source: qrda/CCR/M1-QRDA/M1-PAT_100839_QRDA_V1_0_0Ver2.xml

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

some QRDA files, not final

File size: 38.4 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="c9bec8aa-e5e7-11df-ba06-3b3edcef0468"/>
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="c9bec8aa-e5e7-11df-ba06-3b3edcef0468"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="002030004" root="2.16.840.1.113883.4.1"/>
18 <addr use="H">
19 <streetAddressLine/>
20 <city/>
21 <state/>
22 <postalCode/>
23 </addr>
24 <telecom/>
25 <patient>
26 <name>
27 <given>JODY</given>
28 <given>JEAN</given>
29 <family>JONES</family>
30 </name>
31 <administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
32 <birthTime value="19450101120000"/>
33<raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
34<ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.5.50"/>
35</patient>
36 <providerOrganization>
37<!-- NPI for the provider and this is a real number-->
38 <id root="2.16.840.1.113883.4.6" extension="1558574525" />
39 <name>WorldVistA Test Clinic</name>
40 <!--WVV Address of organization is optional except for the STATE-->
41 <addr>
42 <state>MD</state>
43 <postalCode>20877</postalCode>
44
45 </addr>
46 <!--WVP required asOrganizationPartOf added to sample-->
47 <asOrganizationPartOf>
48 <wholeOrganization>
49 <!-- Tax ID is the extension and this is a dummy numbers-->
50 <id root="2.16.840.1.113883.4.2" extension="226864459"/>
51 </wholeOrganization>
52 </asOrganizationPartOf>
53 </providerOrganization>
54
55 </patientRole>
56 </recordTarget>
57 <author>
58 <time value="20100703"/>
59 <assignedAuthor>
60 <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
61 <assignedPerson>
62 <name>
63 <given>Nancy</given>
64 <family>Anthracite</family>
65 <suffix>MD</suffix>
66 </name>
67 </assignedPerson>
68 <representedOrganization>
69 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
70 <name>WorldVistA Test Clinic</name>
71 </representedOrganization>
72 </assignedAuthor>
73 </author>
74 <informant>
75 <assignedEntity>
76 <id nullFlavor="NA"/>
77 <representedOrganization>
78 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
79 <name>World VistA Test Clinic</name>
80 </representedOrganization>
81 </assignedEntity>
82 </informant>
83 <custodian>
84 <assignedCustodian>
85 <representedCustodianOrganization>
86 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
87 <name>WorldVistA Test Clinic</name>
88 </representedCustodianOrganization>
89 </assignedCustodian>
90 </custodian>
91 <legalAuthenticator>
92 <time value="20100703"/>
93 <signatureCode code="S"/>
94 <assignedEntity>
95 <id root="2.16.840.1.113883.3.543" extension="111111"/>
96 <assignedPerson>
97 <name>
98 <given>Nancy</given>
99 <family>Anthracite</family>
100 <suffix>MD</suffix>
101 </name>
102 </assignedPerson>
103 <representedOrganization>
104 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
105 <name>WorldVistA Test Clinic</name>
106 </representedOrganization>
107 </assignedEntity>
108 </legalAuthenticator>
109 <participant typeCode="PRF">
110 <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
111 <associatedEntity classCode="PROV">
112 <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
113 <associatedPerson>
114 <name>
115 <prefix>Dr.</prefix>
116 <given>Nancy</given>
117 <family>Anthracite</family>
118 </name>
119 </associatedPerson>
120 </associatedEntity>
121 </participant>
122<documentationOf>
123<serviceEvent>
124 <code displayName="EXPANDED, HX &amp; EXAM" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
125 <effectiveTime>
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127 <high value="20100828"/>
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129<performer typeCode="PRF">
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132 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
133 <addr>
134 <streetAddressLine>123 Maple Ave</streetAddressLine>
135 <city>Gaithersburg</city>
136 <state>MD</state>
137 <postalCode>20877</postalCode>
138 </addr>
139 <assignedPerson>
140 <name>
141 <given>Nancy</given>
142 <family>Anthracite</family>
143 <suffix>MD</suffix>
144 </name>
145 </assignedPerson>
146 </assignedEntity>
147 </performer>
148 </serviceEvent>
149 </documentationOf>
150<documentationOf>
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152 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
153 <effectiveTime>
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155 <high value="20101017"/>
156 </effectiveTime>
157<performer typeCode="PRF">
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160 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
161 <addr>
162 <streetAddressLine>123 Maple Ave</streetAddressLine>
163 <city>Gaithersburg</city>
164 <state>MD</state>
165 <postalCode>20877</postalCode>
166 </addr>
167 <assignedPerson>
168 <name>
169 <given>Nancy</given>
170 <family>Anthracite</family>
171 <suffix>MD</suffix>
172 </name>
173 </assignedPerson>
174 </assignedEntity>
175 </performer>
176 </serviceEvent>
177 </documentationOf>
178<documentationOf>
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181 <effectiveTime>
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183 <high value="20101006"/>
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188 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
189 <addr>
190 <streetAddressLine>123 Maple Ave</streetAddressLine>
191 <city>Gaithersburg</city>
192 <state>MD</state>
193 <postalCode>20877</postalCode>
194 </addr>
195 <assignedPerson>
196 <name>
197 <given>Nancy</given>
198 <family>Anthracite</family>
199 <suffix>MD</suffix>
200 </name>
201 </assignedPerson>
202 </assignedEntity>
203 </performer>
204 </serviceEvent>
205 </documentationOf>
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213<performer typeCode="PRF">
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216 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
217 <addr>
218 <streetAddressLine>123 Maple Ave</streetAddressLine>
219 <city>Gaithersburg</city>
220 <state>MD</state>
221 <postalCode>20877</postalCode>
222 </addr>
223 <assignedPerson>
224 <name>
225 <given>Nancy</given>
226 <family>Anthracite</family>
227 <suffix>MD</suffix>
228 </name>
229 </assignedPerson>
230 </assignedEntity>
231 </performer>
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233 </documentationOf>
234<documentationOf>
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236 <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"/>
237 <effectiveTime>
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239 <high value="20100731"/>
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244 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
245 <addr>
246 <streetAddressLine>123 Maple Ave</streetAddressLine>
247 <city>Gaithersburg</city>
248 <state>MD</state>
249 <postalCode>20877</postalCode>
250 </addr>
251 <assignedPerson>
252 <name>
253 <given>Nancy</given>
254 <family>Anthracite</family>
255 <suffix>MD</suffix>
256 </name>
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258 </assignedEntity>
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272 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
273 <addr>
274 <streetAddressLine>123 Maple Ave</streetAddressLine>
275 <city>Gaithersburg</city>
276 <state>MD</state>
277 <postalCode>20877</postalCode>
278 </addr>
279 <assignedPerson>
280 <name>
281 <given>Nancy</given>
282 <family>Anthracite</family>
283 <suffix>MD</suffix>
284 </name>
285 </assignedPerson>
286 </assignedEntity>
287 </performer>
288 </serviceEvent>
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290<documentationOf>
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301 <addr>
302 <streetAddressLine>123 Maple Ave</streetAddressLine>
303 <city>Gaithersburg</city>
304 <state>MD</state>
305 <postalCode>20877</postalCode>
306 </addr>
307 <assignedPerson>
308 <name>
309 <given>Nancy</given>
310 <family>Anthracite</family>
311 <suffix>MD</suffix>
312 </name>
313 </assignedPerson>
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328 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
329 <addr>
330 <streetAddressLine>123 Maple Ave</streetAddressLine>
331 <city>Gaithersburg</city>
332 <state>MD</state>
333 <postalCode>20877</postalCode>
334 </addr>
335 <assignedPerson>
336 <name>
337 <given>Nancy</given>
338 <family>Anthracite</family>
339 <suffix>MD</suffix>
340 </name>
341 </assignedPerson>
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351 <high value="20100705"/>
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353<performer typeCode="PRF">
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355 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
356 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
357 <addr>
358 <streetAddressLine>123 Maple Ave</streetAddressLine>
359 <city>Gaithersburg</city>
360 <state>MD</state>
361 <postalCode>20877</postalCode>
362 </addr>
363 <assignedPerson>
364 <name>
365 <given>Nancy</given>
366 <family>Anthracite</family>
367 <suffix>MD</suffix>
368 </name>
369 </assignedPerson>
370 </assignedEntity>
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373 </documentationOf>
374<component>
375 <structuredBody>
376 <component>
377 <section>
378 <templateId root="2.16.840.1.113883.3.249.11.50"/>
379 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
380 <title>Measure set: CMS EHR Measure Set</title>
381 <text>2010 Measures Set Measures</text>
382 <component>
383 <section>
384 <templateId root="2.16.840.1.113883.3.249.11.2"/>
385 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
386 <title>Measure Section</title>
387 <text>
388 <list>
389 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
390 </list>
391 </text>
392 <entry typeCode="DRIV">
393 <act classCode="ACT" moodCode="DEF">
394 <id root="2.16.840.1.113883.3.249.11.2"/>
395 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
396 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
397 <statusCode code="completed"/>
398 </act>
399 </entry>
400 <component>
401 <section>
402 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
403 <title>Reporting Parameters</title>
404 <text>
405 <list>
406 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
407 </list>
408 </text>
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414 <high value="20101231"/>
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417 </entry>
418 </section>
419 </component>
420 <component>
421 <section>
422 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
423 <title>Patient Data</title>
424 </section>
425 </component>
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427 <section>
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432 <title>Problems</title>
433 <text/>
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438 <code nullFlavor="NA"/>
439 <performer typeCode="PRF">
440 <assignedEntity>
441 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
442 <addr use="WP">
443 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
444 <city>ALBANY</city>
445 <state>NY</state>
446 <postalCode>12180</postalCode>
447 </addr>
448 <telecom/>
449 <assignedPerson>
450 <name>
451 <given>MATTHEW</given>
452 <given>M</given>
453 <family>KING</family>
454 </name>
455 </assignedPerson>
456 </assignedEntity>
457 </performer>
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487 <code nullFlavor="NA"/>
488 <performer typeCode="PRF">
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490 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
491 <addr use="WP">
492 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
493 <city>ALBANY</city>
494 <state>NY</state>
495 <postalCode>12180</postalCode>
496 </addr>
497 <telecom/>
498 <assignedPerson>
499 <name>
500 <given>MATTHEW</given>
501 <given>M</given>
502 <family>KING</family>
503 </name>
504 </assignedPerson>
505 </assignedEntity>
506 </performer>
507 <entryRelationship typeCode="SUBJ">
508 <observation classCode="OBS" moodCode="EVN">
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512 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
513 <statusCode code="completed"/>
514 <effectiveTime>
515 <low value="20101014"/>
516 <high value="20101014"/>
517 </effectiveTime>
518 <value xsi:type="CD" displayName="ANY DEEP VEIN THROMBOSIS" code="453.8" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
519 <entryRelationship typeCode="REFR">
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535 <id root="PROBLEM3" extension="CCRObjectID"/>
536 <code nullFlavor="NA"/>
537 <performer typeCode="PRF">
538 <assignedEntity>
539 <id extension="ACTORPROVIDER_991" root="CCRActorID"/>
540 <addr use="WP">
541 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
542 <city>ALBANY</city>
543 <state>NY</state>
544 <postalCode>12180</postalCode>
545 </addr>
546 <telecom/>
547 <assignedPerson>
548 <name>
549 <prefix>Scholar Extraordinaire</prefix>
550 <given>EIGHT</given>
551 <family>PROVIDER</family>
552 </name>
553 </assignedPerson>
554 </assignedEntity>
555 </performer>
556 <entryRelationship typeCode="SUBJ">
557 <observation classCode="OBS" moodCode="EVN">
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561 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
562 <statusCode code="completed"/>
563 <effectiveTime>
564 <low value="20100904"/>
565 <high value="20100904"/>
566 </effectiveTime>
567 <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"/>
568 <entryRelationship typeCode="REFR">
569 <observation classCode="OBS" moodCode="EVN">
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