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CCD_1.xml
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<?xml version="1.0" encoding="UTF-8" standalone="yes"?><?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!-- Title: US_Realm_Header_Template -->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3"
xmlns:cda="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc">
<!-- ******************************************************** CDA Header
******************************************************** -->
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- US General Header Template -->
<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
<!-- *** Note: The next templateId, code and title will differ depending
on what type of document is being sent. *** -->
<!-- conforms to the document specific requirements -->
<templateId root="2.16.840.1.113883.10.20.22.1.2"/>
<id extension="TT988" root="2.16.840.1.113883.19.5.99999.1"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9"
displayName="Summarization of Episode Note"/>
<title>Community Health and Hospitals: Health Summary</title>
<effectiveTime value="201209150000-0400"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en-US"/>
<setId extension="sTT988" root="2.16.840.1.113883.19.5.99999.19"/>
<versionNumber value="1"/>
<recordTarget>
<patientRole>
<id extension="998991" root="2.16.840.1.113883.19.5.99999.2"/>
<!-- Fake ID using HL7 example OID. -->
<id extension="111-00-2330" root="2.16.840.1.113883.4.1"/>
<!-- Fake Social Security Number using the actual SSN OID. -->
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(816)276-6909" use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<patient>
<name use="L">
<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
<given>Isabella</given>
<given>Isa</given>
<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family>Jones</family>
</name>
<administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"
displayName="Female"/>
<birthTime value="19750501"/>
<maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2"
codeSystemName="MaritalStatusCode"/>
<religiousAffiliationCode code="1013"
displayName="Christian (non-Catholic, non-specific)"
codeSystemName="HL7 Religious Affiliation" codeSystem="2.16.840.1.113883.5.1076"/>
<!-- CDC Race and Ethnicity code set contains the minimum race and ethnicity categories defined by OMB Standards for Race and Ethnicity -->
<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race & Ethnicity - CDC"/>
<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino"
codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & Ethnicity - CDC"/>
<guardian>
<code code="PRN" displayName="Parent" codeSystem="2.16.840.1.113883.5.111"
codeSystemName="HL7 Role code"/>
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:(816)276-6909" use="HP"/>
<guardianPerson>
<name>
<given>Ralph</given>
<family>Jones</family>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="en"/>
<!-- EN is "English" as in the IG -->
<modeCode code="ESP" displayName="Expressed spoken"
codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
<proficiencyLevelCode code="G" displayName="Good"
codeSystem="2.16.840.1.113883.5.61"
codeSystemName="LanguageAbilityProficiency"/>
<preferenceInd value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<id root="2.16.840.1.113883.4.6"/>
<name>Community Health and Hospitals</name>
<telecom use="WP" value="tel: 555-555-5000"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time value="20050329224411+0500"/>
<assignedAuthor>
<id extension="99999999" root="2.16.840.1.113883.4.6"/>
<code code="200000000X" codeSystem="2.16.840.1.113883.6.101"
displayName="Allopathic & Osteopathic Physicians"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<dataEnterer>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="999999943252"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<informant>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</informant>
<informant>
<relatedEntity classCode="PRS">
<!-- classCode PRS represents a person with personal relationship with
the patient. -->
<code code="SPS" displayName="SPOUSE" codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<relatedPerson>
<name>
<given>Frank</given>
<family>Jones</family>
</name>
</relatedPerson>
</relatedEntity>
</informant>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id extension="99999999" root="2.16.840.1.113883.4.6"/>
<name>Community Health and Hospitals</name>
<telecom value="tel: 555-555-1002" use="WP"/>
<addr use="WP">
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<informationRecipient>
<intendedRecipient>
<informationRecipient>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</informationRecipient>
<receivedOrganization>
<name>Community Health and Hospitals</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time value="20090227130000+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="999999999" root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time value="20090227130000+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="999999999" root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<documentationOf>
<serviceEvent classCode="PCPR">
<code code="73761001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Colonoscopy"/>
<effectiveTime>
<low value="201209080000-0400"/>
<high value="201209150000-0400"/>
</effectiveTime>
<performer typeCode="PRF">
<functionCode code="PP" displayName="Primary Performer"
codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
<originalText>Primary Care Provider</originalText>
</functionCode>
<assignedEntity>
<!-- Provider NPI "PseudoMD-1" -->
<id extension="PseudoMD-1" root="2.16.840.1.113883.4.6"/>
<code code="207RG0100X" displayName="Gastroenterologist"
codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1-555-555-5000" use="HP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.19.5.9999.1393"/>
<name>Community Health and Hospitals</name>
<telecom value="tel:+1-555-555-5000" use="HP"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!-- ******************************************************** CDA Body ******************************************************** -->
<component>
<structuredBody>
<!-- *************************************** ADVANCE DIRECTIVES************************** -->
<component>
<section>
<!-- conforms to Advance Directives section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.21"/>
<!-- Advance Directives section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.21.1"/>
<code code="42348-3" codeSystem="2.16.840.1.113883.6.1"/>
<title>ADVANCE DIRECTIVES</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Directive</th>
<th>Description</th>
<th>Verification</th>
<th>Supporting Document(s)</th>
</tr>
</thead>
<tbody>
<tr>
<td>Resuscitation status</td>
<td>
<content ID="AD1">Do not resuscitate</content>
</td>
<td>Dr. Robert Dolin, Feb 13, 2011</td>
<td>
<linkHtml
href="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf"
>Advance directive</linkHtml>
</td>
</tr>
</tbody>
</table>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.48"/>
<!-- ** Advance Directive Observation ** -->
<id root="9b54c3c9-1673-49c7-aef9-b037ed72ed27"/>
<code code="304251008" codeSystem="2.16.840.1.113883.6.96"
displayName="Resuscitation"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20110213"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CD" code="304253006"
codeSystem="2.16.840.1.113883.6.96" displayName="Do not resuscitate">
<originalText>
<reference value="#AD1"/>
</originalText>
</value>
<participant typeCode="VRF">
<templateId root="2.16.840.1.113883.10.20.1.58"/>
<time value="201102013"/>
<participantRole>
<id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
<playingEntity>
<name>
<prefix>Dr.</prefix>
<family>Dolin</family>
<given>Robert</given>
</name>
</playingEntity>
</participantRole>
</participant>
<participant typeCode="CST">
<participantRole classCode="AGNT">
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(555)555-1003"/>
<playingEntity>
<name>
<prefix>Dr.</prefix>
<family>Dolin</family>
<given>Robert</given>
</name>
</playingEntity>
</participantRole>
</participant>
<reference typeCode="REFR">
<seperatableInd value="false"/>
<externalDocument>
<id root="b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3"/>
<text mediaType="application/pdf">
<reference
value="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf"
/>
</text>
</externalDocument>
</reference>
</observation>
</entry>
</section>
</component>
<!-- ********************************* Allergies, Adverse Reactions, Alerts ****************************** -->
<component>
<section>
<!-- conforms to Allergies section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.6"/>
<!-- Allergies section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"/>
<title>ALLERGIES, ADVERSE REACTIONS, ALERTS</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Substance</th>
<th>Overall Severity</th>
<th>Reaction</th>
<th>Reaction Severity</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>ALLERGENIC EXTRACT, PENICILLIN</td>
<td>
<content ID="severity4">Moderate to Severe</content>
</td>
<td>
<content ID="reaction1">Nausea</content>
</td>
<td>
<content ID="severity1">Mild</content>
</td>
<td>Inactive</td>
</tr>
<tr>
<td>Codeine</td>
<td>
<content ID="severity5">Mild</content>
</td>
<td>
<content ID="reaction2">Wheezing</content>
</td>
<td>
<content ID="severity2">Moderate</content>
</td>
<td>Active</td>
</tr>
<tr>
<td>Aspirin</td>
<td>
<content ID="severity6">Mild</content>
</td>
<td>
<content ID="reaction3">Hives</content>
</td>
<td>
<content ID="severity3">Mild to moderate</content>
</td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Allergy problem act ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime value="20070501"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20070501"/>
</effectiveTime>
<value xsi:type="CD" code="419511003"
displayName="Propensity to adverse reactions to drug"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction1"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="314422"
displayName="ALLERGENIC EXTRACT, PENICILLIN"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm">
<originalText>
<reference value="#reaction1"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="73425007"
codeSystem="2.16.840.1.113883.6.96"
displayName="Inactive"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20070501"/>
<high value="20090227130000+0500"/>
</effectiveTime>
<value xsi:type="CD" code="422587007"
codeSystem="2.16.840.1.113883.6.96"
displayName="Nausea"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity4"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV" displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity2"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="371924009"
displayName="Moderate to severe"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="N" displayName="Normal"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Allergy problem act ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime value="20060501"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20060501"/>
</effectiveTime>
<value xsi:type="CD" code="419511003"
displayName="Propensity to adverse reactions to drug"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction2"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="2670" displayName="Codeine"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm">
<originalText>
<reference value="#reaction2"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20060501"/>
<high value="20090227130000+0500"/>
</effectiveTime>
<value xsi:type="CD" code="56018004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Wheezing"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity5"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV" displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity2"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="6736007"
displayName="Moderate"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="N" displayName="Normal"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Allergy problem act ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime value="20080501"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20080501"/>
</effectiveTime>
<value xsi:type="CD" code="59037007"
displayName="Drug intolerance"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT">
<originalText>
<reference value="#reaction3"/>
</originalText>
</value>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="1191" displayName="Aspirin"
codeSystem="2.16.840.1.113883.6.88"
codeSystemName="RxNorm">
<originalText>
<reference value="#reaction3"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#reaction3"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20080501"/>
<high value="20090227130000+0500"/>
</effectiveTime>
<value xsi:type="CD" code="247472004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Hives"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity6"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="371923003"
displayName="Mild to moderate"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code code="SEV" displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference value="#severity3"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="371923003"
displayName="Mild to moderate"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="N" displayName="Normal"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- ************************************ ASSESSMENT ************************************ -->
<component>
<section>
<!-- Assessment section -->
<templateId root="2.16.840.1.113883.10.20.22.2.8"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="51848-0"
displayName="ASSESSMENT"/>
<title>ASSESSMENT</title>
<text>
<list listType="ordered">
<item>Recurrent GI bleed of unknown etiology; hypotension perhaps
secondary to this but as likely secondary to polypharmacy.</item>
<item>Acute on chronic anemia secondary to #1.</item>
<item>Azotemia, acute renal failure with volume loss secondary to
#1.</item>
<item>Hyperkalemia secondary to #3 and on ACE and K+ supplement.</item>
<item>Other chronic diagnoses as noted above, currently stable.</item>
</list>
</text>
</section>
</component>
<!-- ******************************* ENCOUNTERS ***************************** -->
<component>
<section>
<!-- conforms to Encounters section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.22"/>
<!-- Encounters section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>
<code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
displayName="History of encounters"/>
<title>ENCOUNTERS</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Encounter</th>
<th>Performer</th>
<th>Location</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="Encounter1"/> Checkup Examination </td>
<td>Performer Name</td>
<td>Community Urgent Care Center</td>
<td>20090227130000+0500</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<!-- ** Encounter activities ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="99213" displayName="Office outpatient visit 15 minutes"
codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12"
codeSystemVersion="4">
<originalText> Checkup Examination <reference value="#Encounter1"/>
</originalText>
<translation code="AMB" codeSystem="2.16.840.1.113883.5.4"
displayName="Ambulatory" codeSystemName="HL7 ActEncounterCode"/>
</code>
<!-- February 27, 2009 at 1:00PM EST -->
<effectiveTime value="20090227130000+0500"/>
<performer>
<assignedEntity>
<!-- Provider NPI "PseduoMD-3" -->
<id root="PseduoMD-3"/>
<code code="59058001" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="General Physician"/>
</assignedEntity>
</performer>
<participant typeCode="LOC">
<participantRole classCode="SDLOC">
<templateId root="2.16.840.1.113883.10.20.22.4.32"/>
<!-- Service Delivery Location template -->
<code code="1160-1" codeSystem="2.16.840.1.113883.6.259"
codeSystemName="HealthcareServiceLocation"
displayName="Urgent Care Center"/>
<addr>
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom nullFlavor="UNK"/>
<playingEntity classCode="PLC">
<name>Community Urgent Care Center</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id root="db734647-fc99-424c-a864-7e3cda82e703"
extension="45665"/>
<code code="404684003" displayName="Finding"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20070103"/>
</effectiveTime>
<value xsi:type="CD" code="233604007" displayName="Pneumonia"
codeSystem="2.16.840.1.113883.6.96"/>
</observation>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
<!-- ************************ FAMILY HISTORY ********************************** -->
<component>
<section>
<!-- Family history section -->
<templateId root="2.16.840.1.113883.10.20.22.2.15"/>
<code code="10157-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>FAMILY HISTORY</title>
<text>
<paragraph>Father (deceased)</paragraph>
<table border="1" width="100%">
<thead>
<tr>
<th>Diagnosis</th>
<th>Age At Onset</th>
</tr>
</thead>
<tbody>
<tr>
<td>Myocardial Infarction (cause of death)</td>
<td>57</td>
</tr>
<tr>
<td>Diabetes</td>
<td>40</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer moodCode="EVN" classCode="CLUSTER">
<!-- ** Family history organizer ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.45"/>
<statusCode code="completed"/>
<subject>
<relatedSubject classCode="PRS">
<code code="FTH" displayName="Father"
codeSystemName="FamilyRelationshipRoleType"
codeSystem="2.16.840.1.113883.5.111">
<translation code="9947008" displayName="Biological father"
codeSystemName="SNOMED"
codeSystem="2.16.840.1.113883.6.96"/>
</code>
<subject>
<sdtc:id root="2.16.840.1.113883.19.5.99999.2"
extension="99999999"/>
<administrativeGenderCode code="M"
codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="1910"/>
<!-- Example use of sdtc extensions included below in comments -->
<!-- <sdtc:deceasedInd value="true"/> <sdtc:deceasedTime value="1967"/> -->