| 1 | <?xml version="1.0" encoding="utf-8"?>
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| 2 | <?xml-stylesheet type="text/xsl" href="cda.xsl"?>
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| 3 | <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">
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| 4 | <realmCode code="US"/>
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| 5 | <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
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| 6 | <templateId root="2.16.840.1.113883.10.20.12"/>
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| 7 | <templateId root="2.16.840.1.113883.3.249.11.100.1"/>
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| 8 | <id root="e790ee1e-1dc0-491a-9e2c-870eea611db8" extension="01"/>
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| 9 | <code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
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| 10 | <title>QRDA Incidence Report</title>
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| 11 | <effectiveTime value="20100703"/>
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| 12 | <confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
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| 13 | <languageCode code="en-US"/>
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| 14 | <setId root="2.16.840.1.113883.3.543" extension="01"/>
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| 15 | <versionNumber value="1"/>
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| 16 | <recordTarget>
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| 17 | <patientRole>
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| 18 | <id extension="666000200" root="2.16.840.1.113883.4.1"/>
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| 19 | <addr use="H">
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| 20 | <streetAddressLine>Any Street</streetAddressLine>
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| 21 | <city>Any Town</city>
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| 22 | <state>WV</state>
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| 23 | <postalCode/>
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| 24 | </addr>
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| 25 | <telecom use="" value="tel:+1-222-555-8235"/>
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| 26 | <patient>
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| 27 | <name>
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| 28 | <given>MALE-D</given>
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| 29 | <family>MEASURE-TWO</family>
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| 30 | </name>
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| 31 | <administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
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| 32 | <birthTime value="1960111200"/>
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| 33 | <raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
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| 34 | <ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.5.50"/>
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| 35 | </patient>
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| 36 | <providerOrganization>
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| 37 | <!-- NPI for the provider-->
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| 38 | <id root="2.16.840.1.113883.4.6" extension="1558574525" />
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| 39 | <name>WorldVistA Test Clinic</name>
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| 40 | <!--WVV Address of organization is optional except for the STATE-->
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| 41 | <addr>
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| 42 | <state>MD</state>
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| 43 | <postalCode>20877</postalCode>
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| 44 |
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| 45 | </addr>
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| 46 | <!--WVP required asOrganizationPartOf added to sample-->
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| 47 | <asOrganizationPartOf>
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| 48 | <wholeOrganization>
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| 49 | <!-- Tax ID is the extension-->
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| 50 | <id root="2.16.840.1.113883.4.2" extension="226864459"/>
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| 51 | </wholeOrganization>
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| 52 | </asOrganizationPartOf>
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| 53 | </providerOrganization>
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| 54 |
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| 55 | </patientRole>
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| 56 | </recordTarget>
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| 57 | <author>
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| 58 | <time value="20100703"/>
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| 59 | <assignedAuthor>
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| 60 | <id root="2.16.840.1.113883.3.249.6" extension="100001"/>
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| 61 | <assignedPerson>
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| 62 | <name>
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| 63 | <given>Nancy</given>
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| 64 | <family>Anthracite</family>
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| 65 | <suffix>MD</suffix>
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| 66 | </name>
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| 67 | </assignedPerson>
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| 68 | <representedOrganization>
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| 69 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 70 | <name>WorldVistA Test Clinic</name>
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| 71 | </representedOrganization>
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| 72 | </assignedAuthor>
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| 73 | </author>
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| 74 | <informant>
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| 75 | <assignedEntity>
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| 76 | <id nullFlavor="NA"/>
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| 77 | <representedOrganization>
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| 78 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 79 | <name>World VistA Test Clinic</name>
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| 80 | </representedOrganization>
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| 81 | </assignedEntity>
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| 82 | </informant>
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| 83 | <custodian>
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| 84 | <assignedCustodian>
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| 85 | <representedCustodianOrganization>
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| 86 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 87 | <name>WorldVistA Test Clinic</name>
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| 88 | </representedCustodianOrganization>
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| 89 | </assignedCustodian>
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| 90 | </custodian>
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| 91 | <legalAuthenticator>
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| 92 | <time value="20100703"/>
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| 93 | <signatureCode code="S"/>
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| 94 | <assignedEntity>
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| 95 | <id root="2.16.840.1.113883.3.543" extension="111111"/>
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| 96 | <assignedPerson>
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| 97 | <name>
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| 98 | <given>Nancy</given>
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| 99 | <family>Anthracite</family>
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| 100 | <suffix>MD</suffix>
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| 101 | </name>
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| 102 | </assignedPerson>
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| 103 | <representedOrganization>
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| 104 | <id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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| 105 | <name>WorldVistA Test Clinic</name>
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| 106 | </representedOrganization>
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| 107 | </assignedEntity>
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| 108 | </legalAuthenticator>
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| 109 | <participant typeCode="PRF">
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| 110 | <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
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| 111 | <associatedEntity classCode="PROV">
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| 112 | <id root="2.16.840.1.113883.3.249.6" extension="111111"/>
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| 113 | <associatedPerson>
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| 114 | <name>
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| 115 | <prefix>Dr.</prefix>
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| 116 | <given>Nancy</given>
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| 117 | <family>Anthracite</family>
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| 118 | </name>
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| 119 | </associatedPerson>
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| 120 | </associatedEntity>
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| 121 | </participant>
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| 122 | <documentationOf>
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| 123 | <serviceEvent>
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| 124 | <code displayName="Office/Outpatient Visit of an Established Patient requiring (2 of 3) an Expanded History, an Exam and Medical Decision Making of Low Complexity (CPT-4 99213)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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| 125 | <effectiveTime>
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| 126 | <low value="20100104"/>
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| 127 | <high value="20100104"/>
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| 128 | </effectiveTime>
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| 129 | <performer typeCode="PRF">
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| 130 | <assignedEntity>
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| 131 | <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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| 132 | <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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| 133 | <addr>
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| 134 | <streetAddressLine>123 Maple Ave</streetAddressLine>
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| 135 | <city>Gaithersburg</city>
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| 136 | <state>MD</state>
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| 137 | <postalCode>20877</postalCode>
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| 138 | </addr>
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| 139 | <assignedPerson>
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| 140 | <name>
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| 141 | <given>Nancy</given>
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| 142 | <family>Anthracite</family>
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| 143 | <suffix>MD</suffix>
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| 144 | </name>
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| 145 | </assignedPerson>
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| 146 | </assignedEntity>
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| 147 | </performer>
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| 148 | </serviceEvent>
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| 149 | </documentationOf>
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| 150 | <documentationOf>
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| 151 | <serviceEvent>
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| 152 | <code displayName="INTERMEDIATE (30min)" code="99242" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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| 153 | <effectiveTime>
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| 154 | <low value="20101014"/>
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| 155 | <high value="20101014"/>
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| 156 | </effectiveTime>
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| 157 | <performer typeCode="PRF">
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| 158 | <assignedEntity>
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| 159 | <id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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| 160 | <code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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| 161 | <addr>
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| 162 | <streetAddressLine>123 Maple Ave</streetAddressLine>
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| 163 | <city>Gaithersburg</city>
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| 164 | <state>MD</state>
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| 165 | <postalCode>20877</postalCode>
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| 166 | </addr>
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| 167 | <assignedPerson>
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| 168 | <name>
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| 169 | <given>Nancy</given>
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| 170 | <family>Anthracite</family>
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| 171 | <suffix>MD</suffix>
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| 172 | </name>
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| 173 | </assignedPerson>
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| 174 | </assignedEntity>
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| 175 | </performer>
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| 176 | </serviceEvent>
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| 177 | </documentationOf>
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| 178 | <component>
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| 179 | <structuredBody>
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| 180 | <component>
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| 181 | <section>
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| 182 | <templateId root="2.16.840.1.113883.3.249.11.50"/>
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| 183 | <code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
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| 184 | <title>Measure set: CMS EHR Measure Set</title>
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| 185 | <text>2010 Measures Set Measures</text>
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| 186 | <component>
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| 187 | <section>
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| 188 | <templateId root="2.16.840.1.113883.3.249.11.2"/>
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| 189 | <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
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| 190 | <title>Measure Section</title>
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| 191 | <text>
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| 192 | <list>
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| 193 | <item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
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| 194 | </list>
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| 195 | </text>
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| 196 | <entry typeCode="DRIV">
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| 197 | <act classCode="ACT" moodCode="DEF">
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| 198 | <id root="2.16.840.1.113883.3.249.11.2"/>
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| 199 | <code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
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| 200 | <text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
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| 201 | <statusCode code="completed"/>
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| 202 | </act>
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| 203 | </entry>
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| 204 | <component>
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| 205 | <section>
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| 206 | <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
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| 207 | <title>Reporting Parameters</title>
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| 208 | <text>
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| 209 | <list>
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| 210 | <item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
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| 211 | </list>
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| 212 | </text>
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| 213 | <entry>
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| 214 | <act classCode="ACT" moodCode="EVN">
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| 215 | <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
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| 216 | <effectiveTime>
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| 217 | <low value="20100101"/>
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| 218 | <high value="20101231"/>
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| 219 | </effectiveTime>
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| 220 | </act>
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| 221 | </entry>
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| 222 | </section>
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| 223 | </component>
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| 224 | <component>
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| 225 | <section>
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| 226 | <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
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| 227 | <title>Patient Data</title>
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| 228 | </section>
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| 229 | </component>
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| 230 | <component>
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| 231 | <section>
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| 232 | <templateId root="2.16.840.1.113883.10.20.1.9"/>
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| 233 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
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| 234 | <title>Payers</title>
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| 235 | <text />
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| 236 | <entry typeCode="DRIV">
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| 237 | <act classCode="ACT" moodCode="DEF">
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| 238 | <templateId root="2.16.840.1.113883.10.20.1.20"/>
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| 239 | <id root="1751b180-8a54-11df-a4ee-0800200c9c66"/>
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| 240 | <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
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| 241 | <statusCode code="completed"/>
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| 242 | <entryRelationship typeCode="COMP">
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| 243 | <act classCode="ACT" moodCode="EVN">
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| 244 | <templateId root="2.16.840.1.113883.10.20.1.26"/>
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| 245 | <templateId root="2.16.840.1.113883.3.249.11.100.7"/>
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| 246 | <id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
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| 247 | <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
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| 248 | <statusCode code="completed"/>
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| 249 | <performer typeCode="PRF">
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| 250 | <assignedEntity>
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| 251 | <id root="2.16.840.1.113883.12.86" extension="MC"/>
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| 252 | </assignedEntity>
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| 253 | </performer>
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| 254 | <participant typeCode="COV">
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| 255 | <participantRole>
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| 256 | <id root="2.16.840.1.113883.4.1" extension="666000200"/>
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| 257 | <code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
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| 258 | </participantRole>
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| 259 | </participant>
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| 260 | </act>
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| 261 | </entryRelationship>
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| 262 | </act>
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| 263 | </entry>
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| 264 | </section>
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| 265 | </component>
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| 266 | </section>
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| 267 | </component>
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| 268 | </section>
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| 269 | </component>
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| 270 | </structuredBody>
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| 271 | </component>
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| 272 | </ClinicalDocument>
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