source: qrda/CCR/M1-QRDA/M1-PAT_100848_QRDA_V1_0_0.xml@ 1323

Last change on this file since 1323 was 997, checked in by George Lilly, 14 years ago

current QRDA submissions
File size: 25.1 KB
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[997]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="@@@UUID-DOC@@@"/>
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="@@@UUID-SET@@@"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="345097898" root="SSN"/>
18 <addr use="H">
19 <streetAddressLine/>
20 <city/>
21 <state/>
22 <postalCode/>
23 </addr>
24 <telecom/>
25 <patient>
26 <name>
27 <given>FEMALE-B</given>
28 <family>MEASURE-ONE</family>
29 </name>
30 <administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
31 <birthTime value="19600101120000"/>
32 </patient>
33 </patientRole>
34 </recordTarget>
35 <author>
36 <time value="20100703"/>
37 <assignedAuthor>
38 <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
39 <assignedPerson>
40 <name>
41 <given>Nancy</given>
42 <family>Anthracite</family>
43 <suffix>MD</suffix>
44 </name>
45 </assignedPerson>
46 <representedOrganization>
47 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
48 <name>WorldVistA Test Clinic</name>
49 </representedOrganization>
50 </assignedAuthor>
51 </author>
52 <informant>
53 <assignedEntity>
54 <id nullFlavor="NA"/>
55 <representedOrganization>
56 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
57 <name>World VistA Test Clinic</name>
58 </representedOrganization>
59 </assignedEntity>
60 </informant>
61 <custodian>
62 <assignedCustodian>
63 <representedCustodianOrganization>
64 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
65 <name>WorldVistA Test Clinic</name>
66 </representedCustodianOrganization>
67 </assignedCustodian>
68 </custodian>
69 <legalAuthenticator>
70 <time value="20100703"/>
71 <signatureCode code="S"/>
72 <assignedEntity>
73 <id root="2.16.840.1.113883.3.543" extension="111111"/>
74 <assignedPerson>
75 <name>
76 <given>Nancy</given>
77 <family>Anthracite</family>
78 <suffix>MD</suffix>
79 </name>
80 </assignedPerson>
81 <representedOrganization>
82 <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
83 <name>WorldVistA Test Clinic</name>
84 </representedOrganization>
85 </assignedEntity>
86 </legalAuthenticator>
87 <participant typeCode="PRF">
88 <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
89 <associatedEntity classCode="PROV">
90 <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
91 <associatedPerson>
92 <name>
93 <prefix>Dr.</prefix>
94 <given>Nancy</given>
95 <family>Anthracite</family>
96 </name>
97 </associatedPerson>
98 </associatedEntity>
99 </participant>
100 <component>
101 <structuredBody>
102 <component>
103 <section>
104 <templateId root="2.16.840.1.113883.3.249.11.50"/>
105 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
106 <title>Measure set: CMS EHR Measure Set</title>
107 <text>2010 Measures Set Measures</text>
108 <component>
109 <section>
110 <templateId root="2.16.840.1.113883.3.249.11.2"/>
111 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
112 <title>Measure Section</title>
113 <text>
114 <list>
115 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
116 </list>
117 </text>
118 <entry typeCode="DRIV">
119 <act classCode="ACT" moodCode="DEF">
120 <id root="2.16.840.1.113883.3.249.11.2"/>
121 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
122 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
123 <statusCode code="completed"/>
124 </act>
125 </entry>
126 <component>
127 <section>
128 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
129 <title>Reporting Parameters</title>
130 <text>
131 <list>
132 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
133 </list>
134 </text>
135 <entry>
136 <act classCode="ACT" moodCode="EVN">
137 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
138 <effectiveTime>
139 <low value="20100101"/>
140 <high value="20101231"/>
141 </effectiveTime>
142 </act>
143 </entry>
144 </section>
145 </component>
146 <component>
147 <section>
148 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
149 <title>Patient Data</title>
150 </section>
151 </component>
152 <component>
153 <section>
154 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
155 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
156 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
157 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
158 <title>Problems</title>
159 <text>
160 <table>
161 <tbody>
162 <tr>
163 <th>Type</th>
164 <th>Date</th>
165 <th>Code</th>
166 <th>Description</th>
167 <th>Status</th>
168 <th>Source</th>
169 </tr>
170 <tr>
171 <td>Problem</td>
172 <td>
173 <table>
174 <tbody>
175 <tr xmlns="">
176 <td>Oct 13, 2010</td>
177 </tr>
178 </tbody>
179 </table>
180 </td>
181 <td>250.00 (ICD9CM)
182 </td>
183 <td ID="PROBLEM1">Diabetes Mellitus without mention of Complication, type II or unspecified type,</td>
184 <td>Active</td>
185 <td>EIGHT PROVIDER Scholar Extraordinaire </td>
186 </tr>
187 <tr>
188 <td>Problem</td>
189 <td>
190 <table>
191 <tbody>
192 <tr xmlns="">
193 <td>Oct 05, 2010</td>
194 </tr>
195 </tbody>
196 </table>
197 </td>
198 <td>848.9 (ICD9CM)
199 </td>
200 <td ID="PROBLEM2">Sprains (ICD-9-CM 848.9)</td>
201 <td>Active</td>
202 <td>MATTHEW M KING </td>
203 </tr>
204 </tbody>
205 </table>
206 </text>
207 <entry typeCode="DRIV">
208 <act classCode="ACT" moodCode="EVN">
209 <templateId root="2.16.840.1.113883.10.20.1.27"/>
210 <id root="PROBLEM1" extension="CCRObjectID"/>
211 <code nullFlavor="NA"/>
212 <performer typeCode="PRF">
213 <assignedEntity>
214 <id extension="ACTORPROVIDER_991" root="CCRActorID"/>
215 <addr use="WP">
216 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
217 <city>ALBANY</city>
218 <state>NY</state>
219 <postalCode>12180</postalCode>
220 </addr>
221 <telecom/>
222 <assignedPerson>
223 <name>
224 <prefix>Scholar Extraordinaire</prefix>
225 <given>EIGHT</given>
226 <family>PROVIDER</family>
227 </name>
228 </assignedPerson>
229 </assignedEntity>
230 </performer>
231 <entryRelationship typeCode="SUBJ">
232 <observation classCode="OBS" moodCode="EVN">
233 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
234 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
235 <id root="PROBLEM1" extension="CCRObjectID"/>
236 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
237 <statusCode code="completed"/>
238 <text>
239 <reference value="#PROBLEM1"/>
240 </text>
241 <effectiveTime>
242 <low value="20101013"/>
243 <high nullFlavor="UNK"/>
244 </effectiveTime>
245 <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
246 <entryRelationship typeCode="REFR">
247 <observation classCode="OBS" moodCode="EVN">
248 <templateId root="2.16.840.1.113883.10.20.1.50"/>
249 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
250 <statusCode code="completed"/>
251 <value>
252 <originalText>Active</originalText>
253 </value>
254 </observation>
255 </entryRelationship>
256 </observation>
257 </entryRelationship>
258 </act>
259 </entry>
260 <entry typeCode="DRIV">
261 <act classCode="ACT" moodCode="EVN">
262 <templateId root="2.16.840.1.113883.10.20.1.27"/>
263 <id root="PROBLEM2" extension="CCRObjectID"/>
264 <code nullFlavor="NA"/>
265 <performer typeCode="PRF">
266 <assignedEntity>
267 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
268 <addr use="WP">
269 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
270 <city>ALBANY</city>
271 <state>NY</state>
272 <postalCode>12180</postalCode>
273 </addr>
274 <telecom/>
275 <assignedPerson>
276 <name>
277 <given>MATTHEW</given>
278 <given>M</given>
279 <family>KING</family>
280 </name>
281 </assignedPerson>
282 </assignedEntity>
283 </performer>
284 <entryRelationship typeCode="SUBJ">
285 <observation classCode="OBS" moodCode="EVN">
286 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
287 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
288 <id root="PROBLEM2" extension="CCRObjectID"/>
289 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
290 <statusCode code="completed"/>
291 <text>
292 <reference value="#PROBLEM2"/>
293 </text>
294 <effectiveTime>
295 <low value="20101005"/>
296 <high nullFlavor="UNK"/>
297 </effectiveTime>
298 <value displayName="Sprains (ICD-9-CM 848.9)" code="848.9" codeSystemName="ICD9CM" codeSystem=""/>
299 <entryRelationship typeCode="REFR">
300 <observation classCode="OBS" moodCode="EVN">
301 <templateId root="2.16.840.1.113883.10.20.1.50"/>
302 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
303 <statusCode code="completed"/>
304 <value>
305 <originalText>Active</originalText>
306 </value>
307 </observation>
308 </entryRelationship>
309 </observation>
310 </entryRelationship>
311 </act>
312 </entry>
313 </section>
314 </component>
315 <component>
316 <section>
317 <templateId root="2.16.840.1.113883.10.20.1.12"/>
318 <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
319 <title>Procedures</title>
320 <text>
321 <table>
322 <tbody>
323 <tr>
324 <th>Type</th>
325 <th>Date</th>
326 <th>Code</th>
327 <th>Description</th>
328 <th>Location</th>
329 <th>Substance</th>
330 <th>Method</th>
331 <th>Position</th>
332 <th>Site</th>
333 <th>Status</th>
334 <th>Source</th>
335 </tr>
336 <tr id="PROCEDURE_4108_8">
337 <td/>
338 <table>
339 <tbody>
340 <tr xmlns="">
341 <td>Procedure Date:
342 </td>
343 <td>Oct 13, 2010</td>
344 </tr>
345 </tbody>
346 </table>
347 <td>84295 (CPT-4)
348 </td>
349 <td>Sodium; serum, plasma or whole blood (CPT-4 84295)</td>
350 <td/>
351 <td/>
352 <td/>
353 <td/>
354 <td/>
355 <td>Completed</td>
356 <td>NANCY ANTHRACITE </td>
357 </tr>
358 <tr id="PROCEDURE_4093_5">
359 <td/>
360 <table>
361 <tbody>
362 <tr xmlns="">
363 <td>Procedure Date:
364 </td>
365 <td>Oct 05, 2010</td>
366 </tr>
367 </tbody>
368 </table>
369 <td>99213 (CPT-4)
370 </td>
371 <td>INTERMEDIATE (15min)</td>
372 <td/>
373 <td/>
374 <td/>
375 <td/>
376 <td/>
377 <td>Completed</td>
378 <td>MATTHEW M KING </td>
379 </tr>
380 </tbody>
381 </table>
382 </text>
383 <entry typeCode="DRIV">
384 <procedure classCode="PROC" moodCode="EVN">
385 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
386 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
387 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
388 <id root="PROCEDURE_4108_8" extension="CCRObjectID"/>
389 <code displayName="Sodium; serum, plasma or whole blood (CPT-4 84295)" code="84295" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
390 <text>
391 <reference value="#PROCEDURE_4108_8"/>
392 </text>
393 <statusCode code="completed"/>
394 <effectiveTime>
395 <low value="20101013"/>
396 <high nullFlavor="UNK"/>
397 </effectiveTime>
398 </procedure>
399 </entry>
400 <entry typeCode="DRIV">
401 <procedure classCode="PROC" moodCode="EVN">
402 <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
403 <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
404 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
405 <id root="PROCEDURE_4093_5" extension="CCRObjectID"/>
406 <code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
407 <text>
408 <reference value="#PROCEDURE_4093_5"/>
409 </text>
410 <statusCode code="completed"/>
411 <effectiveTime>
412 <low value="20101005"/>
413 <high nullFlavor="UNK"/>
414 </effectiveTime>
415 </procedure>
416 </entry>
417 </section>
418 </component>
419 <component>
420 <section>
421 <templateId root="2.16.840.1.113883.10.20.1.9"/>
422 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
423 <title>Payers</title>
424 <text/>
425 <entry typeCode="DRIV">
426 <act classCode="ACT" moodCode="DEF">
427 <templateId root="2.16.840.1.113883.10.20.1.20"/>
428 <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
429 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
430 <statusCode code="completed"/>
431 <entryRelationship typeCode="COMP">
432 <act classCode="ACT" moodCode="EVN">
433 <templateId root="2.16.840.1.113883.10.20.1.26"/>
434 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
435 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
436 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
437 <statusCode code="completed"/>
438 <performer typeCode="PRF">
439 <assignedEntity>
440 <id root="2.16.840.1.113883.12.86" extension="MC"/>
441 </assignedEntity>
442 </performer>
443 <participant typeCode="COV">
444 <participantRole>
445 <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
446 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
447 </participantRole>
448 </participant>
449 </act>
450 </entryRelationship>
451 </act>
452 </entry>
453 </section>
454 </component>
455 </section>
456 </component>
457 </section>
458 </component>
459 </structuredBody>
460 </component>
461</ClinicalDocument>
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