source: qrda/CCR/M1-QRDA/M1-PAT_100855_QRDA_V1_0_0.xml@ 1436

Last change on this file since 1436 was 997, checked in by George Lilly, 14 years ago

current QRDA submissions
File size: 29.4 KB
RevLine 
[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="498212298" 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-E</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_4127_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>99212 (CPT-4)
415 </td>
416 <td>LIMITED (10min)</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_4110_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_4127_7" extension="CCRObjectID"/>
456 <code displayName="LIMITED (10min)" code="99212" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
457 <text>
458 <reference value="#PROCEDURE_4127_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_4110_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_4110_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>
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