source: qrda/CCR/M1-QRDA/M1-PAT_100846_QRDA_V1_0_0Ver2.xml@ 1485

Last change on this file since 1485 was 1013, checked in by George Lilly, 14 years ago

some QRDA files, not final
File size: 19.6 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="d894b664-e5e7-11df-a39b-df28313564e3"/>
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="d894b664-e5e7-11df-a39b-df28313564e3"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="345982321" 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>MALE-A</given>
28 <family>MEASURE-ONE</family>
29 </name>
30 <administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
31 <birthTime value="19600101120000"/>
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="COMPREHENSIVE (45min)" code="99204" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
124 <effectiveTime>
125 <low value="20101013"/>
126 <high value="20101013"/>
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="LIMITED (10min)" code="99212" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
152 <effectiveTime>
153 <low value="20101014"/>
154 <high value="20101014"/>
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_10000000020" 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>NANCY</given>
255 <family>ANTHRACITE</family>
256 </name>
257 </assignedPerson>
258 </assignedEntity>
259 </performer>
260 <entryRelationship typeCode="SUBJ">
261 <observation classCode="OBS" moodCode="EVN">
262 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
263 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
264 <id root="PROBLEM1" extension="CCRObjectID"/>
265 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
266 <statusCode code="completed"/>
267 <effectiveTime>
268 <low value="20101014"/>
269 <high value="20101014"/>
270 </effectiveTime>
271 <value xsi:type="CD" displayName="Diabetes (ICD-9-CM 250.00)" code="250.00" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
272 <entryRelationship typeCode="REFR">
273 <observation classCode="OBS" moodCode="EVN">
274 <templateId root="2.16.840.1.113883.10.20.1.50"/>
275<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
276 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
277 <statusCode code="completed"/>
278<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
279 </observation>
280 </entryRelationship>
281 </observation>
282 </entryRelationship>
283 </act>
284 </entry>
285 <entry typeCode="DRIV">
286 <act classCode="ACT" moodCode="EVN">
287 <templateId root="2.16.840.1.113883.10.20.1.27"/>
288 <id root="PROBLEM2" extension="CCRObjectID"/>
289 <code nullFlavor="NA"/>
290 <performer typeCode="PRF">
291 <assignedEntity>
292 <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
293 <addr use="WP">
294 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
295 <city>ALBANY</city>
296 <state>NY</state>
297 <postalCode>12180</postalCode>
298 </addr>
299 <telecom/>
300 <assignedPerson>
301 <name>
302 <given>NANCY</given>
303 <family>ANTHRACITE</family>
304 </name>
305 </assignedPerson>
306 </assignedEntity>
307 </performer>
308 <entryRelationship typeCode="SUBJ">
309 <observation classCode="OBS" moodCode="EVN">
310 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
311 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
312 <id root="PROBLEM2" extension="CCRObjectID"/>
313 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
314 <statusCode code="completed"/>
315 <effectiveTime>
316 <low value="20101013"/>
317 <high value="20101013"/>
318 </effectiveTime>
319 <value xsi:type="CD" displayName="Nonproliferative Diabetic retinopathy NOS (ICD-9-CM 362.03)" code="362.03" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
320 <entryRelationship typeCode="REFR">
321 <observation classCode="OBS" moodCode="EVN">
322 <templateId root="2.16.840.1.113883.10.20.1.50"/>
323<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
324 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
325 <statusCode code="completed"/>
326<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
327 </observation>
328 </entryRelationship>
329 </observation>
330 </entryRelationship>
331 </act>
332 </entry>
333 </section>
334 </component>
335 <component>
336 <section>
337 <templateId root="2.16.840.1.113883.10.20.1.9"/>
338 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
339 <title>Payers</title>
340 <text/>
341 <entry typeCode="DRIV">
342 <act classCode="ACT" moodCode="DEF">
343 <templateId root="2.16.840.1.113883.10.20.1.20"/>
344 <id root="2.16.840.1.113883.3.543" extension="d894b664-e5e7-11df-a39b-df28313564e3"/>
345 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
346 <statusCode code="completed"/>
347 <entryRelationship typeCode="COMP">
348 <act classCode="ACT" moodCode="EVN">
349 <templateId root="2.16.840.1.113883.10.20.1.26"/>
350 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
351 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
352 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
353 <statusCode code="completed"/>
354 <performer typeCode="PRF">
355 <assignedEntity>
356 <id root="2.16.840.1.113883.12.86" extension="MC"/>
357 </assignedEntity>
358 </performer>
359 <participant typeCode="COV">
360 <participantRole>
361 <id root="2.16.840.1.113883.4.1" extension="345982321"/>
362 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
363 </participantRole>
364 </participant>
365 </act>
366 </entryRelationship>
367 </act>
368 </entry>
369 </section>
370 </component>
371 </section>
372 </component>
373 </section>
374 </component>
375 </structuredBody>
376 </component>
377</ClinicalDocument>
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