source: qrda/CCR/M1-QRDA/M1-PAT_100676_QRDA_V1_0_0Ver2.xml@ 1154

Last change on this file since 1154 was 1013, checked in by George Lilly, 14 years ago

some QRDA files, not final
File size: 16.6 KB
RevLine 
[1013]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="bc1d4d3e-e5e7-11df-8095-df6887f9bf98"/>
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="bc1d4d3e-e5e7-11df-8095-df6887f9bf98"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="666000669" root="2.16.840.1.113883.4.1"/>
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="2.16.840.1.113883.5.1"/>
31 <birthTime value="19450309120000"/>
32<raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
33<ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.5.50"/>
34</patient>
35 <providerOrganization>
36<!-- NPI for the provider and this is a real number-->
37 <id root="2.16.840.1.113883.4.6" extension="1558574525" />
38 <name>WorldVistA Test Clinic</name>
39 <!--WVV Address of organization is optional except for the STATE-->
40 <addr>
41 <state>MD</state>
42 <postalCode>20877</postalCode>
43
44 </addr>
45 <!--WVP required asOrganizationPartOf added to sample-->
46 <asOrganizationPartOf>
47 <wholeOrganization>
48 <!-- Tax ID is the extension and this is a dummy numbers-->
49 <id root="2.16.840.1.113883.4.2" extension="226864459"/>
50 </wholeOrganization>
51 </asOrganizationPartOf>
52 </providerOrganization>
53
54 </patientRole>
55 </recordTarget>
56 <author>
57 <time value="20100703"/>
58 <assignedAuthor>
59 <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
60 <assignedPerson>
61 <name>
62 <given>Nancy</given>
63 <family>Anthracite</family>
64 <suffix>MD</suffix>
65 </name>
66 </assignedPerson>
67 <representedOrganization>
68 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
69 <name>WorldVistA Test Clinic</name>
70 </representedOrganization>
71 </assignedAuthor>
72 </author>
73 <informant>
74 <assignedEntity>
75 <id nullFlavor="NA"/>
76 <representedOrganization>
77 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
78 <name>World VistA Test Clinic</name>
79 </representedOrganization>
80 </assignedEntity>
81 </informant>
82 <custodian>
83 <assignedCustodian>
84 <representedCustodianOrganization>
85 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
86 <name>WorldVistA Test Clinic</name>
87 </representedCustodianOrganization>
88 </assignedCustodian>
89 </custodian>
90 <legalAuthenticator>
91 <time value="20100703"/>
92 <signatureCode code="S"/>
93 <assignedEntity>
94 <id root="2.16.840.1.113883.3.543" extension="111111"/>
95 <assignedPerson>
96 <name>
97 <given>Nancy</given>
98 <family>Anthracite</family>
99 <suffix>MD</suffix>
100 </name>
101 </assignedPerson>
102 <representedOrganization>
103 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
104 <name>WorldVistA Test Clinic</name>
105 </representedOrganization>
106 </assignedEntity>
107 </legalAuthenticator>
108 <participant typeCode="PRF">
109 <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
110 <associatedEntity classCode="PROV">
111 <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
112 <associatedPerson>
113 <name>
114 <prefix>Dr.</prefix>
115 <given>Nancy</given>
116 <family>Anthracite</family>
117 </name>
118 </associatedPerson>
119 </associatedEntity>
120 </participant>
121<documentationOf>
122<serviceEvent>
123 <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"/>
124 <effectiveTime>
125 <low value="20100917"/>
126 <high value="20100917"/>
127 </effectiveTime>
128<performer typeCode="PRF">
129 <assignedEntity>
130 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
131 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
132 <addr>
133 <streetAddressLine>123 Maple Ave</streetAddressLine>
134 <city>Gaithersburg</city>
135 <state>MD</state>
136 <postalCode>20877</postalCode>
137 </addr>
138 <assignedPerson>
139 <name>
140 <given>Nancy</given>
141 <family>Anthracite</family>
142 <suffix>MD</suffix>
143 </name>
144 </assignedPerson>
145 </assignedEntity>
146 </performer>
147 </serviceEvent>
148 </documentationOf>
149<documentationOf>
150<serviceEvent>
151 <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"/>
152 <effectiveTime>
153 <low value="20100916"/>
154 <high value="20100916"/>
155 </effectiveTime>
156<performer typeCode="PRF">
157 <assignedEntity>
158 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
159 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
160 <addr>
161 <streetAddressLine>123 Maple Ave</streetAddressLine>
162 <city>Gaithersburg</city>
163 <state>MD</state>
164 <postalCode>20877</postalCode>
165 </addr>
166 <assignedPerson>
167 <name>
168 <given>Nancy</given>
169 <family>Anthracite</family>
170 <suffix>MD</suffix>
171 </name>
172 </assignedPerson>
173 </assignedEntity>
174 </performer>
175 </serviceEvent>
176 </documentationOf>
177<component>
178 <structuredBody>
179 <component>
180 <section>
181 <templateId root="2.16.840.1.113883.3.249.11.50"/>
182 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
183 <title>Measure set: CMS EHR Measure Set</title>
184 <text>2010 Measures Set Measures</text>
185 <component>
186 <section>
187 <templateId root="2.16.840.1.113883.3.249.11.2"/>
188 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
189 <title>Measure Section</title>
190 <text>
191 <list>
192 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
193 </list>
194 </text>
195 <entry typeCode="DRIV">
196 <act classCode="ACT" moodCode="DEF">
197 <id root="2.16.840.1.113883.3.249.11.2"/>
198 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
199 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
200 <statusCode code="completed"/>
201 </act>
202 </entry>
203 <component>
204 <section>
205 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
206 <title>Reporting Parameters</title>
207 <text>
208 <list>
209 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
210 </list>
211 </text>
212 <entry>
213 <act classCode="ACT" moodCode="EVN">
214 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
215 <effectiveTime>
216 <low value="20100101"/>
217 <high value="20101231"/>
218 </effectiveTime>
219 </act>
220 </entry>
221 </section>
222 </component>
223 <component>
224 <section>
225 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
226 <title>Patient Data</title>
227 </section>
228 </component>
229 <component>
230 <section>
231 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
232 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
233 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
234 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
235 <title>Problems</title>
236 <text/>
237 <entry typeCode="DRIV">
238 <act classCode="ACT" moodCode="EVN">
239 <templateId root="2.16.840.1.113883.10.20.1.27"/>
240 <id root="PROBLEM1" extension="CCRObjectID"/>
241 <code nullFlavor="NA"/>
242 <performer typeCode="PRF">
243 <assignedEntity>
244 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
245 <addr use="WP">
246 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
247 <city>ALBANY</city>
248 <state>NY</state>
249 <postalCode>12180</postalCode>
250 </addr>
251 <telecom/>
252 <assignedPerson>
253 <name>
254 <given>MATTHEW</given>
255 <given>M</given>
256 <family>KING</family>
257 </name>
258 </assignedPerson>
259 </assignedEntity>
260 </performer>
261 <entryRelationship typeCode="SUBJ">
262 <observation classCode="OBS" moodCode="EVN">
263 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
264 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
265 <id root="PROBLEM1" extension="CCRObjectID"/>
266 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
267 <statusCode code="completed"/>
268 <effectiveTime>
269 <low value="20100916"/>
270 <high value="20100916"/>
271 </effectiveTime>
272 <value xsi:type="CD" displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
273 <entryRelationship typeCode="REFR">
274 <observation classCode="OBS" moodCode="EVN">
275 <templateId root="2.16.840.1.113883.10.20.1.50"/>
276<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
277 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
278 <statusCode code="completed"/>
279<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
280 </observation>
281 </entryRelationship>
282 </observation>
283 </entryRelationship>
284 </act>
285 </entry>
286 </section>
287 </component>
288 <component>
289 <section>
290 <templateId root="2.16.840.1.113883.10.20.1.9"/>
291 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
292 <title>Payers</title>
293 <text/>
294 <entry typeCode="DRIV">
295 <act classCode="ACT" moodCode="DEF">
296 <templateId root="2.16.840.1.113883.10.20.1.20"/>
297 <id root="2.16.840.1.113883.3.543" extension="bc1d4d3e-e5e7-11df-8095-df6887f9bf98"/>
298 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
299 <statusCode code="completed"/>
300 <entryRelationship typeCode="COMP">
301 <act classCode="ACT" moodCode="EVN">
302 <templateId root="2.16.840.1.113883.10.20.1.26"/>
303 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
304 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
305 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
306 <statusCode code="completed"/>
307 <performer typeCode="PRF">
308 <assignedEntity>
309 <id root="2.16.840.1.113883.12.86" extension="MC"/>
310 </assignedEntity>
311 </performer>
312 <participant typeCode="COV">
313 <participantRole>
314 <id root="2.16.840.1.113883.4.1" extension="666000669"/>
315 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
316 </participantRole>
317 </participant>
318 </act>
319 </entryRelationship>
320 </act>
321 </entry>
322 </section>
323 </component>
324 </section>
325 </component>
326 </section>
327 </component>
328 </structuredBody>
329 </component>
330</ClinicalDocument>
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