source: qrda/CCR/M1-QRDA/M1-PAT_100146_QRDA_V1_0_0.xml@ 1751

Last change on this file since 1751 was 997, checked in by George Lilly, 14 years ago

current QRDA submissions

File size: 25.3 KB
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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="666000200" root="SSN"/>
18 <addr use="H">
19 <streetAddressLine>Any Street</streetAddressLine>
20 <city>Any Town</city>
21 <state>WEST VIRGINIA</state>
22 <postalCode/>
23 </addr>
24 <telecom use="" value="tel:+1-222-555-8235"/>
25 <patient>
26 <name>
27 <given>MALE-D</given>
28 <family>MEASURE-TWO</family>
29 </name>
30 <administrativeGenderCode displayName="MALE" code="M" 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 <templateId root="2.16.840.1.113883.3.249.11.50"/>
105 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
106 <title>Measure set: CMS EHR Measure Set</title>
107 <text>2010 Measures Set Measures</text>
108 <component>
109 <section>
110 <templateId root="2.16.840.1.113883.3.249.11.2"/>
111 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
112 <title>Measure Section</title>
113 <text>
114 <list>
115 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
116 </list>
117 </text>
118 <entry typeCode="DRIV">
119 <act classCode="ACT" moodCode="DEF">
120 <id root="2.16.840.1.113883.3.249.11.2"/>
121 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
122 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
123 <statusCode code="completed"/>
124 </act>
125 </entry>
126 <component>
127 <section>
128 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
129 <title>Reporting Parameters</title>
130 <text>
131 <list>
132 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
133 </list>
134 </text>
135 <entry>
136 <act classCode="ACT" moodCode="EVN">
137 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
138 <effectiveTime>
139 <low value="20100101"/>
140 <high value="20101231"/>
141 </effectiveTime>
142 </act>
143 </entry>
144 </section>
145 </component>
146 <component>
147 <section>
148 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
149 <title>Patient Data</title>
150 </section>
151 </component>
152 <component>
153 <section>
154 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
155 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
156 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
157 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
158 <title>Problems</title>
159 <text>
160 <table>
161 <tbody>
162 <tr>
163 <th>Type</th>
164 <th>Date</th>
165 <th>Code</th>
166 <th>Description</th>
167 <th>Status</th>
168 <th>Source</th>
169 </tr>
170 <tr>
171 <td>Problem</td>
172 <td>
173 <table>
174 <tbody>
175 <tr xmlns="">
176 <td>Oct 13, 2010</td>
177 </tr>
178 </tbody>
179 </table>
180 </td>
181 <td>250.02 (ICD9CM)
182 </td>
183 <td ID="PROBLEM1">Diabetes Mellitus without mention of Complication, type II or unspecified type,</td>
184 <td>Active</td>
185 <td>NANCY ANTHRACITE </td>
186 </tr>
187 <tr>
188 <td>Problem</td>
189 <td>
190 <table>
191 <tbody>
192 <tr xmlns="">
193 <td>Oct 04, 2010</td>
194 </tr>
195 </tbody>
196 </table>
197 </td>
198 <td>250.00 (ICD9CM)
199 </td>
200 <td ID="PROBLEM2">Diabetes Mellitus</td>
201 <td>Active</td>
202 <td>MATTHEW M KING </td>
203 </tr>
204 </tbody>
205 </table>
206 </text>
207 <entry typeCode="DRIV">
208 <act classCode="ACT" moodCode="EVN">
209 <templateId root="2.16.840.1.113883.10.20.1.27"/>
210 <id root="PROBLEM1" extension="CCRObjectID"/>
211 <code nullFlavor="NA"/>
212 <performer typeCode="PRF">
213 <assignedEntity>
214 <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
215 <addr use="WP">
216 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
217 <city>ALBANY</city>
218 <state>NY</state>
219 <postalCode>12180</postalCode>
220 </addr>
221 <telecom/>
222 <assignedPerson>
223 <name>
224 <given>NANCY</given>
225 <family>ANTHRACITE</family>
226 </name>
227 </assignedPerson>
228 </assignedEntity>
229 </performer>
230 <entryRelationship typeCode="SUBJ">
231 <observation classCode="OBS" moodCode="EVN">
232 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
233 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
234 <id root="PROBLEM1" extension="CCRObjectID"/>
235 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
236 <statusCode code="completed"/>
237 <text>
238 <reference value="#PROBLEM1"/>
239 </text>
240 <effectiveTime>
241 <low value="20101013"/>
242 <high nullFlavor="UNK"/>
243 </effectiveTime>
244 <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.02" codeSystemName="ICD9CM" codeSystem=""/>
245 <entryRelationship typeCode="REFR">
246 <observation classCode="OBS" moodCode="EVN">
247 <templateId root="2.16.840.1.113883.10.20.1.50"/>
248 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
249 <statusCode code="completed"/>
250 <value>
251 <originalText>Active</originalText>
252 </value>
253 </observation>
254 </entryRelationship>
255 </observation>
256 </entryRelationship>
257 </act>
258 </entry>
259 <entry typeCode="DRIV">
260 <act classCode="ACT" moodCode="EVN">
261 <templateId root="2.16.840.1.113883.10.20.1.27"/>
262 <id root="PROBLEM2" extension="CCRObjectID"/>
263 <code nullFlavor="NA"/>
264 <performer typeCode="PRF">
265 <assignedEntity>
266 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
267 <addr use="WP">
268 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
269 <city>ALBANY</city>
270 <state>NY</state>
271 <postalCode>12180</postalCode>
272 </addr>
273 <telecom/>
274 <assignedPerson>
275 <name>
276 <given>MATTHEW</given>
277 <given>M</given>
278 <family>KING</family>
279 </name>
280 </assignedPerson>
281 </assignedEntity>
282 </performer>
283 <entryRelationship typeCode="SUBJ">
284 <observation classCode="OBS" moodCode="EVN">
285 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
286 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
287 <id root="PROBLEM2" extension="CCRObjectID"/>
288 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
289 <statusCode code="completed"/>
290 <text>
291 <reference value="#PROBLEM2"/>
292 </text>
293 <effectiveTime>
294 <low value="20101004"/>
295 <high nullFlavor="UNK"/>
296 </effectiveTime>
297 <value displayName="Diabetes Mellitus" code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
298 <entryRelationship typeCode="REFR">
299 <observation classCode="OBS" moodCode="EVN">
300 <templateId root="2.16.840.1.113883.10.20.1.50"/>
301 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
302 <statusCode code="completed"/>
303 <value>
304 <originalText>Active</originalText>
305 </value>
306 </observation>
307 </entryRelationship>
308 </observation>
309 </entryRelationship>
310 </act>
311 </entry>
312 </section>
313 </component>
314 <component>
315 <section>
316 <templateId root="2.16.840.1.113883.10.20.1.12"/>
317 <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
318 <title>Procedures</title>
319 <text>
320 <table>
321 <tbody>
322 <tr>
323 <th>Type</th>
324 <th>Date</th>
325 <th>Code</th>
326 <th>Description</th>
327 <th>Location</th>
328 <th>Substance</th>
329 <th>Method</th>
330 <th>Position</th>
331 <th>Site</th>
332 <th>Status</th>
333 <th>Source</th>
334 </tr>
335 <tr id="PROCEDURE_4141_10">
336 <td/>
337 <table>
338 <tbody>
339 <tr xmlns="">
340 <td>Procedure Date:
341 </td>
342 <td>Oct 14, 2010</td>
343 </tr>
344 </tbody>
345 </table>
346 <td>99242 (CPT-4)
347 </td>
348 <td>INTERMEDIATE (30min)</td>
349 <td/>
350 <td/>
351 <td/>
352 <td/>
353 <td/>
354 <td>Completed</td>
355 <td>NANCY ANTHRACITE </td>
356 </tr>
357 <tr id="PROCEDURE_4092_7">
358 <td/>
359 <table>
360 <tbody>
361 <tr xmlns="">
362 <td>Procedure Date:
363 </td>
364 <td>Oct 04, 2010</td>
365 </tr>
366 </tbody>
367 </table>
368 <td>99213 (CPT-4)
369 </td>
370 <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>
371 <td/>
372 <td/>
373 <td/>
374 <td/>
375 <td/>
376 <td>Completed</td>
377 <td>MATTHEW M KING </td>
378 </tr>
379 </tbody>
380 </table>
381 </text>
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_4141_10" extension="CCRObjectID"/>
388 <code displayName="INTERMEDIATE (30min)" code="99242" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
389 <text>
390 <reference value="#PROCEDURE_4141_10"/>
391 </text>
392 <statusCode code="completed"/>
393 <effectiveTime>
394 <low value="20101014"/>
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_4092_7" extension="CCRObjectID"/>
405 <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"/>
406 <text>
407 <reference value="#PROCEDURE_4092_7"/>
408 </text>
409 <statusCode code="completed"/>
410 <effectiveTime>
411 <low value="20101004"/>
412 <high nullFlavor="UNK"/>
413 </effectiveTime>
414 </procedure>
415 </entry>
416 </section>
417 </component>
418 <component>
419 <section>
420 <templateId root="2.16.840.1.113883.10.20.1.9"/>
421 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
422 <title>Payers</title>
423 <text/>
424 <entry typeCode="DRIV">
425 <act classCode="ACT" moodCode="DEF">
426 <templateId root="2.16.840.1.113883.10.20.1.20"/>
427 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
428 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
429 <statusCode code="completed"/>
430 <entryRelationship typeCode="COMP">
431 <act classCode="ACT" moodCode="EVN">
432 <templateId root="2.16.840.1.113883.10.20.1.26"/>
433 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
434 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
435 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
436 <statusCode code="completed"/>
437 <performer typeCode="PRF">
438 <assignedEntity>
439 <id root="2.16.840.1.113883.12.86" extension="MC"/>
440 </assignedEntity>
441 </performer>
442 <participant typeCode="COV">
443 <participantRole>
444 <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
445 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
446 </participantRole>
447 </participant>
448 </act>
449 </entryRelationship>
450 </act>
451 </entry>
452 </section>
453 </component>
454 </section>
455 </component>
456 </section>
457 </component>
458 </structuredBody>
459 </component>
460</ClinicalDocument>
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