source: qrda/CCR/M1-QRDA/M1-PAT_100848_QRDA_V1_0_0Ver2.xml@ 1013

Last change on this file since 1013 was 1013, checked in by George Lilly, 13 years ago

some QRDA files, not final
File size: 18.6 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="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
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="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
14 <versionNumber value="1"/>
15 <recordTarget>
16 <patientRole>
17 <id extension="345097898" 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>FEMALE-B</given>
28 <family>MEASURE-ONE</family>
29 </name>
30 <administrativeGenderCode displayName="FEMALE" code="F" 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="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
124 <effectiveTime>
125 <low value="20101005"/>
126 <high value="20101005"/>
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<component>
150 <structuredBody>
151 <component>
152 <section>
153 <templateId root="2.16.840.1.113883.3.249.11.50"/>
154 <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
155 <title>Measure set: CMS EHR Measure Set</title>
156 <text>2010 Measures Set Measures</text>
157 <component>
158 <section>
159 <templateId root="2.16.840.1.113883.3.249.11.2"/>
160 <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
161 <title>Measure Section</title>
162 <text>
163 <list>
164 <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
165 </list>
166 </text>
167 <entry typeCode="DRIV">
168 <act classCode="ACT" moodCode="DEF">
169 <id root="2.16.840.1.113883.3.249.11.2"/>
170 <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
171 <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
172 <statusCode code="completed"/>
173 </act>
174 </entry>
175 <component>
176 <section>
177 <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
178 <title>Reporting Parameters</title>
179 <text>
180 <list>
181 <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
182 </list>
183 </text>
184 <entry>
185 <act classCode="ACT" moodCode="EVN">
186 <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
187 <effectiveTime>
188 <low value="20100101"/>
189 <high value="20101231"/>
190 </effectiveTime>
191 </act>
192 </entry>
193 </section>
194 </component>
195 <component>
196 <section>
197 <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
198 <title>Patient Data</title>
199 </section>
200 </component>
201 <component>
202 <section>
203 <templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
204 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
205 <templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
206 <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
207 <title>Problems</title>
208 <text/>
209 <entry typeCode="DRIV">
210 <act classCode="ACT" moodCode="EVN">
211 <templateId root="2.16.840.1.113883.10.20.1.27"/>
212 <id root="PROBLEM1" extension="CCRObjectID"/>
213 <code nullFlavor="NA"/>
214 <performer typeCode="PRF">
215 <assignedEntity>
216 <id extension="ACTORPROVIDER_991" root="CCRActorID"/>
217 <addr use="WP">
218 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
219 <city>ALBANY</city>
220 <state>NY</state>
221 <postalCode>12180</postalCode>
222 </addr>
223 <telecom/>
224 <assignedPerson>
225 <name>
226 <prefix>Scholar Extraordinaire</prefix>
227 <given>EIGHT</given>
228 <family>PROVIDER</family>
229 </name>
230 </assignedPerson>
231 </assignedEntity>
232 </performer>
233 <entryRelationship typeCode="SUBJ">
234 <observation classCode="OBS" moodCode="EVN">
235 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
236 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
237 <id root="PROBLEM1" extension="CCRObjectID"/>
238 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
239 <statusCode code="completed"/>
240 <effectiveTime>
241 <low value="20101013"/>
242 <high value="20101013"/>
243 </effectiveTime>
244 <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"/>
245 <entryRelationship typeCode="REFR">
246 <observation classCode="OBS" moodCode="EVN">
247 <templateId root="2.16.840.1.113883.10.20.1.50"/>
248<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
249 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
250 <statusCode code="completed"/>
251<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
252 </observation>
253 </entryRelationship>
254 </observation>
255 </entryRelationship>
256 </act>
257 </entry>
258 <entry typeCode="DRIV">
259 <act classCode="ACT" moodCode="EVN">
260 <templateId root="2.16.840.1.113883.10.20.1.27"/>
261 <id root="PROBLEM2" extension="CCRObjectID"/>
262 <code nullFlavor="NA"/>
263 <performer typeCode="PRF">
264 <assignedEntity>
265 <id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
266 <addr use="WP">
267 <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
268 <city>ALBANY</city>
269 <state>NY</state>
270 <postalCode>12180</postalCode>
271 </addr>
272 <telecom/>
273 <assignedPerson>
274 <name>
275 <given>MATTHEW</given>
276 <given>M</given>
277 <family>KING</family>
278 </name>
279 </assignedPerson>
280 </assignedEntity>
281 </performer>
282 <entryRelationship typeCode="SUBJ">
283 <observation classCode="OBS" moodCode="EVN">
284 <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
285 <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
286 <id root="PROBLEM2" extension="CCRObjectID"/>
287 <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
288 <statusCode code="completed"/>
289 <effectiveTime>
290 <low value="20101005"/>
291 <high value="20101005"/>
292 </effectiveTime>
293 <value xsi:type="CD" displayName="Sprains (ICD-9-CM 848.9)" code="848.9" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
294 <entryRelationship typeCode="REFR">
295 <observation classCode="OBS" moodCode="EVN">
296 <templateId root="2.16.840.1.113883.10.20.1.50"/>
297<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
298 <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
299 <statusCode code="completed"/>
300<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
301 </observation>
302 </entryRelationship>
303 </observation>
304 </entryRelationship>
305 </act>
306 </entry>
307 </section>
308 </component>
309 <component>
310 <section>
311 <templateId root="2.16.840.1.113883.10.20.1.9"/>
312 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
313 <title>Payers</title>
314 <text/>
315 <entry typeCode="DRIV">
316 <act classCode="ACT" moodCode="DEF">
317 <templateId root="2.16.840.1.113883.10.20.1.20"/>
318 <id root="2.16.840.1.113883.3.543" extension="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
319 <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
320 <statusCode code="completed"/>
321 <entryRelationship typeCode="COMP">
322 <act classCode="ACT" moodCode="EVN">
323 <templateId root="2.16.840.1.113883.10.20.1.26"/>
324 <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
325 <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
326 <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
327 <statusCode code="completed"/>
328 <performer typeCode="PRF">
329 <assignedEntity>
330 <id root="2.16.840.1.113883.12.86" extension="MC"/>
331 </assignedEntity>
332 </performer>
333 <participant typeCode="COV">
334 <participantRole>
335 <id root="2.16.840.1.113883.4.1" extension="345097898"/>
336 <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
337 </participantRole>
338 </participant>
339 </act>
340 </entryRelationship>
341 </act>
342 </entry>
343 </section>
344 </component>
345 </section>
346 </component>
347 </section>
348 </component>
349 </structuredBody>
350 </component>
351</ClinicalDocument>
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