source: qrda/CCR/M1-QRDA/M1-PAT_100676_QRDA_V1_0_0.xml@ 1154

Last change on this file since 1154 was 997, checked in by George Lilly, 14 years ago

current QRDA submissions
File size: 21.2 KB
RevLine 
[997]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="666000669" root="SSN"/>
18 <addr use="H">
19 <streetAddressLine>Any Street</streetAddressLine>
20 <city>Any Town</city>
21 <state/>
22 <postalCode/>
23 </addr>
24 <telecom/>
25 <patient>
26 <name>
27 <given>OUTPATIENT</given>
28 <family>SIXTYNINE</family>
29 </name>
30 <administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
31 <birthTime value="19450309120000"/>
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>Sep 16, 2010</td>
177 </tr>
178 </tbody>
179 </table>
180 </td>
181 <td>250.00 (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>MATTHEW M KING </td>
186 </tr>
187 </tbody>
188 </table>
189 </text>
190 <entry typeCode="DRIV">
191 <act classCode="ACT" moodCode="EVN">
192 <templateId root="2.16.840.1.113883.10.20.1.27"/>
193 <id root="PROBLEM1" extension="CCRObjectID"/>
194 <code nullFlavor="NA"/>
195 <performer typeCode="PRF">
196 <assignedEntity>
197 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
198 <addr use="WP">
199 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
200 <city>ALBANY</city>
201 <state>NY</state>
202 <postalCode>12180</postalCode>
203 </addr>
204 <telecom/>
205 <assignedPerson>
206 <name>
207 <given>MATTHEW</given>
208 <given>M</given>
209 <family>KING</family>
210 </name>
211 </assignedPerson>
212 </assignedEntity>
213 </performer>
214 <entryRelationship typeCode="SUBJ">
215 <observation classCode="OBS" moodCode="EVN">
216 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
217 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
218 <id root="PROBLEM1" extension="CCRObjectID"/>
219 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
220 <statusCode code="completed"/>
221 <text>
222 <reference value="#PROBLEM1"/>
223 </text>
224 <effectiveTime>
225 <low value="20100916"/>
226 <high nullFlavor="UNK"/>
227 </effectiveTime>
228 <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
229 <entryRelationship typeCode="REFR">
230 <observation classCode="OBS" moodCode="EVN">
231 <templateId root="2.16.840.1.113883.10.20.1.50"/>
232 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
233 <statusCode code="completed"/>
234 <value>
235 <originalText>Active</originalText>
236 </value>
237 </observation>
238 </entryRelationship>
239 </observation>
240 </entryRelationship>
241 </act>
242 </entry>
243 </section>
244 </component>
245 <component>
246 <section>
247 <templateId root="2.16.840.1.113883.10.20.1.12"/>
248 <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
249 <title>Procedures</title>
250 <text>
251 <table>
252 <tbody>
253 <tr>
254 <th>Type</th>
255 <th>Date</th>
256 <th>Code</th>
257 <th>Description</th>
258 <th>Location</th>
259 <th>Substance</th>
260 <th>Method</th>
261 <th>Position</th>
262 <th>Site</th>
263 <th>Status</th>
264 <th>Source</th>
265 </tr>
266 <tr id="PROCEDURE_4067_7">
267 <td/>
268 <table>
269 <tbody>
270 <tr xmlns="">
271 <td>Procedure Date:
272 </td>
273 <td>Sep 17, 2010</td>
274 </tr>
275 </tbody>
276 </table>
277 <td>99213 (CPT-4)
278 </td>
279 <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>
280 <td/>
281 <td/>
282 <td/>
283 <td/>
284 <td/>
285 <td>Completed</td>
286 <td>MATTHEW M KING </td>
287 </tr>
288 <tr id="PROCEDURE_4066_4">
289 <td/>
290 <table>
291 <tbody>
292 <tr xmlns="">
293 <td>Procedure Date:
294 </td>
295 <td>Sep 16, 2010</td>
296 </tr>
297 </tbody>
298 </table>
299 <td>99214 (CPT-4)
300 </td>
301 <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>
302 <td/>
303 <td/>
304 <td/>
305 <td/>
306 <td/>
307 <td>Completed</td>
308 <td>MATTHEW M KING </td>
309 </tr>
310 </tbody>
311 </table>
312 </text>
313 <entry typeCode="DRIV">
314 <procedure classCode="PROC" moodCode="EVN">
315 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
316 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
317 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
318 <id root="PROCEDURE_4067_7" extension="CCRObjectID"/>
319 <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"/>
320 <text>
321 <reference value="#PROCEDURE_4067_7"/>
322 </text>
323 <statusCode code="completed"/>
324 <effectiveTime>
325 <low value="20100917"/>
326 <high nullFlavor="UNK"/>
327 </effectiveTime>
328 </procedure>
329 </entry>
330 <entry typeCode="DRIV">
331 <procedure classCode="PROC" moodCode="EVN">
332 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
333 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
334 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
335 <id root="PROCEDURE_4066_4" extension="CCRObjectID"/>
336 <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"/>
337 <text>
338 <reference value="#PROCEDURE_4066_4"/>
339 </text>
340 <statusCode code="completed"/>
341 <effectiveTime>
342 <low value="20100916"/>
343 <high nullFlavor="UNK"/>
344 </effectiveTime>
345 </procedure>
346 </entry>
347 </section>
348 </component>
349 <component>
350 <section>
351 <templateId root="2.16.840.1.113883.10.20.1.9"/>
352 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
353 <title>Payers</title>
354 <text/>
355 <entry typeCode="DRIV">
356 <act classCode="ACT" moodCode="DEF">
357 <templateId root="2.16.840.1.113883.10.20.1.20"/>
358 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
359 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
360 <statusCode code="completed"/>
361 <entryRelationship typeCode="COMP">
362 <act classCode="ACT" moodCode="EVN">
363 <templateId root="2.16.840.1.113883.10.20.1.26"/>
364 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
365 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
366 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
367 <statusCode code="completed"/>
368 <performer typeCode="PRF">
369 <assignedEntity>
370 <id root="2.16.840.1.113883.12.86" extension="MC"/>
371 </assignedEntity>
372 </performer>
373 <participant typeCode="COV">
374 <participantRole>
375 <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
376 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
377 </participantRole>
378 </participant>
379 </act>
380 </entryRelationship>
381 </act>
382 </entry>
383 </section>
384 </component>
385 </section>
386 </component>
387 </section>
388 </component>
389 </structuredBody>
390 </component>
391</ClinicalDocument>
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