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@mjszczep
Last active January 9, 2020 17:44
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<observation classCode="OBS" moodCode="EVN">
<!-- Standard result observation template IDs -->
<templateId root="2.16.840.1.113883.10.20.22.4.2" />
<templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2014-06-09" />
<templateId root="1.2.840.114350.1.72.3.12"/>
<id extension="..." root="..." />
<code code="18782-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="..."/> <!-- Exam begin instant -->
<high value="..."/> <!-- Exam end instant -->
</effectiveTime>
<value xsi:type="ST" nullFlavor="NA" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text/>
<methodCode code="..."> <!-- Modality Type -->
<qualifier>
<name code="..."/> <!-- Report type -->
<value code="..."/>
</qualifier>
</methodCode>
<!-- Anatomical Region -->
<targetSiteCode code="...">
<qualifier> <!-- Laterality -->
<name code="..."/>
<value code="..."/>
</qualifier>
</targetSiteCode>
<!-- Reading Physician -->
<author>
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<!-- No functionCode at all for regular non-signing physicians -->
<time value="..." /> <!-- Date/time read -->
<assignedAuthor>
<!-- code, addr, etc -->
</assignedAuthor>
</author>
<!-- Signing Physician -->
<author>
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<!-- functionCode[@code='VRF'] implies signing (but not finalizing) -->
<functionCode code="VRF" codeSystem="2.16.840.1.113883.5.90" codeSystemName="ParticipationType" />
<time value="..." /> <!-- Date/time signed -->
<assignedAuthor>
<!-- code, addr, etc -->
</assignedAuthor>
</author>
<!-- Finalizing Physician -->
<author>
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<!-- functionCode[@code='LA'] implies finalizing -->
<!-- Can use 'AUTHEN' instead if the finalizing physician's signature doesn't carry legal weight. -->
<functionCode code="LA" codeSystem="2.16.840.1.113883.5.90" codeSystemName="ParticipationType" />
<time value="..." /> <!-- Date/time finalized -->
<assignedAuthor>
<!-- code, addr, etc -->
</assignedAuthor>
</author>
</observation>
@jddamore
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IRCP (information recipient) typo

@brettmarquard
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brettmarquard commented Jan 9, 2020

Leave finalizing and verifying as -is, Example TF would like SDWG to weigh in on the use of ParticipationType code system in the
<functionCode> element.

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