| [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="098487630" 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-D</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 14, 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>NANCY ANTHRACITE </td>
|
|---|
| 186 | </tr>
|
|---|
| 187 | <tr>
|
|---|
| 188 | <td>Problem</td>
|
|---|
| 189 | <td>
|
|---|
| 190 | <table>
|
|---|
| 191 | <tbody>
|
|---|
| 192 | <tr xmlns="">
|
|---|
| 193 | <td>Oct 14, 2010</td>
|
|---|
| 194 | </tr>
|
|---|
| 195 | </tbody>
|
|---|
| 196 | </table>
|
|---|
| 197 | </td>
|
|---|
| 198 | <td>250.00 (ICD9CM)
|
|---|
| 199 | </td>
|
|---|
| 200 | <td ID="PROBLEM2">Diabetes (ICD-9-CM 250.00)</td>
|
|---|
| 201 | <td>Active</td>
|
|---|
| 202 | <td>NANCY ANTHRACITE </td>
|
|---|
| 203 | </tr>
|
|---|
| 204 | <tr>
|
|---|
| 205 | <td>Problem</td>
|
|---|
| 206 | <td>
|
|---|
| 207 | <table>
|
|---|
| 208 | <tbody>
|
|---|
| 209 | <tr xmlns="">
|
|---|
| 210 | <td>Oct 13, 2010</td>
|
|---|
| 211 | </tr>
|
|---|
| 212 | </tbody>
|
|---|
| 213 | </table>
|
|---|
| 214 | </td>
|
|---|
| 215 | <td>250.00 (ICD9CM)
|
|---|
| 216 | </td>
|
|---|
| 217 | <td ID="PROBLEM3">Diabetes Mellitus without mention of Complication, type II or unspecified type,</td>
|
|---|
| 218 | <td>Active</td>
|
|---|
| 219 | <td>NANCY ANTHRACITE </td>
|
|---|
| 220 | </tr>
|
|---|
| 221 | </tbody>
|
|---|
| 222 | </table>
|
|---|
| 223 | </text>
|
|---|
| 224 | <entry typeCode="DRIV">
|
|---|
| 225 | <act classCode="ACT" moodCode="EVN">
|
|---|
| 226 | <templateId root="2.16.840.1.113883.10.20.1.27"/>
|
|---|
| 227 | <id root="PROBLEM1" extension="CCRObjectID"/>
|
|---|
| 228 | <code nullFlavor="NA"/>
|
|---|
| 229 | <performer typeCode="PRF">
|
|---|
| 230 | <assignedEntity>
|
|---|
| 231 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
|
|---|
| 232 | <addr use="WP">
|
|---|
| 233 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
|
|---|
| 234 | <city>ALBANY</city>
|
|---|
| 235 | <state>NY</state>
|
|---|
| 236 | <postalCode>12180</postalCode>
|
|---|
| 237 | </addr>
|
|---|
| 238 | <telecom/>
|
|---|
| 239 | <assignedPerson>
|
|---|
| 240 | <name>
|
|---|
| 241 | <given>NANCY</given>
|
|---|
| 242 | <family>ANTHRACITE</family>
|
|---|
| 243 | </name>
|
|---|
| 244 | </assignedPerson>
|
|---|
| 245 | </assignedEntity>
|
|---|
| 246 | </performer>
|
|---|
| 247 | <entryRelationship typeCode="SUBJ">
|
|---|
| 248 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 249 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
|
|---|
| 250 | <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
|
|---|
| 251 | <id root="PROBLEM1" extension="CCRObjectID"/>
|
|---|
| 252 | <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
|
|---|
| 253 | <statusCode code="completed"/>
|
|---|
| 254 | <text>
|
|---|
| 255 | <reference value="#PROBLEM1"/>
|
|---|
| 256 | </text>
|
|---|
| 257 | <effectiveTime>
|
|---|
| 258 | <low value="20101014"/>
|
|---|
| 259 | <high nullFlavor="UNK"/>
|
|---|
| 260 | </effectiveTime>
|
|---|
| 261 | <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
|
|---|
| 262 | <entryRelationship typeCode="REFR">
|
|---|
| 263 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 264 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
|
|---|
| 265 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
|
|---|
| 266 | <statusCode code="completed"/>
|
|---|
| 267 | <value>
|
|---|
| 268 | <originalText>Active</originalText>
|
|---|
| 269 | </value>
|
|---|
| 270 | </observation>
|
|---|
| 271 | </entryRelationship>
|
|---|
| 272 | </observation>
|
|---|
| 273 | </entryRelationship>
|
|---|
| 274 | </act>
|
|---|
| 275 | </entry>
|
|---|
| 276 | <entry typeCode="DRIV">
|
|---|
| 277 | <act classCode="ACT" moodCode="EVN">
|
|---|
| 278 | <templateId root="2.16.840.1.113883.10.20.1.27"/>
|
|---|
| 279 | <id root="PROBLEM2" extension="CCRObjectID"/>
|
|---|
| 280 | <code nullFlavor="NA"/>
|
|---|
| 281 | <performer typeCode="PRF">
|
|---|
| 282 | <assignedEntity>
|
|---|
| 283 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
|
|---|
| 284 | <addr use="WP">
|
|---|
| 285 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
|
|---|
| 286 | <city>ALBANY</city>
|
|---|
| 287 | <state>NY</state>
|
|---|
| 288 | <postalCode>12180</postalCode>
|
|---|
| 289 | </addr>
|
|---|
| 290 | <telecom/>
|
|---|
| 291 | <assignedPerson>
|
|---|
| 292 | <name>
|
|---|
| 293 | <given>NANCY</given>
|
|---|
| 294 | <family>ANTHRACITE</family>
|
|---|
| 295 | </name>
|
|---|
| 296 | </assignedPerson>
|
|---|
| 297 | </assignedEntity>
|
|---|
| 298 | </performer>
|
|---|
| 299 | <entryRelationship typeCode="SUBJ">
|
|---|
| 300 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 301 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
|
|---|
| 302 | <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
|
|---|
| 303 | <id root="PROBLEM2" extension="CCRObjectID"/>
|
|---|
| 304 | <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
|
|---|
| 305 | <statusCode code="completed"/>
|
|---|
| 306 | <text>
|
|---|
| 307 | <reference value="#PROBLEM2"/>
|
|---|
| 308 | </text>
|
|---|
| 309 | <effectiveTime>
|
|---|
| 310 | <low value="20101014"/>
|
|---|
| 311 | <high nullFlavor="UNK"/>
|
|---|
| 312 | </effectiveTime>
|
|---|
| 313 | <value displayName="Diabetes (ICD-9-CM 250.00)" code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
|
|---|
| 314 | <entryRelationship typeCode="REFR">
|
|---|
| 315 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 316 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
|
|---|
| 317 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
|
|---|
| 318 | <statusCode code="completed"/>
|
|---|
| 319 | <value>
|
|---|
| 320 | <originalText>Active</originalText>
|
|---|
| 321 | </value>
|
|---|
| 322 | </observation>
|
|---|
| 323 | </entryRelationship>
|
|---|
| 324 | </observation>
|
|---|
| 325 | </entryRelationship>
|
|---|
| 326 | </act>
|
|---|
| 327 | </entry>
|
|---|
| 328 | <entry typeCode="DRIV">
|
|---|
| 329 | <act classCode="ACT" moodCode="EVN">
|
|---|
| 330 | <templateId root="2.16.840.1.113883.10.20.1.27"/>
|
|---|
| 331 | <id root="PROBLEM3" extension="CCRObjectID"/>
|
|---|
| 332 | <code nullFlavor="NA"/>
|
|---|
| 333 | <performer typeCode="PRF">
|
|---|
| 334 | <assignedEntity>
|
|---|
| 335 | <id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
|
|---|
| 336 | <addr use="WP">
|
|---|
| 337 | <streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
|
|---|
| 338 | <city>ALBANY</city>
|
|---|
| 339 | <state>NY</state>
|
|---|
| 340 | <postalCode>12180</postalCode>
|
|---|
| 341 | </addr>
|
|---|
| 342 | <telecom/>
|
|---|
| 343 | <assignedPerson>
|
|---|
| 344 | <name>
|
|---|
| 345 | <given>NANCY</given>
|
|---|
| 346 | <family>ANTHRACITE</family>
|
|---|
| 347 | </name>
|
|---|
| 348 | </assignedPerson>
|
|---|
| 349 | </assignedEntity>
|
|---|
| 350 | </performer>
|
|---|
| 351 | <entryRelationship typeCode="SUBJ">
|
|---|
| 352 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 353 | <templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
|
|---|
| 354 | <templateId root="2.16.840.1.113883.3.249.11.100.8"/>
|
|---|
| 355 | <id root="PROBLEM3" extension="CCRObjectID"/>
|
|---|
| 356 | <code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
|
|---|
| 357 | <statusCode code="completed"/>
|
|---|
| 358 | <text>
|
|---|
| 359 | <reference value="#PROBLEM3"/>
|
|---|
| 360 | </text>
|
|---|
| 361 | <effectiveTime>
|
|---|
| 362 | <low value="20101013"/>
|
|---|
| 363 | <high nullFlavor="UNK"/>
|
|---|
| 364 | </effectiveTime>
|
|---|
| 365 | <value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="ICD9CM" codeSystem=""/>
|
|---|
| 366 | <entryRelationship typeCode="REFR">
|
|---|
| 367 | <observation classCode="OBS" moodCode="EVN">
|
|---|
| 368 | <templateId root="2.16.840.1.113883.10.20.1.50"/>
|
|---|
| 369 | <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
|
|---|
| 370 | <statusCode code="completed"/>
|
|---|
| 371 | <value>
|
|---|
| 372 | <originalText>Active</originalText>
|
|---|
| 373 | </value>
|
|---|
| 374 | </observation>
|
|---|
| 375 | </entryRelationship>
|
|---|
| 376 | </observation>
|
|---|
| 377 | </entryRelationship>
|
|---|
| 378 | </act>
|
|---|
| 379 | </entry>
|
|---|
| 380 | </section>
|
|---|
| 381 | </component>
|
|---|
| 382 | <component>
|
|---|
| 383 | <section>
|
|---|
| 384 | <templateId root="2.16.840.1.113883.10.20.1.12"/>
|
|---|
| 385 | <code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
|
|---|
| 386 | <title>Procedures</title>
|
|---|
| 387 | <text>
|
|---|
| 388 | <table>
|
|---|
| 389 | <tbody>
|
|---|
| 390 | <tr>
|
|---|
| 391 | <th>Type</th>
|
|---|
| 392 | <th>Date</th>
|
|---|
| 393 | <th>Code</th>
|
|---|
| 394 | <th>Description</th>
|
|---|
| 395 | <th>Location</th>
|
|---|
| 396 | <th>Substance</th>
|
|---|
| 397 | <th>Method</th>
|
|---|
| 398 | <th>Position</th>
|
|---|
| 399 | <th>Site</th>
|
|---|
| 400 | <th>Status</th>
|
|---|
| 401 | <th>Source</th>
|
|---|
| 402 | </tr>
|
|---|
| 403 | <tr id="PROCEDURE_4126_7">
|
|---|
| 404 | <td/>
|
|---|
| 405 | <table>
|
|---|
| 406 | <tbody>
|
|---|
| 407 | <tr xmlns="">
|
|---|
| 408 | <td>Procedure Date:
|
|---|
| 409 | </td>
|
|---|
| 410 | <td>Oct 14, 2010</td>
|
|---|
| 411 | </tr>
|
|---|
| 412 | </tbody>
|
|---|
| 413 | </table>
|
|---|
| 414 | <td>99202 (CPT-4)
|
|---|
| 415 | </td>
|
|---|
| 416 | <td>INTERMEDIATE (20min)</td>
|
|---|
| 417 | <td/>
|
|---|
| 418 | <td/>
|
|---|
| 419 | <td/>
|
|---|
| 420 | <td/>
|
|---|
| 421 | <td/>
|
|---|
| 422 | <td>Completed</td>
|
|---|
| 423 | <td>NANCY ANTHRACITE </td>
|
|---|
| 424 | </tr>
|
|---|
| 425 | <tr id="PROCEDURE_4109_4">
|
|---|
| 426 | <td/>
|
|---|
| 427 | <table>
|
|---|
| 428 | <tbody>
|
|---|
| 429 | <tr xmlns="">
|
|---|
| 430 | <td>Procedure Date:
|
|---|
| 431 | </td>
|
|---|
| 432 | <td>Oct 13, 2010</td>
|
|---|
| 433 | </tr>
|
|---|
| 434 | </tbody>
|
|---|
| 435 | </table>
|
|---|
| 436 | <td>99202 (CPT-4)
|
|---|
| 437 | </td>
|
|---|
| 438 | <td>INTERMEDIATE (20min)</td>
|
|---|
| 439 | <td/>
|
|---|
| 440 | <td/>
|
|---|
| 441 | <td/>
|
|---|
| 442 | <td/>
|
|---|
| 443 | <td/>
|
|---|
| 444 | <td>Completed</td>
|
|---|
| 445 | <td>NANCY ANTHRACITE </td>
|
|---|
| 446 | </tr>
|
|---|
| 447 | </tbody>
|
|---|
| 448 | </table>
|
|---|
| 449 | </text>
|
|---|
| 450 | <entry typeCode="DRIV">
|
|---|
| 451 | <procedure classCode="PROC" moodCode="EVN">
|
|---|
| 452 | <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
|
|---|
| 453 | <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
|
|---|
| 454 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
|
|---|
| 455 | <id root="PROCEDURE_4126_7" extension="CCRObjectID"/>
|
|---|
| 456 | <code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
|
|---|
| 457 | <text>
|
|---|
| 458 | <reference value="#PROCEDURE_4126_7"/>
|
|---|
| 459 | </text>
|
|---|
| 460 | <statusCode code="completed"/>
|
|---|
| 461 | <effectiveTime>
|
|---|
| 462 | <low value="20101014"/>
|
|---|
| 463 | <high nullFlavor="UNK"/>
|
|---|
| 464 | </effectiveTime>
|
|---|
| 465 | </procedure>
|
|---|
| 466 | </entry>
|
|---|
| 467 | <entry typeCode="DRIV">
|
|---|
| 468 | <procedure classCode="PROC" moodCode="EVN">
|
|---|
| 469 | <templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
|
|---|
| 470 | <templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
|
|---|
| 471 | <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
|
|---|
| 472 | <id root="PROCEDURE_4109_4" extension="CCRObjectID"/>
|
|---|
| 473 | <code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
|
|---|
| 474 | <text>
|
|---|
| 475 | <reference value="#PROCEDURE_4109_4"/>
|
|---|
| 476 | </text>
|
|---|
| 477 | <statusCode code="completed"/>
|
|---|
| 478 | <effectiveTime>
|
|---|
| 479 | <low value="20101013"/>
|
|---|
| 480 | <high nullFlavor="UNK"/>
|
|---|
| 481 | </effectiveTime>
|
|---|
| 482 | </procedure>
|
|---|
| 483 | </entry>
|
|---|
| 484 | </section>
|
|---|
| 485 | </component>
|
|---|
| 486 | <component>
|
|---|
| 487 | <section>
|
|---|
| 488 | <templateId root="2.16.840.1.113883.10.20.1.9"/>
|
|---|
| 489 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
|
|---|
| 490 | <title>Payers</title>
|
|---|
| 491 | <text/>
|
|---|
| 492 | <entry typeCode="DRIV">
|
|---|
| 493 | <act classCode="ACT" moodCode="DEF">
|
|---|
| 494 | <templateId root="2.16.840.1.113883.10.20.1.20"/>
|
|---|
| 495 | <id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
|
|---|
| 496 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
|
|---|
| 497 | <statusCode code="completed"/>
|
|---|
| 498 | <entryRelationship typeCode="COMP">
|
|---|
| 499 | <act classCode="ACT" moodCode="EVN">
|
|---|
| 500 | <templateId root="2.16.840.1.113883.10.20.1.26"/>
|
|---|
| 501 | <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
|
|---|
| 502 | <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
|
|---|
| 503 | <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
|
|---|
| 504 | <statusCode code="completed"/>
|
|---|
| 505 | <performer typeCode="PRF">
|
|---|
| 506 | <assignedEntity>
|
|---|
| 507 | <id root="2.16.840.1.113883.12.86" extension="MC"/>
|
|---|
| 508 | </assignedEntity>
|
|---|
| 509 | </performer>
|
|---|
| 510 | <participant typeCode="COV">
|
|---|
| 511 | <participantRole>
|
|---|
| 512 | <id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
|
|---|
| 513 | <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
|
|---|
| 514 | </participantRole>
|
|---|
| 515 | </participant>
|
|---|
| 516 | </act>
|
|---|
| 517 | </entryRelationship>
|
|---|
| 518 | </act>
|
|---|
| 519 | </entry>
|
|---|
| 520 | </section>
|
|---|
| 521 | </component>
|
|---|
| 522 | </section>
|
|---|
| 523 | </component>
|
|---|
| 524 | </section>
|
|---|
| 525 | </component>
|
|---|
| 526 | </structuredBody>
|
|---|
| 527 | </component>
|
|---|
| 528 | </ClinicalDocument>
|
|---|
