source: qrda/CCR/M1-QRDA/M1-PAT_100839_QRDA_V1_0_0Ver2.xml@ 1501

Last change on this file since 1501 was 1013, checked in by George Lilly, 14 years ago

some QRDA files, not final
File size: 38.4 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="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>
126 <low value="20100828"/>
127 <high value="20100828"/>
128 </effectiveTime>
129<performer typeCode="PRF">
130 <assignedEntity>
131 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
151<serviceEvent>
152 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
153 <effectiveTime>
154 <low value="20101017"/>
155 <high value="20101017"/>
156 </effectiveTime>
157<performer typeCode="PRF">
158 <assignedEntity>
159 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
179<serviceEvent>
180 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
181 <effectiveTime>
182 <low value="20101006"/>
183 <high value="20101006"/>
184 </effectiveTime>
185<performer typeCode="PRF">
186 <assignedEntity>
187 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
206<documentationOf>
207<serviceEvent>
208 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
209 <effectiveTime>
210 <low value="20100904"/>
211 <high value="20100904"/>
212 </effectiveTime>
213<performer typeCode="PRF">
214 <assignedEntity>
215 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
232 </serviceEvent>
233 </documentationOf>
234<documentationOf>
235<serviceEvent>
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>
238 <low value="20100731"/>
239 <high value="20100731"/>
240 </effectiveTime>
241<performer typeCode="PRF">
242 <assignedEntity>
243 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
257 </assignedPerson>
258 </assignedEntity>
259 </performer>
260 </serviceEvent>
261 </documentationOf>
262<documentationOf>
263<serviceEvent>
264 <code displayName="EXTENDED (25min)" code="99214" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
265 <effectiveTime>
266 <low value="20101016"/>
267 <high value="20101016"/>
268 </effectiveTime>
269<performer typeCode="PRF">
270 <assignedEntity>
271 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
289 </documentationOf>
290<documentationOf>
291<serviceEvent>
292 <code displayName="EXTENDED (25min)" code="99214" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
293 <effectiveTime>
294 <low value="20101015"/>
295 <high value="20101015"/>
296 </effectiveTime>
297<performer typeCode="PRF">
298 <assignedEntity>
299 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
300 <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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>
314 </assignedEntity>
315 </performer>
316 </serviceEvent>
317 </documentationOf>
318<documentationOf>
319<serviceEvent>
320 <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"/>
321 <effectiveTime>
322 <low value="20100917"/>
323 <high value="20100917"/>
324 </effectiveTime>
325<performer typeCode="PRF">
326 <assignedEntity>
327 <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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>
342 </assignedEntity>
343 </performer>
344 </serviceEvent>
345 </documentationOf>
346<documentationOf>
347<serviceEvent>
348 <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"/>
349 <effectiveTime>
350 <low value="20100705"/>
351 <high value="20100705"/>
352 </effectiveTime>
353<performer typeCode="PRF">
354 <assignedEntity>
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>
371 </performer>
372 </serviceEvent>
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>
409 <entry>
410 <act classCode="ACT" moodCode="EVN">
411 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
412 <effectiveTime>
413 <low value="20100101"/>
414 <high value="20101231"/>
415 </effectiveTime>
416 </act>
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>
426 <component>
427 <section>
428 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
429 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
430 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
431 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
432 <title>Problems</title>
433 <text/>
434 <entry typeCode="DRIV">
435 <act classCode="ACT" moodCode="EVN">
436 <templateId root="2.16.840.1.113883.10.20.1.27"/>
437 <id root="PROBLEM1" extension="CCRObjectID"/>
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>
458 <entryRelationship typeCode="SUBJ">
459 <observation classCode="OBS" moodCode="EVN">
460 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
461 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
462 <id root="PROBLEM1" extension="CCRObjectID"/>
463 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
464 <statusCode code="completed"/>
465 <effectiveTime>
466 <low value="20101016"/>
467 <high value="20101016"/>
468 </effectiveTime>
469 <value xsi:type="CD" displayName="HTN (ICD-9-CM 401.9)" code="401.9" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
470 <entryRelationship typeCode="REFR">
471 <observation classCode="OBS" moodCode="EVN">
472 <templateId root="2.16.840.1.113883.10.20.1.50"/>
473<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
474 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
475 <statusCode code="completed"/>
476<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
477 </observation>
478 </entryRelationship>
479 </observation>
480 </entryRelationship>
481 </act>
482 </entry>
483 <entry typeCode="DRIV">
484 <act classCode="ACT" moodCode="EVN">
485 <templateId root="2.16.840.1.113883.10.20.1.27"/>
486 <id root="PROBLEM2" extension="CCRObjectID"/>
487 <code nullFlavor="NA"/>
488 <performer typeCode="PRF">
489 <assignedEntity>
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">
509 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
510 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
511 <id root="PROBLEM2" extension="CCRObjectID"/>
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">
520 <observation classCode="OBS" moodCode="EVN">
521 <templateId root="2.16.840.1.113883.10.20.1.50"/>
522<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
523 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
524 <statusCode code="completed"/>
525<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
526 </observation>
527 </entryRelationship>
528 </observation>
529 </entryRelationship>
530 </act>
531 </entry>
532 <entry typeCode="DRIV">
533 <act classCode="ACT" moodCode="EVN">
534 <templateId root="2.16.840.1.113883.10.20.1.27"/>
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">
558 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
559 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
560 <id root="PROBLEM3" extension="CCRObjectID"/>
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">
570 <templateId root="2.16.840.1.113883.10.20.1.50"/>
571<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
572 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
573 <statusCode code="completed"/>
574<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
575 </observation>
576 </entryRelationship>
577 </observation>
578 </entryRelationship>
579 </act>
580 </entry>
581 <entry typeCode="DRIV">
582 <act classCode="ACT" moodCode="EVN">
583 <templateId root="2.16.840.1.113883.10.20.1.27"/>
584 <id root="PROBLEM4" extension="CCRObjectID"/>
585 <code nullFlavor="NA"/>
586 <performer typeCode="PRF">
587 <assignedEntity>
588 <id extension="ACTORPROVIDER_991" root="CCRActorID"/>
589 <addr use="WP">
590 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
591 <city>ALBANY</city>
592 <state>NY</state>
593 <postalCode>12180</postalCode>
594 </addr>
595 <telecom/>
596 <assignedPerson>
597 <name>
598 <prefix>Scholar Extraordinaire</prefix>
599 <given>EIGHT</given>
600 <family>PROVIDER</family>
601 </name>
602 </assignedPerson>
603 </assignedEntity>
604 </performer>
605 <entryRelationship typeCode="SUBJ">
606 <observation classCode="OBS" moodCode="EVN">
607 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
608 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
609 <id root="PROBLEM4" extension="CCRObjectID"/>
610 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
611 <statusCode code="completed"/>
612 <effectiveTime>
613 <low value="20100705"/>
614 <high value="20100705"/>
615 </effectiveTime>
616 <value xsi:type="CD" displayName="Congestive Heart Failure (ICD-9-CM 428.0)" code="428.0" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
617 <entryRelationship typeCode="REFR">
618 <observation classCode="OBS" moodCode="EVN">
619 <templateId root="2.16.840.1.113883.10.20.1.50"/>
620<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
621 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
622 <statusCode code="completed"/>
623<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
624 </observation>
625 </entryRelationship>
626 </observation>
627 </entryRelationship>
628 </act>
629 </entry>
630 <entry typeCode="DRIV">
631 <act classCode="ACT" moodCode="EVN">
632 <templateId root="2.16.840.1.113883.10.20.1.27"/>
633 <id root="PROBLEM5" extension="CCRObjectID"/>
634 <code nullFlavor="NA"/>
635 <performer typeCode="PRF">
636 <assignedEntity>
637 <id extension="ACTORPROVIDER_991" root="CCRActorID"/>
638 <addr use="WP">
639 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
640 <city>ALBANY</city>
641 <state>NY</state>
642 <postalCode>12180</postalCode>
643 </addr>
644 <telecom/>
645 <assignedPerson>
646 <name>
647 <prefix>Scholar Extraordinaire</prefix>
648 <given>EIGHT</given>
649 <family>PROVIDER</family>
650 </name>
651 </assignedPerson>
652 </assignedEntity>
653 </performer>
654 <entryRelationship typeCode="SUBJ">
655 <observation classCode="OBS" moodCode="EVN">
656 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
657 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
658 <id root="PROBLEM5" extension="CCRObjectID"/>
659 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
660 <statusCode code="completed"/>
661 <effectiveTime>
662 <low value="20100705"/>
663 <high value="20100705"/>
664 </effectiveTime>
665 <value xsi:type="CD" displayName="Postmyocardial infarction syndrome (ICD-9-CM 411.0)" code="411.0" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
666 <entryRelationship typeCode="REFR">
667 <observation classCode="OBS" moodCode="EVN">
668 <templateId root="2.16.840.1.113883.10.20.1.50"/>
669<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
670 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
671 <statusCode code="completed"/>
672<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
673 </observation>
674 </entryRelationship>
675 </observation>
676 </entryRelationship>
677 </act>
678 </entry>
679 </section>
680 </component>
681 <component>
682 <section>
683 <templateId root="2.16.840.1.113883.10.20.1.9"/>
684 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
685 <title>Payers</title>
686 <text/>
687 <entry typeCode="DRIV">
688 <act classCode="ACT" moodCode="DEF">
689 <templateId root="2.16.840.1.113883.10.20.1.20"/>
690 <id root="2.16.840.1.113883.3.543" extension="c9bec8aa-e5e7-11df-ba06-3b3edcef0468"/>
691 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
692 <statusCode code="completed"/>
693 <entryRelationship typeCode="COMP">
694 <act classCode="ACT" moodCode="EVN">
695 <templateId root="2.16.840.1.113883.10.20.1.26"/>
696 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
697 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
698 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
699 <statusCode code="completed"/>
700 <performer typeCode="PRF">
701 <assignedEntity>
702 <id root="2.16.840.1.113883.12.86" extension="MC"/>
703 </assignedEntity>
704 </performer>
705 <participant typeCode="COV">
706 <participantRole>
707 <id root="2.16.840.1.113883.4.1" extension="002030004"/>
708 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
709 </participantRole>
710 </participant>
711 </act>
712 </entryRelationship>
713 </act>
714 </entry>
715 </section>
716 </component>
717 </section>
718 </component>
719 </section>
720 </component>
721 </structuredBody>
722 </component>
723</ClinicalDocument>
Note: See TracBrowser for help on using the repository browser.