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Created August 15, 2013 04:46
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gistfile1.xml
<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
Title: US_Realm_Header_Template
Revision History:
01/31/2011 bam created
07/29/2011 RWM modified
11/26/2011 RWM modified
08/12/2012 RWM modified
09/12/2012 BNR(Dragon) modified
-->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xsi:schemaLocation="urn:hl7-org:v3 C:\XML\C32_CDA_Schema\infrastructure\cda\C32_CDA.xsd"
xmlns="urn:hl7-org:v3"
xmlns:cda="urn:hl7-org:v3"
xmlns:sdtc="urn:hl7-org:sdtc">
<!--
********************************************************
CDA Header
********************************************************
-->
<!-- CONF 16791 -->
<realmCode
code="US"/>
<!-- CONF 5361 -->
<typeId
root="2.16.840.1.113883.1.3"
extension="POCD_HD000040"/>
<!-- US General Header Template -->
<!-- CONF 5252 -->
<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"/>
<!-- CONF 5363 -->
<id
extension="Test CCDA"
root="1.1.1.1.1.1.1.1.1"/>
<!-- CONF 5253 "CCD document" -->
<code
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
code="34133-9"
displayName="Summarization of Episode Note"/>
<!-- CONF 5254 -->
<title>Get Well Clinic: Health Summary</title>
<!-- CONF 5256 -->
<effectiveTime
value="20120912000000-0000"/>
<!-- 5259 -->
<confidentialityCode
code="N"
codeSystem="2.16.840.1.113883.5.25"/>
<!-- 5372 -->
<languageCode
code="en-US"/>
<!-- CONF 5266 -->
<recordTarget>
<!-- CONF 5267 -->
<patientRole>
<!-- CONF 5268-->
<id
extension="1"
root="2.16.840.1.113883.4.6"/>
<!-- Fake ID using HL7 example OID. -->
<!-- Patient SSN recorded as an ID -->
<id
extension="123-101-5230"
root="2.16.840.1.113883.4.1"/>
<!-- CONF 5271 -->
<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>
<!-- CONF 5280 -->
<telecom
value="tel:(816)276-6909"
use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<!-- CONF 5283 -->
<patient>
<!-- CONF 5284 -->
<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="19470501"/>
<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"/>
<!-- Need to Fix the Race Code to be from the OMB Standards -->
<raceCode
code="2106-3"
displayName="White"
codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race and Ethnicity - CDC"/>
<ethnicGroupCode
code="2186-5"
displayName="Not Hispanic or Latino"
codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race and Ethnicity - CDC"/>
<guardian>
<code
code="GRPRN"
displayName="Grandfather"
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>97006</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>
<!-- FIX the Code System to be 639.2 -->
<languageCommunication>
<languageCode
code="eng"/>
<modeCode
code="ESP"
displayName="Expressed spoken"
codeSystem="2.16.840.1.113883.5.60"
codeSystemName="LanguageAbilityMode"/>
<preferenceInd
value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<id
root="1.1.1.1.1.1.1.1.4"/>
<name>Get Well Clinic</name>
<telecom
use="WP"
value="tel: 555-555-5000"/>
<addr>
<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time
value="20120806"/>
<assignedAuthor>
<id
extension="111111"
root="2.16.840.1.113883.4.6"/>
<code
code="200000000X"
codeSystem="2.16.840.1.113883.6.101"
displayName="Allopathic &amp; 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>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>Mary</given>
<family>McDonald</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<informant>
<assignedEntity>
<id
extension="KP00017"
root="2.16.840.1.113883.19.5"/>
<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>
</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>Get Well Clinic</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>Get Well Clinic</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time
value="20120806"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="999999999"
root="2.16.840.1.113883.4.6"/>
<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>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time
value="20120806000000+0500"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="999999999"
root="2.16.840.1.113883.4.6"/>
<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>
</assignedEntity>
</authenticator>
<participant typeCode="IND">
<associatedEntity classCode="PRS">
<code
code="GRPRN"
displayName="Grand Parent"
codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<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:(555)555-2006' use='WP'/>
<associatedPerson>
<name>
<prefix>Mr.</prefix>
<given>Ralph</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<participant typeCode="IND">
<associatedEntity classCode="PRS">
<code
code="SPS"
displayName="SPOUSE"
codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<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:(555)555-2006' use='WP'/>
<associatedPerson>
<name>
<prefix>Mr.</prefix>
<given>Frank</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<!-- add site example of documentation of to confirm there is an issue with manual constraint -->
<documentationOf>
<serviceEvent classCode="PCPR">
<id extension="5283815" root="1.3.6.1.4.1.22812.3.99930.3.3.8" />
<code codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" code="99200-04" />
<effectiveTime>
<low value="20110714090051" />
<high value="20110714100051" />
</effectiveTime>
<performer typeCode="PRF">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.3" />
<templateId root="2.16.840.1.113883.3.88.11.32.4" />
<functionCode codeSystem="2.16.840.1.113883.12.443" code="RP" displayName="Referring Provider" />
<time>
<low />
<high />
</time>
<assignedEntity>
<id extension="3333" root="1.3.6.1.4.1.22812.3.99930.3" />
<code codeSystem="2.16.840.1.113883.6.101" codeSystemName="ProviderCodes" code="140000000X" displayName="Emergency Medical Service Providers" />
<addr nullFlavor="UNK">
<streetAddressLine nullFlavor="UNK" />
<city nullFlavor="UNK" />
<state nullFlavor="UNK" />
<postalCode nullFlavor="UNK" />
<country nullFlavor="UNK" />
</addr>
<telecom value="tel:+1-(859)555-4242" />
<telecom value="mailto:outside.provider@somePractice.org" />
<assignedPerson>
<name>
<family>Provider</family>
<given>Outside</given>
<suffix qualifier="AC">MD, PHd</suffix>
</name>
</assignedPerson>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.3" />
<templateId root="2.16.840.1.113883.3.88.11.32.4" />
<templateId root="2.16.840.1.113883.3.88.11.83.4" />
<functionCode codeSystem="2.16.840.1.113883.12.443" code="PP" displayName="Primary Care Provider" />
<time>
<low />
<high />
</time>
<assignedEntity>
<id extension="2222222222" root="2.16.840.1.113883.4.6" />
<code codeSystem="2.16.840.1.113883.6.101" codeSystemName="ProviderCodes" code="260000000X" displayName="Ambulatory Health Care Facilities" />
<addr>
<streetAddressLine>#456, Lincon Street</streetAddressLine>
<streetAddressLine>Wilson Garden</streetAddressLine>
<city>Colorado</city>
<state>DE</state>
<postalCode>80203</postalCode>
<country nullFlavor="UNK" />
</addr>
<telecom value="tel:+1-(859)085-0945" />
<telecom value="mailto:provider@allscripts.com" />
<assignedPerson>
<name>
<family>Allscripts</family>
<given>Provider</given>
</name>
</assignedPerson>
</assignedEntity>
</performer>
<!-- REMOVE LAST PERFORMER (3rd), LEAVE FIRST 2 PERFORMERS
<performer typeCode="PRF">
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.3" />
<time>
<low />
<high />
</time>
<assignedEntity classCode="ASSIGNED">
<id extension="0619479" root="1.3.6.1.4.1.22812.3.99930.3.3.6" />
<code code="PHARMACY" codeSystem="1.3.5.1.4.1.19376.1.5.3.3" codeSystemName="IHERoleCode" />
<addr>
<streetAddressLine>1604 EAST 17TH AVENUE</streetAddressLine>
<city>DENVER</city>
<state>CO</state>
<postalCode>80218</postalCode>
<country nullFlavor="UNK" />
</addr>
<telecom value="tel:+1-(406)761-0124" />
<representedOrganization>
<name>CVS PHARMACY # 102</name>
<telecom value="tel:+1-(406)761-0124" />
<addr>
<streetAddressLine>1604 EAST 17TH AVENUE</streetAddressLine>
<city>DENVER</city>
<state>CO</state>
<postalCode>80218</postalCode>
<country nullFlavor="UNK" />
</addr>
</representedOrganization>
</assignedEntity>
</performer>
-->
</serviceEvent>
</documentationOf>
<componentOf>
<encompassingEncounter>
<id extension="1" root="2.16.840.1.113883.4.6"/>
<code
code="233604007"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT"
displayName="Pnuemonia"/>
<effectiveTime>
<low
value="201208060028+0500"/>
<high
value="201208060058+0500"/>
</effectiveTime>
<responsibleParty>
<assignedEntity>
<id root="2.16.840.1.113883.4.6"/>
<assignedPerson>
<name>
<prefix>Dr</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</responsibleParty>
<encounterParticipant typeCode="ATND">
<assignedEntity>
<id root="2.16.840.1.113883.4.6"/>
<assignedPerson>
<name>
<prefix>Dr</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</encounterParticipant>
<location>
<healthCareFacility>
<id root="2.16.840.1.113883.4.6"/>
</healthCareFacility>
</location>
</encompassingEncounter>
</componentOf>
<!-- ********************************************************
CDA Body
******************************************************** -->
<component>
<structuredBody>
<!-- *********************** -->
<!--
********************************************************
Allergies, Adverse Reactions, Alerts
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.6.1"/>
<!-- Alerts section template -->
<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>Reaction</th>
<th>Severity</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>Penicillin G benzathine</td>
<td><content
ID="reaction1">Hives</content></td>
<td><content
ID="severity1">Moderate to severe</content></td>
<td>Inactive</td>
</tr>
<tr>
<td>Codeine</td>
<td><content
ID="reaction2">Shortness of Breath</content></td>
<td><content
ID="severity2">Moderate</content></td>
<td>Active</td>
</tr>
<tr>
<td>Aspirin</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">
<templateId
root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<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="completed"/>
<effectiveTime
value="20070501">
<low
value="20070501"/>
<high
value="20120806000028+0500"/>
</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- allergy observation template -->
<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 nullFlavor="UNK"/>
<high
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="419511003"
displayName="Propensity to adverse reaction 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="7982"
displayName="Penicillin G benzathine"
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">
<templateId
root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Allergy status observation template -->
<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">
<templateId
root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code
nullFlavor="NA"/>
<text>
<reference
value="#reaction1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20070501"/>
</effectiveTime>
<value
xsi:type="CD"
code="247472004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Hives"/>
</observation>
</entryRelationship>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code xsi:type="CE"
code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference
value="#severity1"/>
</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"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry
typeCode="DRIV">
<act
classCode="ACT"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<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="completed"/>
<effectiveTime
value="20060501">
<low
value="20060501"/>
<high
value="20120806000028+0500"/>
</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- allergy observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.7"/>
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code
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<statusCode
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<low
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<value
xsi:type="CD"
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<originalText>
<reference
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</originalText>
</value>
<participant
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<participantRole
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<playingEntity
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<code
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<originalText>
<reference
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<entryRelationship
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<observation
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moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Allergy status observation template -->
<code
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codeSystem="2.16.840.1.113883.6.1"
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displayName="Status"/>
<statusCode
code="completed"/>
<value
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codeSystem="2.16.840.1.113883.6.96"
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<entryRelationship
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inversionInd="true">
<observation
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<templateId
root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code
nullFlavor="NA"/>
<text>
<reference
value="#reaction2"/>
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<statusCode
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<effectiveTime>
<low
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</effectiveTime>
<value
xsi:type="CD"
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codeSystem="2.16.840.1.113883.6.96"
displayName="Shortness of Breath"/>
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</entryRelationship>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
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moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code xsi:type="CE"
code="SEV"
displayName="Severity Observation"
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codeSystemName="ActCode"/>
<text>
<reference
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</text>
<statusCode
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<value
xsi:type="CD"
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codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
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</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry
typeCode="DRIV">
<act
classCode="ACT"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<id
root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code
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codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
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<effectiveTime
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<low
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<high
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</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- allergy observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.7"/>
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
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<statusCode
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<low
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<value
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codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT">
<originalText>
<reference
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</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>
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</participant>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Allergy status observation template -->
<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"/>
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</entryRelationship>
<entryRelationship
typeCode="MFST"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code
nullFlavor="NA"/>
<text>
<reference
value="#reaction3"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20080501"/>
<high value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="247472004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Hives"/>
</observation>
</entryRelationship>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code xsi:type="CE"
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"/>
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</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!--
************************************
ASSESSMENT
************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.9"/>
<code
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
code="51847-2"
displayName="ASSESSMENT"/>
<title>ASSESSMENT</title>
<text>
<list
listType="ordered">
<item> Pnuemonia</item>
<item ID="assessment1"> Asthma exacerbation.</item>
</list>
</text>
<entry
typeCode="DRIV">
<act
classCode="ACT"
moodCode="EVN">
<!-- Problem act template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.3"/>
<id
root="ec8a6ff8-ed4b-4f7e-82c3-e98e58b45de7"/>
<code
code="CONC"
codeSystem="2.16.840.1.113883.5.6"
displayName="Concern"/>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
<high
value="20120806"/>
</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.4"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#assessment1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="195967001"
codeSystem="2.16.840.1.113883.6.96"
displayName="Asthma"/>
<entryRelationship
typeCode="REFR">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.68"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#assessment1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="195967001"
codeSystem="2.16.840.1.113883.6.96"
displayName="Asthma"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<!-- Status observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<code xsi:type="CE"
code="33999-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Status"/>
<text><reference
value="#assessment1"/></text>
<statusCode code="completed"/>
<value xsi:type="CD"
code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Active"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!--
********************************************************
IMMUNIZATIONS
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.2.1"/>
<!-- Entries Required -->
<!-- ******** Immunizations section template ******** -->
<code
code="11369-6"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="History of immunizations"/>
<title>IMMUNIZATIONS</title>
<text><content
ID="immunSect"/>
<table
border="1"
width="100%">
<thead>
<tr>
<th>Vaccine</th>
<th>Date</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr>
<td><content
ID="immun1"/>Influenza virus vaccine, IM</td>
<td>Nov 2005</td>
<td>Completed</td>
</tr>
<tr>
<td><content
ID="immun2"/>Influenza virus vaccine, IM</td>
<td>September 2006</td>
<td>Completed</td>
</tr>
<tr>
<td><content
ID="immun3"/>Pneumococcal polysaccharide vaccine, IM</td>
<td>August 2012</td>
<td>Completed</td>
</tr>
<tr>
<td><content
ID="immun4"/>Tetanus and diphtheria toxoids, IM</td>
<td>January 2007</td>
<td>Completed</td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<substanceAdministration
classCode="SBADM"
moodCode="EVN"
negationInd="false">
<templateId
root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id
root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference
value="#immun1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
xsi:type="IVL_TS"
value="20051101"/>
<routeCode
code="C28161"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="National Cancer Institute (NCI) Thesaurus"
displayName="Intramuscular injection"/>
<doseQuantity
value="50"
unit="mcg"/>
<consumable>
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code
code="88"
codeSystem="2.16.840.1.113883.6.59"
displayName="Influenza virus vaccine"
codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation
code="111"
displayName="influenza, live, intranasal"
codeSystemName="CVX"
codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<entryRelationship
typeCode="SUBJ" inversionInd="true">
<act
classCode="ACT"
moodCode="INT">
<templateId
root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code xsi:type="CE"
code="171044003"
codeSystem="2.16.840.1.113883.6.96"
displayName="immunization education"/>
<text><reference
value="#immunSect"/>Possible flu-like symptoms for three days.</text>
<statusCode
code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry
typeCode="DRIV">
<substanceAdministration
classCode="SBADM"
moodCode="EVN"
negationInd="false">
<templateId
root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id
root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference
value="#immun2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
xsi:type="IVL_TS"
value="20060910"/>
<routeCode
code="C28161"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="National Cancer Institute (NCI) Thesaurus"
displayName="Intramuscular injection"/>
<doseQuantity
value="50"
unit="mcg"/>
<consumable>
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code
code="88"
codeSystem="2.16.840.1.113883.6.59"
displayName="Influenza virus vaccine"
codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation
code="111"
displayName="influenza, live, intranasal"
codeSystemName="CVX"
codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<entryRelationship
typeCode="SUBJ" inversionInd="true">
<act
classCode="ACT"
moodCode="INT">
<templateId
root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code xsi:type="CE"
code="171044003"
codeSystem="2.16.840.1.113883.6.96"
displayName="immunization education"/>
<text><reference
value="#immunSect"/>Possible flu-like symptoms for three days.</text>
<statusCode
code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry
typeCode="DRIV">
<substanceAdministration
classCode="SBADM"
moodCode="EVN"
negationInd="false">
<templateId
root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id
root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference
value="#immun3"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
xsi:type="IVL_TS"
value="20120806"/>
<routeCode
code="C28161"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="National Cancer Institute (NCI) Thesaurus"
displayName="Intramuscular injection"/>
<doseQuantity
value="50"
unit="mcg"/>
<consumable>
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code
code="33"
codeSystem="2.16.840.1.113883.6.59"
displayName="Pneumococcal polysaccharide vaccine"
codeSystemName="CVX">
<originalText>Influenza virus vaccine</originalText>
<translation
code="109"
displayName="Pneumococcal NOS"
codeSystemName="CVX"
codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<entryRelationship
typeCode="SUBJ" inversionInd="true">
<act
classCode="ACT"
moodCode="INT">
<templateId
root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code xsi:type="CE"
code="171044003"
codeSystem="2.16.840.1.113883.6.96"
displayName="immunization education"/>
<text><reference
value="#immunSect"/>Possible flu-like symptoms for three days.</text>
<statusCode
code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
<entry
typeCode="DRIV">
<substanceAdministration
classCode="SBADM"
moodCode="EVN"
negationInd="false">
<templateId
root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- ******** Immunization activity template ******** -->
<id
root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
<text>
<reference
value="#immun4"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
xsi:type="IVL_TS"
value="20070104"/>
<routeCode
code="C28161"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="National Cancer Institute (NCI) Thesaurus"
displayName="Intramuscular injection"/>
<doseQuantity
value="50"
unit="mcg"/>
<consumable>
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.54"/>
<!-- ******** Immunization Medication Information ******** -->
<manufacturedMaterial>
<code
code="103"
codeSystem="2.16.840.1.113883.6.59"
displayName="Tetanus and diphtheria toxoids - preservative free"
codeSystemName="CVX">
<originalText>Tetanus and diphtheria toxoids - preservative free</originalText>
<translation
code="09"
displayName="Tetanus and diphtheria toxoids - preservative free"
codeSystemName="CVX"
codeSystem="2.16.840.1.113883.6.59"/>
</code>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Health LS - Immuno Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<act
classCode="ACT"
moodCode="INT">
<templateId
root="2.16.840.1.113883.10.20.22.4.20"/>
<!-- ** Instructions Template ** -->
<code xsi:type="CE"
code="171044003"
codeSystem="2.16.840.1.113883.6.96"
displayName="immunization education"/>
<text><reference
value="#immunSect"/>Possible flu-like symptoms for three days.</text>
<statusCode
code="completed"/>
</act>
</entryRelationship>
</substanceAdministration>
</entry>
</section>
</component>
<!--
********************************************************
MEDICATIONS
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.1.1"/>
<code
code="10160-0"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="HISTORY OF MEDICATION USE"/>
<title>Medications</title>
<text>
<table
border="1"
width="100%">
<thead>
<tr>
<th>Medication</th>
<th>Directions</th>
<th>Start Date</th>
<th>Status</th>
<th>Indications</th>
<th>Fill Instructions</th>
</tr>
</thead>
<tbody>
<tr>
<td><content
ID="Med2">metoprolol tartrate</content></td>
<td>25 MG Tablet once per day</td>
<td>20090501</td>
<td>Active</td>
<td>Cardiac/Lung Function</td>
<td><content ID="FillIns2">Generic Substitition Allowed</content></td>
</tr>
<tr>
<td><content
ID="Med3">clarithromycin</content></td>
<td>500 MG Tablet twice daily for 7 days</td>
<td>20120806</td>
<td>Active</td>
<td>Cardiac/Lung Function</td>
<td><content ID="FillIns3">Generic Substitition Allowed</content></td>
</tr>
<tr>
<td><content
ID="Med4">Albuterol 0.09 MG/ACTUAT inhalant solution</content></td>
<td>0.09 MG/ACTUAT inhalant solution, 2 puffs every 6 hours PRN Wheezing</td>
<td>20070103</td>
<td>Active</td>
<td>Pneumonia (233604007 SNOMED CT)</td>
<td><content ID="FillIns4">Generic Substitition Allowed</content></td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<substanceAdministration
classCode="SBADM"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.16"/>
<!-- ** MEDICATION ACTIVITY -->
<id
root="cdbd33f0-6cde-11db-9fe1-0800200c9a66"/>
<text>
<reference
value="#Med2"/>25 MG Tablet Metoprolol tartrate once per day</text>
<statusCode
code="completed"/>
<effectiveTime
xsi:type="IVL_TS">
<low
value="20090501"/>
<high
value="20120806"/>
</effectiveTime>
<routeCode
code="C38288"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="NCI Thesaurus"
displayName="ORAL"/>
<doseQuantity
value="25"
unit="mg"/>
<rateQuantity
value="1"
unit="d"/>
<administrationUnitCode
code="C42998"
displayName="Tablet"
codeSystem="2.16.840.1.113883.3.26.1.1"
codeSystemName="NCI Thesaurus"/>
<consumable>
<manufacturedProduct
classCode="MANU">
<templateId
root="2.16.840.1.113883.10.20.22.4.23"/>
<id
root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
<manufacturedMaterial>
<code
code="866924"
codeSystem="2.16.840.1.113883.6.88"
displayName="Metoprolol tartrate">
<originalText><reference
value="#Med2"/></originalText>
</code>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Medication Factory Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</consumable>
<performer>
<assignedEntity>
<id
nullFlavor="NI"/>
<addr
nullFlavor="UNK"/>
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<!-- ** MEDICATION ACTIVITY -->
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<!--
********************************************************
MEDICATIONS ADMINISTERED
********************************************************
-->
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<!-- ** Instructions Template ** -->
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<!-- ** Medication Dispense Template ** -->
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</section>
</component>
<!--
********************************************************
CARE PLAN
********************************************************
-->
<component>
<section>
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<!-- **** Plan of Care section template **** -->
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<td>20120820</td>
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<tr>
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<tr>
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<tr>
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<!-- **** Plan of Care Activity Encounter template **** -->
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<!-- ** Instructions Template ** -->
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<!-- ** Plan of Care Activity Procedure template ** -->
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<code
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<!-- Plan of Care Activity Observation template -->
<id
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<code
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<!-- ** Plan of Care Activity Procedure template ** -->
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<!-- **** Plan of Care Activity Encounter template **** -->
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<text>Follow up with Dr Dr Henry Seven</text>
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<!--
************************************
CHIEF COMPLAINT / REASON FOR VISIT
************************************
-->
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<paragraph>1. Mild Fever, 2 days</paragraph>
<paragraph>2. Chills, 2 days</paragraph>
<paragraph>3. Cough productive of greenish sputum, 2 days</paragraph>
</text>
</section>
</component>
<!--
************************************
CLINICAL INSTRUCTIONS / PATIENT Decision Aids
************************************
-->
<component> <!-- Patient Decision Aids -->
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<text>
<content ID="instructions-1">Patient may have low grade fever and chills</content>
<content ID="instruct-2">- Return to clinic or call 911 if you experience chest pain, shortness of breath, high fevers, or intractable vomiting/diarrhea</content>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="INT">
<templateId root="2.16.840.1.113883.10.20.22.4.20" />
<code xsi:type="CE"
code="311401005" codeSystem="2.16.840.1.113883.6.96"
displayName="Patient Education" />
<text>
<reference value="#instructions-1" />
</text>
<statusCode code="completed" />
</act>
</entry>
</section>
</component>
<!--
********************************************************
PROBLEM LIST
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.5.1"/>
<code
code="11450-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="PROBLEM LIST"/>
<title>PROBLEMS</title>
<text><content
ID="problems"/>
<list
listType="ordered">
<item><content
ID="problem1">Pneumonia : Status - Active</content></item>
<item><content
ID="problem2">Asthma : Status - Active</content></item>
</list>
</text>
<entry
typeCode="DRIV">
<act
classCode="ACT"
moodCode="EVN">
<!-- Problem act template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.3"/>
<id
root="ec8a6ff8-ed4b-4f7e-82c3-e98e58b45de7"/>
<code
code="CONC"
codeSystem="2.16.840.1.113883.5.6"
displayName="Concern"/>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
<high
value="20120806"/>
</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.4"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#problem1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="233604007"
codeSystem="2.16.840.1.113883.6.96"
displayName="Pneumonia"/>
<entryRelationship
typeCode="REFR">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.68"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#problem1"/>
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<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="233604007"
codeSystem="2.16.840.1.113883.6.96"
displayName="Pneumonia"/>
</observation>
</entryRelationship>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.31"/>
<!-- Age observation template -->
<code
code="445518008"
codeSystem="2.16.840.1.113883.6.96"
displayName="Age At Onset"/>
<statusCode
code="completed"/>
<value
xsi:type="PQ"
value="65"
unit="a"/>
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</entryRelationship>
<entryRelationship
typeCode="REFR">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.5"/>
<!-- Health status observation template -->
<code xsi:type="CE"
code="11323-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Health status"/>
<text><reference
value="#problems"/></text>
<statusCode
code="completed"/>
<value
xsi:type="CD"
code="162467007"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Resolved"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<!-- Status observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<code xsi:type="CE"
code="33999-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Status"/>
<text><reference
value="#problem2"/></text>
<statusCode code="completed"/>
<value xsi:type="CD"
code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Active"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry
typeCode="DRIV">
<act
classCode="ACT"
moodCode="EVN">
<!-- Problem act template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.3"/>
<id
root="ec8a6ff8-ed4b-4f7e-82c3-e98e58b45de7"/>
<code
code="CONC"
codeSystem="2.16.840.1.113883.5.6"
displayName="Concern"/>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20070103"/>
<high
value="20120806"/>
</effectiveTime>
<entryRelationship
typeCode="SUBJ">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.4"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#problem2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20120806"/>
</effectiveTime>
<value
xsi:type="CD"
code="195967001"
codeSystem="2.16.840.1.113883.6.96"
displayName="Asthma"/>
<entryRelationship
typeCode="REFR">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.68"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#problem2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20070103"/>
</effectiveTime>
<value
xsi:type="CD"
code="195967001"
codeSystem="2.16.840.1.113883.6.96"
displayName="Asthma"/>
</observation>
</entryRelationship>
<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.31"/>
<!-- Age observation template -->
<code
code="445518008"
codeSystem="2.16.840.1.113883.6.96"
displayName="Age At Onset"/>
<statusCode
code="completed"/>
<value
xsi:type="PQ"
value="60"
unit="a"/>
</observation>
</entryRelationship>
<entryRelationship
typeCode="REFR">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.5"/>
<!-- Health status observation template -->
<code xsi:type="CE"
code="11323-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Health status"/>
<text><reference
value="#problems"/></text>
<statusCode
code="completed"/>
<value
xsi:type="CD"
code="162467007"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Resolved"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<!-- Status observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<code xsi:type="CE"
code="33999-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Status"/>
<text><reference
value="#problem2"/></text>
<statusCode code="completed"/>
<value xsi:type="CD"
code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Active"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!--
********************************************************
PROCEDURES
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.7.1"/>
<!-- Procedures section template -->
<code
code="47519-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="HISTORY OF PROCEDURES"/>
<title>PROCEDURES</title>
<text>
<table
border="1"
width="100%">
<thead>
<tr>
<th>Procedure</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="Proc2">Chest X-Ray</content>
</td>
<td>2012</td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<procedure
classCode="PROC"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.14"/>
<!-- ***** Procedure Activity Procedure Template ***** -->
<id
root="d68b7e32-7810-4f5b-9cc2-acd54b0fd85d"/>
<code xsi:type="CE"
code="168731009"
codeSystem="2.16.840.1.113883.6.96"
displayName="Chest X-Ray"
codeSystemName="SNOMED-CT">
<originalText>
<reference
value="#Proc2"/>
</originalText>
</code>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<methodCode
nullFlavor="UNK"/>
<performer>
<assignedEntity>
<id
root="2.16.840.1.113883.19.5.9999.456"
extension="2981823"/>
<addr>
<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="555-555-1002"/>
<representedOrganization>
<id
root="2.16.840.1.113883.19.5.9999.1393"/>
<name>Get Well Clinic</name>
<telecom
use="WP"
value="555-555-1002"/>
<addr>
<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</procedure>
</entry>
<entry
typeCode="DRIV">
<procedure
classCode="PROC"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.13"/>
<!-- Procedure Activity Observation -->
<id
extension="123456789"
root="2.16.840.1.113883.19"/>
<code
code="168731009"
codeSystem="2.16.840.1.113883.6.96"
displayName="Chest X-Ray"
codeSystemName="SNOMED-CT">
<originalText>
<reference
value="#Proc2"/>
</originalText>
</code>
<statusCode
code="Completed"/>
<effectiveTime
value="20120806"/>
<priorityCode
code="CR"
codeSystem="2.16.840.1.113883.5.7"
codeSystemName="ActPriority"
displayName="Callback results"/>
<methodCode
nullFlavor="UNK"/>
<targetSiteCode
code="82094008"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Lower Respiratory Tract Structure"/>
<performer>
<assignedEntity>
<id
root="2.16.840.1.113883.19.5"
extension="1234"/>
<addr>
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="(555)555-555-1234"/>
<representedOrganization>
<id
root="2.16.840.1.113883.19.5"/>
<name>Get Well Clinic</name>
<telecom
nullFlavor="UNK"/>
<addr
nullFlavor="UNK"/>
</representedOrganization>
</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>Get Well Clinic</name>
</playingEntity>
</participantRole>
</participant>
</procedure>
</entry>
</section>
</component>
<!--
********************************************************
FUNCTIONAL and COGNITIVE STATUS
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.14"/>
<!-- ******** Functional status section template ******** -->
<code
code="47420-5"
codeSystem="2.16.840.1.113883.6.1"/>
<title>FUNCTIONAL STATUS</title>
<text>
<table
border="1"
width="100%">
<thead>
<tr>
<th>Functional Condition</th>
<th>Effective Dates</th>
<th>Condition Status</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="fs1">Dependence on cane</content></td>
<td>1999</td>
<td>Active</td>
</tr>
<tr>
<td>
<content ID="fs2">Memory impairment</content>
</td>
<td>1998</td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.68"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code xsi:type="CE"
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#fs1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="199803"/>
</effectiveTime>
<value
xsi:type="CD"
code="105504002"
codeSystem="2.16.840.1.113883.6.96"
displayName="Dependence on Cane"/>
</observation>
</entry>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Problem observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.68"/>
<id
root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code xsi:type="CE"
code="409586006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference
value="#fs2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="199910"/>
</effectiveTime>
<value
xsi:type="CD"
code="386807006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Memory Impairment"/>
</observation>
</entry>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Functional Status Result observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.67"/>
<id
root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code xsi:type="CE"
code="30313-1"
displayName="HGB"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"> </code>
<text>
<reference
value="#fs2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
value="200003231430"/>
<value
xsi:type="PQ"
value="13.2"
unit="g/dl"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id
root="2.16.840.1.113883.19.5"/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<text>M 13-18 g/dl; F 12-16 g/dl</text>
</observationRange>
</referenceRange>
</observation>
</entry>
</section>
</component>
<!--
********************************************************
RESULTS
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.3.1"/>
<!-- Entries Required -->
<code
code="30954-2"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="RESULTS"/>
<title>RESULTS</title>
<text>
<table>
<tbody>
<tr>
<td
colspan="2">LABORATORY INFORMATION</td>
</tr>
<tr>
<td
colspan="2">Chemistries and drug levels</td>
</tr>
<tr>
<td><content
ID="result1">HGB (M 13-18 g/dl; F 12-16 g/dl)</content></td>
<td>10.2</td>
</tr>
<tr>
<td><content
ID="result2">WBC (4.3-10.8 10+3/ul)</content></td>
<td>12.3</td>
</tr>
<tr>
<td><content
ID="result3">PLT (150-350 10+3/ul)</content></td>
<td>223</td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<organizer
classCode="BATTERY"
moodCode="EVN">
<!-- Result organizer template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.1"/>
<id
root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
<code xsi:type="CE"
code="43789009"
displayName="CBC WO DIFFERENTIAL"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<statusCode
code="completed"/>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<!-- Result observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.2"/>
<id
root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code xsi:type="CE"
code="30313-1"
displayName="HGB"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"> </code>
<text>
<reference
value="#result1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="10.2"
unit="g/dl"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id
root="2a620155-9d11-439e-92b3-5d9816ff4de8"/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<text>M 13-18 g/dl; F 12-16 g/dl</text>
</observationRange>
</referenceRange>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<!-- Result observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.2"/>
<id
root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code xsi:type="CE"
code="33765-9"
displayName="WBC"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"> </code>
<text>
<reference
value="#result2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="12.3"
unit="10+3/ul"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id
root="2a620154-9d11-439e-92b3-5d9815ff4de8"/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<value
xsi:type="IVL_PQ">
<low
value="4.3"
unit="10+3/ul"/>
<high
value="10.8"
unit="10+3/ul"/>
</value>
</observationRange>
</referenceRange>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<!-- Result observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.2"/>
<id
root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code xsi:type="CE"
code="26515-7"
displayName="PLT"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"> </code>
<text>
<reference
value="#result3"/>
</text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="223"
unit="10+3/ul"/>
<interpretationCode
code="L"
codeSystem="2.16.840.1.113883.5.83"/>
<methodCode/>
<targetSiteCode/>
<author>
<time/>
<assignedAuthor>
<id
root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
</assignedAuthor>
</author>
<referenceRange>
<observationRange>
<value
xsi:type="IVL_PQ">
<low
value="150"
unit="10+3/ul"/>
<high
value="350"
unit="10+3/ul"/>
</value>
</observationRange>
</referenceRange>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!--
********************************************************
SOCIAL HISTORY
********************************************************
-->
<component>
<!-- Social History ******** -->
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.17"/>
<!-- ******** Social history section template ******** -->
<code
code="29762-2"
codeSystem="2.16.840.1.113883.6.1"
displayName="Social History"/>
<title>SOCIAL HISTORY</title>
<text>
<table
border="1"
width="100%">
<thead>
<tr>
<th>Social History Element</th>
<th>Description</th>
<th>Effective Dates</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content
ID="soc1"/> smoking</td>
<td>1 pack per day</td>
<td>19920501 to 20090227</td>
</tr>
<tr>
<td>
<content
ID="soc2"/> Former Smoker</td>
<td>None</td>
<td>20090227 - Unknown</td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<!-- Smoking status observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.78"/>
<id
extension="123456789"
root="2.16.840.1.113883.19"/>
<code
code="ASSERTION"
codeSystem="2.16.840.1.113883.5.4"/>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20090227"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value
xsi:type="CD"
code="8517006"
displayName="Former smoker"
codeSystem="2.16.840.1.113883.6.96"/>
</observation>
</entry>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.38"/>
<!-- ******** Social history observation template ******** -->
<id
root="9b56c25d-9104-45ee-9fa4-e0f3afaa01c1"/>
<code
code="230056004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Cigarette smoking">
<originalText>
<reference
value="#soc1"/>
</originalText>
</code>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="19920501"/>
<high
value="20090227"/>
</effectiveTime>
<value
xsi:type="ST">1 pack per day</value>
</observation>
</entry>
<entry
typeCode="DRIV">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.38"/>
<!-- ******** Social history observation template ******** -->
<id
root="45efb604-7049-4a2e-ad33-d38556c9636c"/>
<code
code="230056004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Cigarette smoking">
<originalText>
<reference
value="#soc2"/>
</originalText>
</code>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20090227"/>
</effectiveTime>
<value
xsi:type="ST">None</value>
</observation>
</entry>
</section>
</component>
<!--
********************************************************
VITAL SIGNS
********************************************************
-->
<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.4.1"/>
<code
code="8716-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="VITAL SIGNS"/>
<title>VITAL SIGNS</title>
<text>
<table
border="1"
width="100%">
<thead>
<tr>
<th
align="right">Date / Time: </th>
<th>Nov 1, 2008</th>
<th>August 6, 2012</th>
</tr>
</thead>
<tbody>
<tr>
<th
align="left">Height</th>
<td>
<content
ID="vit1">177 cm</content></td>
<td>
<content
ID="vit2">177 cm</content></td>
</tr>
<tr>
<th
align="left">Weight</th>
<td>
<content
ID="vit3">86 kg</content></td>
<td>
<content
ID="vit4">88 kg</content></td>
</tr>
<tr>
<th
align="left">Blood Pressure</th>
<td><content
ID="vit5">132/86 mmHg</content></td>
<td><content
ID="vit6">145/88 mmHg</content></td>
</tr>
<tr>
<th
align="left">BMI</th>
<td><content
ID="vit7">27.45</content></td>
<td><content
ID="vit8">28.09</content></td>
</tr>
</tbody>
</table>
</text>
<entry
typeCode="DRIV">
<organizer
classCode="CLUSTER"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.26"/>
<!-- Vital signs organizer template -->
<id
root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code
code="46680005"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED -CT"
displayName="Vital signs"/>
<statusCode
code="completed"/>
<effectiveTime
value="20081101"/>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="8302-2"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Height"/>
<text><reference
value="#vit1"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20081101"/>
<value
xsi:type="PQ"
value="177"
unit="cm"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="3141-9"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Patient Body Weight - Measured"/>
<text><reference
value="#vit4"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20081101"/>
<value
xsi:type="PQ"
value="86"
unit="kg"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="8480-6"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Intravascular Systolic"/>
<text><reference
value="#vit5"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20081101"/>
<value
xsi:type="PQ"
value="132"
unit="mm[Hg]"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="60621009"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT"
displayName="BMI"/>
<text><reference
value="#vit7"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20081101"/>
<value
xsi:type="PQ"
value="27.45" unit="kg/m2"/>
</observation>
</component>
</organizer>
</entry>
<entry
typeCode="DRIV">
<organizer
classCode="CLUSTER"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.26"/>
<!-- Vital signs organizer template -->
<id
root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code
code="46680005"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED -CT"
displayName="Vital signs"/>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="8302-2"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Height"/>
<text><reference
value="#vit2"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="177"
unit="cm"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="3141-9"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Patient Body Weight - Measured"/>
<text><reference
value="#vit4"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="88"
unit="kg"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="8480-6"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Intravascular Systolic"/>
<text><reference
value="#vit6"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="145"
unit="mm[Hg]"/>
<interpretationCode
code="N"
codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital Sign Observation template -->
<id
root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code
code="60621009"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT"
displayName="BMI"/>
<text><reference
value="#vit8"/></text>
<statusCode
code="completed"/>
<effectiveTime
value="20120806"/>
<value
xsi:type="PQ"
value="28.09" unit="kg.m2"/>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>
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