
296 <participantRole>
297 <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
298 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
299 </participantRole>
300 </participant>
301 </act>
302 </entryRelationship>
303 </act>
304 </entry>
305 </section>
306 </component>
307 </section>
308 </component>
309 </section>
310 </component>
311 </structuredBody>
312 </component>
313</ClinicalDocument>
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