| 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="666000669" root="SSN"/>
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| 18 | <addr use="H">
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| 19 | <streetAddressLine>Any Street</streetAddressLine>
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| 20 | <city>Any Town</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>OUTPATIENT</given>
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| 28 | <family>SIXTYNINE</family>
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| 29 | </name>
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| 30 | <administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
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| 31 | <birthTime value="19450309120000"/>
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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 | <templateId root="2.16.840.1.113883.3.249.11.50"/>
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| 105 | <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
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| 106 | <title>Measure set: CMS EHR Measure Set</title>
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| 107 | <text>2010 Measures Set Measures</text>
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| 108 | <component>
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| 109 | <section>
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| 110 | <templateId root="2.16.840.1.113883.3.249.11.2"/>
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| 111 | <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
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| 112 | <title>Measure Section</title>
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| 113 | <text>
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| 114 | <list>
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| 115 | <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
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| 116 | </list>
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| 117 | </text>
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| 118 | <entry typeCode="DRIV">
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| 119 | <act classCode="ACT" moodCode="DEF">
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| 120 | <id root="2.16.840.1.113883.3.249.11.2"/>
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| 121 | <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
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| 122 | <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
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| 123 | <statusCode code="completed"/>
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| 124 | </act>
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| 125 | </entry>
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| 126 | <component>
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| 127 | <section>
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| 128 | <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
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| 129 | <title>Reporting Parameters</title>
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| 130 | <text>
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| 131 | <list>
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| 132 | <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
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| 133 | </list>
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| 134 | </text>
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| 135 | <entry>
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| 136 | <act classCode="ACT" moodCode="EVN">
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| 137 | <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
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| 138 | <effectiveTime>
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| 139 | <low value="20100101"/>
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| 140 | <high value="20101231"/>
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| 141 | </effectiveTime>
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| 142 | </act>
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| 143 | </entry>
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| 144 | </section>
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| 145 | </component>
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| 146 | <component>
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| 147 | <section>
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| 148 | <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
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| 149 | <title>Patient Data</title>
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| 150 | </section>
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| 151 | </component>
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| 152 | <component>
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| 153 | <section>
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| 154 | <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
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| 155 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
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| 156 | <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
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| 157 | <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
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| 158 | <title>Problems</title>
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| 159 | <text>
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| 160 | <table>
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| 161 | <tbody>
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| 162 | <tr>
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| 163 | <th>Type</th>
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| 164 | <th>Date</th>
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| 165 | <th>Code</th>
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| 166 | <th>Description</th>
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| 167 | <th>Status</th>
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| 168 | <th>Source</th>
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| 169 | </tr>
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| 170 | <tr>
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| 171 | <td>Problem</td>
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| 172 | <td>
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| 173 | <table>
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| 174 | <tbody>
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| 175 | <tr xmlns="">
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| 176 | <td>Sep 16, 2010</td>
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| 177 | </tr>
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| 178 | </tbody>
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| 179 | </table>
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| 180 | </td>
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| 181 | <td>250.00 (ICD9CM)
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| 182 | </td>
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| 183 | <td ID="PROBLEM1">Diabetes Mellitus without mention of Complication, type II or unspecified type,</td>
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| 184 | <td>Active</td>
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| 185 | <td>MATTHEW M KING </td>
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| 186 | </tr>
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| 187 | </tbody>
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| 188 | </table>
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| 189 | </text>
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| 190 | <entry typeCode="DRIV">
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| 191 | <act classCode="ACT" moodCode="EVN">
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| 192 | <templateId root="2.16.840.1.113883.10.20.1.27"/>
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| 193 | <id root="PROBLEM1" extension="CCRObjectID"/>
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| 194 | <code nullFlavor="NA"/>
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| 195 | <performer typeCode="PRF">
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| 196 | <assignedEntity>
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| 197 | <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
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| 198 | <addr use="WP">
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| 199 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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| 200 | <city>ALBANY</city>
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| 201 | <state>NY</state>
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| 202 | <postalCode>12180</postalCode>
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| 203 | </addr>
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| 204 | <telecom/>
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| 205 | <assignedPerson>
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| 206 | <name>
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| 207 | <given>MATTHEW</given>
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| 208 | <given>M</given>
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|---|
| 209 | <family>KING</family>
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| 210 | </name>
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| 211 | </assignedPerson>
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| 212 | </assignedEntity>
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| 213 | </performer>
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| 214 | <entryRelationship typeCode="SUBJ">
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| 215 | <observation classCode="OBS" moodCode="EVN">
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| 216 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
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| 217 | <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
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| 218 | <id root="PROBLEM1" extension="CCRObjectID"/>
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| 219 | <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
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| 220 | <statusCode code="completed"/>
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| 221 | <text>
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| 222 | <reference value="#PROBLEM1"/>
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| 223 | </text>
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| 224 | <effectiveTime>
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| 225 | <low value="20100916"/>
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| 226 | <high nullFlavor="UNK"/>
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| 227 | </effectiveTime>
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|---|
| 228 | <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
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|---|
| 229 | <entryRelationship typeCode="REFR">
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|---|
| 230 | <observation classCode="OBS" moodCode="EVN">
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| 231 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
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| 232 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
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| 233 | <statusCode code="completed"/>
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|---|
| 234 | <value>
|
|---|
| 235 | <originalText>Active</originalText>
|
|---|
| 236 | </value>
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|---|
| 237 | </observation>
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|---|
| 238 | </entryRelationship>
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|---|
| 239 | </observation>
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|---|
| 240 | </entryRelationship>
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| 241 | </act>
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| 242 | </entry>
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| 243 | </section>
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|---|
| 244 | </component>
|
|---|
| 245 | <component>
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|---|
| 246 | <section>
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|---|
| 247 | <templateId root="2.16.840.1.113883.10.20.1.12"/>
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|---|
| 248 | <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
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|---|
| 249 | <title>Procedures</title>
|
|---|
| 250 | <text>
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|---|
| 251 | <table>
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|---|
| 252 | <tbody>
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|---|
| 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">
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|---|
| 267 | <td/>
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|---|
| 268 | <table>
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|---|
| 269 | <tbody>
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|---|
| 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)
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|---|
| 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>
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| 280 | <td/>
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|---|
| 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">
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|---|
| 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">
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|---|
| 314 | <procedure classCode="PROC" moodCode="EVN">
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|---|
| 315 | <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
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| 316 | <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
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| 317 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
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| 318 | <id root="PROCEDURE_4067_7" extension="CCRObjectID"/>
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| 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"/>
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|---|
| 320 | <text>
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|---|
| 321 | <reference value="#PROCEDURE_4067_7"/>
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| 322 | </text>
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| 323 | <statusCode code="completed"/>
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| 324 | <effectiveTime>
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| 325 | <low value="20100917"/>
|
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| 326 | <high nullFlavor="UNK"/>
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| 327 | </effectiveTime>
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| 328 | </procedure>
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|---|
| 329 | </entry>
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| 330 | <entry typeCode="DRIV">
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| 331 | <procedure classCode="PROC" moodCode="EVN">
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| 332 | <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
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| 333 | <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
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| 334 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
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| 335 | <id root="PROCEDURE_4066_4" extension="CCRObjectID"/>
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| 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"/>
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| 337 | <text>
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| 338 | <reference value="#PROCEDURE_4066_4"/>
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| 339 | </text>
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| 340 | <statusCode code="completed"/>
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| 341 | <effectiveTime>
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| 342 | <low value="20100916"/>
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| 343 | <high nullFlavor="UNK"/>
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| 344 | </effectiveTime>
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| 345 | </procedure>
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| 346 | </entry>
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| 347 | </section>
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| 348 | </component>
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| 349 | <component>
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| 350 | <section>
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| 351 | <templateId root="2.16.840.1.113883.10.20.1.9"/>
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| 352 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
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|---|
| 353 | <title>Payers</title>
|
|---|
| 354 | <text/>
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|---|
| 355 | <entry typeCode="DRIV">
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| 356 | <act classCode="ACT" moodCode="DEF">
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| 357 | <templateId root="2.16.840.1.113883.10.20.1.20"/>
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| 358 | <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
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| 359 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
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| 360 | <statusCode code="completed"/>
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|---|
| 361 | <entryRelationship typeCode="COMP">
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| 362 | <act classCode="ACT" moodCode="EVN">
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| 363 | <templateId root="2.16.840.1.113883.10.20.1.26"/>
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| 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>
|
|---|
