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CCDA_23128_MJ_24Oct2017_1209498.xml
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CCDA_23128_MJ_24Oct2017_1209498.xml
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<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!-- This XML document was retrieved from a public repository of certified EHR samples for Meaningful Use
That repository states "The public will be able to view-download the submitted files from this repository."
The original files have been edited to make them human-readable and easier to download. Please refer to source repository for original versions
The copy date of original repository was February 1, 2018. Here is original repository: https://github.com/siteadmin/2015-C-CDA-Certification-Samples
All of these samples were supposed be C-CDA 2.1 clinical documents. The following disclaimer applies to ALL INFORMATION contained herein:
THIS INFORMATION IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY,
WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE INFORMATION OR THE USE OR OTHER DEALINGS IN THE INFORMATION.
Beyond that, I hope they are useful and "hooray" for government transparency! John D'Amore, Diameter Health, Inc. -->
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xmlns="urn:hl7-org:v3"
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xmlns:voc="urn:hl7-org:v3/voc"
xmlns:sdtc="urn:hl7-org:sdtc">
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<!-- CCD template ID-->
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<templateId root="2.16.840.1.113883.10.20.22.1.1" />
<!-- Globally unique identifier for the document -->
<id extension="TT988" root="ClinicalDocumentGUID" />
<code code="34133-9" displayName="Summarization of Episode Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<!-- Title of this document -->
<title>Summarization of Episode Note</title>
<effectiveTime value="20171024072811" />
<confidentialityCode code="N" displayName="normal" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" />
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<!-- Version of this document -->
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<country>US</country>
</addr>
<telecom value="8162766909" use="HP" />
<patient>
<name>
<given>Myra</given>
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</authenticator>
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<originalText>Primary Care Provider</originalText>
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<addr>
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<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002" />
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</performer>
</serviceEvent>
</documentationOf>
<!-- ******************************************************** CDA Body ******************************************************** -->
<component>
<structuredBody>
<!-- ***************** ALLERGIES *************** -->
<component>
<section>
<!-- *** Allergies and Intolerances Section (entries required) (V3) *** -->
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<title>ALLERGIES AND ADVERSE REACTIONS</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>Aspirin</td>
<td>Hives</td>
<td>Mild to moderate</td>
<td>Active</td>
</tr>
<tr>
<td>Codeine</td>
<td>Shortness of Breath</td>
<td>Moderate</td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Allergy Concern Act (V3) ** -->
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<!--Critical Change-->
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<!-- The statusCode represents the need to continue tracking the allergy -->
<!-- This is of ongoing concern to the provider -->
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<!-- ** Allergy observation (V2) ** -->
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<text>
<reference value="#allergytype1" />
</text>
<!-- Observation statusCode represents the status of the act of observing -->
<statusCode code="completed" />
<effectiveTime>
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<value xsi:type="CD" code="419199007" displayName="Allergy to substance" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
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<participant typeCode="CSM">
<participantRole classCode="MANU">
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<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction Observation (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.9" />
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64" />
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high nullFlavor="UNK" />
</effectiveTime>
<value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" displayName="Hives"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.8" extension="2014-06-09" />
<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" />
<statusCode code="completed" />
<value xsi:type="CD" code="371923003" displayName="Mild to moderate" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Allergy Concern Act (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-08-01" />
<!--Critical Change-->
<templateId root="2.16.840.1.113883.10.20.22.4.30" />
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66" />
<code code="CONC" codeSystem="2.16.840.1.113883.5.6" />
<!-- The statusCode represents the need to continue tracking the allergy -->
<!-- This is of ongoing concern to the provider -->
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high nullFlavor="UNK" />
</effectiveTime>
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20120806" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy observation (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.7" extension="2014-06-09" />
<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" />
<text>
<reference value="#allergytype1" />
</text>
<!-- Observation statusCode represents the status of the act of observing -->
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high nullFlavor="UNK" />
</effectiveTime>
<value xsi:type="CD" code="419199007" displayName="Allergy to substance" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20120806" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207KA0200X" displayName="Allergy" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="2670" displayName="Codeine" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RXNORM" />
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.8" extension="2014-06-09" />
<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" />
<statusCode code="completed" />
<value xsi:type="CD" code="6736007" displayName="Moderate" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
</observation>
</entryRelationship>
<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction Observation (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.9" />
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64" />
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high nullFlavor="UNK" />
</effectiveTime>
<value xsi:type="CD" code="267036007" codeSystem="2.16.840.1.113883.6.96" displayName="Shortness of Breath"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.8" extension="2014-06-09" />
<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" />
<statusCode code="completed" />
<value xsi:type="CD" code="6736007" displayName="Moderate" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- ************************ ENCOUNTERS *********************** -->
<component>
<section>
<!-- *** Encounters section (entries required) (V3) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01" />
<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>15 Mins - Asthma (disorder)</td>
<td>Albert Davis</td>
<td>Neighborhood Physicians Practice EMR</td>
<td>20120806</td>
</tr>
<tr>
<td>15 Mins - Pneumonia (disorder)</td>
<td>Albert Davis</td>
<td>Neighborhood Physicians Practice EMR</td>
<td>20120806</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<!-- ** Encounter Activity (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.49" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.49" />
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8" />
<code code="99212" displayName="Est Pt Level 2" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12"></code>
<effectiveTime value="20120806" />
<performer>
<assignedEntity>
<!-- Provider NPI "333444555" -->
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<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="HL7 HealthcareServiceLocation" displayName="Urgent Care Center" />
<addr>
<streetAddressLine>2472, Rocky Place</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002" />
<playingEntity classCode="PLC">
<name>Neighborhood Physicians Practice EMR</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="EVN" negationInd="false">
<!-- Encounter Diagnosis -->
<templateId root="2.16.840.1.113883.10.20.22.4.80" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.80" />
<code code="29308-4" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- Problem Observation -->
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" />
<id root="db734647-fc99-424c-a864-7e3cda82e704" />
<code code="282291009" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<translation code="29308-4" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
</code>
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high value="20171024" />
</effectiveTime>
<value xsi:type="CD" code="195967001" displayName="Asthma (disorder)" codeSystem="2.16.840.1.113883.6.96"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
</value>
</observation>
</entryRelationship>
</act>
</entryRelationship>
</encounter>
</entry>
<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<!-- ** Encounter Activity (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.49" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.49" />
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8" />
<code code="99212" displayName="Est Pt Level 2" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12"></code>
<effectiveTime value="20120806" />
<performer>
<assignedEntity>
<!-- Provider NPI "333444555" -->
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<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="HL7 HealthcareServiceLocation" displayName="Urgent Care Center" />
<addr>
<streetAddressLine>2472, Rocky Place</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:555-555-1002" />
<playingEntity classCode="PLC">
<name>Neighborhood Physicians Practice EMR</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="EVN" negationInd="false">
<!-- Encounter Diagnosis -->
<templateId root="2.16.840.1.113883.10.20.22.4.80" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.80" />
<code code="29308-4" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- Problem Observation -->
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" />
<id root="db734647-fc99-424c-a864-7e3cda82e704" />
<code code="282291009" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<translation code="29308-4" displayName="Diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
</code>
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high value="20171024" />
</effectiveTime>
<value xsi:type="CD" code="233604007" displayName="Pneumonia (disorder)" codeSystem="2.16.840.1.113883.6.96"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
</value>
</observation>
</entryRelationship>
</act>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
<!-- ************************ FAMILY HISTORY *********************** -->
<component>
<section nullFlavor="NI">
<!-- *** Family history section (V3) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.15" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.2.15" />
<code code="10157-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>FAMILY HISTORY</title>
<text>No information</text>
</section>
</component>
<!-- ***************** FUNCTIONAL STATUS *********************** -->
<component>
<!-- Functional Status Section (V2)-->
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.14" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.2.14" />
<code code="47420-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Functional Status" />
<title>FUNCTIONAL STATUS</title>
<text>No information</text>
</section>
</component>
<!-- ******************** IMMUNIZATIONS ********************* -->
<component>
<section nullFlavor="NI">
<!-- *** Immunizations Section (entries required) (V2) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.2.2.1" />
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations" />
<title>IMMUNIZATIONS</title>
<text>No information</text>
</section>
</component>
<!-- *********************** MEDICAL EQUIPMENT *************************** -->
<component>
<section nullFlavor="NI">
<!-- Medical Equipment Section (V2) -->
<templateId root="2.16.840.1.113883.10.20.22.2.23" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.2.23" />
<code code="46264-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>MEDICAL EQUIPMENT</title>
<text>No information</text>
</section>
</component>
<!-- ******************************* MEDICATIONS ***************************** -->
<component>
<section>
<!-- *** Medications Section (entries required) (V2) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-09" />
<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>
</tr>
</thead>
<tbody>
<tr>
<td>200 ACTUAT Albuterol 0.09 MG/ACTUAT Dry Powder Inhaler</td>
<td>0.09 MG/ACTUAT inhalant powder, 2 puffs QID PRN wheezing</td>
<td>20120801</td>
<td>A</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<substanceAdministration classCode="SBADM" moodCode="EVN">
<!-- ** Medication Activity (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.16" />
<id root="cdbd33f0-6cde-11db-9fe1-0800200c9a66" />
<statusCode code="completed" />
<effectiveTime xsi:type="IVL_TS"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<low value="20120801" />
<high nullFlavor="UNK" />
</effectiveTime>
<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
</effectiveTime>
<routeCode code="C48623" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" displayName="RESPIRATORY (INHALATION)" />
<doseQuantity nullFlavor="UNK" />
<consumable>
<manufacturedProduct classCode="MANU">
<!--** Medication information **-->
<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.23" />
<id root="2a620155-9d11-439e-92b3-5d9815ff4ee8" />
<manufacturedMaterial>
<code code="1649560" displayName="200 ACTUAT Albuterol 0.09 MG/ACTUAT Dry Powder Inhaler" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" />
</manufacturedMaterial>
<manufacturerOrganization></manufacturerOrganization>
</manufacturedProduct>
</consumable>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<!-- ** Drug vehicle ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.24" />
<code code="412307009" displayName="drug vehicle" codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96" />
<playingEntity classCode="MMAT">
<code code="1649560" displayName="200 ACTUAT Albuterol 0.09 MG/ACTUAT Dry Powder Inhaler" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" />
<name>200 ACTUAT Albuterol 0.09 MG/ACTUAT Dry Powder Inhaler</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="REFR">
<supply classCode="SPLY" moodCode="INT">
<!-- ** Medication supply order (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.17" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.17" />
<id nullFlavor="NI" />
<statusCode code="completed" />
<effectiveTime xsi:type="IVL_TS"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<low value="20120801" />
<high nullFlavor="UNK" />
</effectiveTime>
<repeatNumber value="1" />
<quantity nullFlavor="UNK" />
<product>
<manufacturedProduct classCode="MANU">
<!-- ** Medication information (V2) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.4.23" />
<id root="2a620155-9d11-439e-92b3-5d9815ff4ee8" />
<manufacturedMaterial>
<code code="1649560" codeSystem="2.16.840.1.113883.6.88" displayName="200 ACTUAT Albuterol 0.09 MG/ACTUAT Dry Powder Inhaler"></code>
</manufacturedMaterial>
<manufacturerOrganization></manufacturerOrganization>
</manufacturedProduct>
</product>
</supply>
</entryRelationship>
</substanceAdministration>
</entry>
</section>
</component>
<!-- *********************** PAYERS ********************** -->
<component>
<section nullFlavor="NI">
<!-- *** Payers Section (V3) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.18" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.2.18" />
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payer" />
<title>INSURANCE PROVIDERS</title>
<text>No information</text>
</section>
</component>
<!-- ******************* PLAN OF TREATMENT ********************** -->
<component>
<section nullFlavor="NI">
<!-- **** Plan of Treatment Section (V2) **** -->
<templateId root="2.16.840.1.113883.10.20.22.2.10" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.2.10" />
<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Treatment plan" />
<title>TREATMENT PLAN</title>
<text>No information</text>
</section>
</component>
<!-- ***************** PROBLEM LIST *********************** -->
<component>
<section>
<!-- *** Problem Section (entries required) (V3) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01" />
<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>
<paragraph>Active Concerns</paragraph>
<list>
<item>Asthma (disorder) -20070103 </item>
<item>Pneumonia (disorder) -20120806 </item>
</list>
<paragraph>Resolved Concerns</paragraph>
<list>
<item />
<item />
</list>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Problem Concern Act (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
<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 nullFlavor="UNK" />
</effectiveTime>
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<!-- Same as Concern effectiveTime/low -->
<time value="20070103" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation (V3)** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" />
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66" />
<code code="64572001" displayName="Condition" codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.96">
<translation nullFlavor="NI" />
</code>
<statusCode code="completed" />
<effectiveTime>
<low value="20070103" />
<high nullFlavor="UNK" />
</effectiveTime>
<value xsi:type="CD" code="195967001" codeSystem="2.16.840.1.113883.6.96" displayName="Asthma (disorder)" codeSystemName="SNOMED-CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20070103" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Problem Concern Act (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
<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 nullFlavor="UNK" />
</effectiveTime>
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<!-- Same as Concern effectiveTime/low -->
<time value="20120806" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation (V3)** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" />
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66" />
<code code="64572001" displayName="Condition" codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.96">
<translation nullFlavor="NI" />
</code>
<statusCode code="completed" />
<effectiveTime>
<low value="20120806" />
<high nullFlavor="UNK" />
</effectiveTime>
<value xsi:type="CD" code="233604007" codeSystem="2.16.840.1.113883.6.96" displayName="Pneumonia (disorder)" codeSystemName="SNOMED-CT"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" />
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20120806" />
<assignedAuthor>
<id extension="1234567899" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- ************** PROCEDURES ***************** -->
<component>
<section nullFlavor="NI">
<!-- Procedures Section (entries required) (V2) -->
<templateId root="2.16.840.1.113883.10.20.22.2.7.1" extension="2014-06-09" />
<templateId root="2.16.840.1.113883.10.20.22.2.7.1" />
<code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF PROCEDURES" />
<title>PROCEDURES</title>
<text>No information</text>
</section>
</component>
<!-- ******************** RESULTS ************************ -->
<component>
<section nullFlavor="NI">
<!-- Results Section (entries required) (V3) -->
<templateId root="2.16.840.1.113883.10.20.22.2.3.1" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.2.3.1" />
<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="RESULTS" />
<title>RESULTS</title>
<text>No information</text>
</section>
</component>
<!-- ******************* SOCIAL HISTORY ********************* -->
<component>
<section nullFlavor="NI">
<!-- ** Social History Section (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.2.17" />
<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History" />
<title>SOCIAL HISTORY</title>
<text>No information</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.200" extension="2016-06-01" />
<code code="76689-9" codeSystem="2.16.840.1.113883.6.1" displayName="Sex Assigned At Birth" />
<statusCode code="completed" />
<!-- effectiveTime if present should match birthTime -->
<!-- Request name change to QRDA value set (2.16.840.1.113762.1.4.1) - ONC Birth Sex -->
<value xsi:type="CD" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" code="F" displayName="Female"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
</value>
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20150622" />
<assignedAuthor>
<id extension="9999999999" root="2.16.840.1.113883.4.6" />
<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
</assignedAuthor>
</author>
</observation>
</entry>
</section>
</component>
<!-- ************* VITAL SIGNS *************** -->
<component>
<section nullFlavor="NI">
<!-- ** Vital Signs Section (entries required) (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.2.4.1" extension="2015-08-01" />
<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>No information</text>
</section>
</component>
<!-- ************* Goals *************** -->
<component>
<section nullFlavor="NI">
<!-- Goals Section -->
<!-- -->
<templateId root="2.16.840.1.113883.10.20.22.2.60" />
<code code="61146-7" displayName="Goals" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Goals Section</title>
<text>No information</text>
</section>
</component>
<!-- ************* Health Concerns *************** -->
<component>
<section nullFlavor="NI">
<!-- Health Concerns Section (V2) (V1 was added as a NEW template in R2.0, V2 was updated in R2.1) -db -->
<templateId root="2.16.840.1.113883.10.20.22.2.58" extension="2015-08-01" />
<code code="75310-3" displayName="Health Concerns Document" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Health Concerns</title>
<text>No information</text>
</section>