351 lines
19 KiB
XML
351 lines
19 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
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<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
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<realmCode code="US"/>
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<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
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<templateId root="2.16.840.1.113883.10.20.12"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.1"/>
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<id root="2.16.840.1.113883.3.543" extension="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
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<code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
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<title>QRDA Incidence Report</title>
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<effectiveTime value="20100703"/>
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<confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
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<languageCode code="en-US"/>
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<setId root="2.16.840.1.113883.3.543" extension="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
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<versionNumber value="1"/>
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<recordTarget>
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<patientRole>
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<id extension="345097898" root="2.16.840.1.113883.4.1"/>
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<addr use="H">
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<streetAddressLine/>
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<city/>
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<state/>
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<postalCode/>
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</addr>
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<telecom/>
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<patient>
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<name>
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<given>FEMALE-B</given>
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<family>MEASURE-ONE</family>
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</name>
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<administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
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<birthTime value="19600101120000"/>
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<raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
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<ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.5.50"/>
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</patient>
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<providerOrganization>
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<!-- NPI for the provider and this is a real number-->
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<id root="2.16.840.1.113883.4.6" extension="1558574525" />
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<name>WorldVistA Test Clinic</name>
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<!--WVV Address of organization is optional except for the STATE-->
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<addr>
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<state>MD</state>
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<postalCode>20877</postalCode>
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</addr>
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<!--WVP required asOrganizationPartOf added to sample-->
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<asOrganizationPartOf>
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<wholeOrganization>
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<!-- Tax ID is the extension and this is a dummy numbers-->
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<id root="2.16.840.1.113883.4.2" extension="226864459"/>
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</wholeOrganization>
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</asOrganizationPartOf>
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</providerOrganization>
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</patientRole>
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</recordTarget>
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<author>
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<time value="20100703"/>
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<assignedAuthor>
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<id root="2.16.840.1.113883.3.249.6" extension="100001"/>
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<assignedPerson>
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<name>
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<given>Nancy</given>
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<family>Anthracite</family>
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<suffix>MD</suffix>
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</name>
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</assignedPerson>
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<representedOrganization>
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<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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<name>WorldVistA Test Clinic</name>
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</representedOrganization>
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</assignedAuthor>
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</author>
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<informant>
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<assignedEntity>
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<id nullFlavor="NA"/>
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<representedOrganization>
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<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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<name>World VistA Test Clinic</name>
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</representedOrganization>
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</assignedEntity>
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</informant>
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<custodian>
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<assignedCustodian>
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<representedCustodianOrganization>
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<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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<name>WorldVistA Test Clinic</name>
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</representedCustodianOrganization>
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</assignedCustodian>
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</custodian>
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<legalAuthenticator>
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<time value="20100703"/>
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<signatureCode code="S"/>
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<assignedEntity>
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<id root="2.16.840.1.113883.3.543" extension="111111"/>
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<assignedPerson>
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<name>
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<given>Nancy</given>
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<family>Anthracite</family>
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<suffix>MD</suffix>
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</name>
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</assignedPerson>
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<representedOrganization>
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<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
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<name>WorldVistA Test Clinic</name>
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</representedOrganization>
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</assignedEntity>
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</legalAuthenticator>
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<participant typeCode="PRF">
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<functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
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<associatedEntity classCode="PROV">
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<id root="2.16.840.1.113883.3.249.6" extension="111111"/>
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<associatedPerson>
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<name>
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<prefix>Dr.</prefix>
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<given>Nancy</given>
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<family>Anthracite</family>
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</name>
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</associatedPerson>
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</associatedEntity>
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</participant>
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<documentationOf>
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<serviceEvent>
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<code displayName="INTERMEDIATE (15min)" code="99213" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
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<effectiveTime>
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<low value="20101005"/>
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<high value="20101005"/>
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</effectiveTime>
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<performer typeCode="PRF">
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<assignedEntity>
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<id root="2.16.840.1.113883.4.6" extension="1558574525"/>
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<code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
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<addr>
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<streetAddressLine>123 Maple Ave</streetAddressLine>
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<city>Gaithersburg</city>
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<state>MD</state>
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<postalCode>20877</postalCode>
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</addr>
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<assignedPerson>
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<name>
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<given>Nancy</given>
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<family>Anthracite</family>
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<suffix>MD</suffix>
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</name>
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</assignedPerson>
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</assignedEntity>
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</performer>
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</serviceEvent>
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</documentationOf>
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<component>
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<structuredBody>
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<component>
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<section>
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<templateId root="2.16.840.1.113883.3.249.11.50"/>
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<code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
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<title>Measure set: CMS EHR Measure Set</title>
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<text>2010 Measures Set Measures</text>
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<component>
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<section>
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<templateId root="2.16.840.1.113883.3.249.11.2"/>
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<code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
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<title>Measure Section</title>
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<text>
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<list>
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<item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
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</list>
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</text>
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<entry typeCode="DRIV">
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<act classCode="ACT" moodCode="DEF">
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<id root="2.16.840.1.113883.3.249.11.2"/>
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<code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
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<text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
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<statusCode code="completed"/>
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</act>
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</entry>
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<component>
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<section>
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<code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
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<title>Reporting Parameters</title>
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<text>
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<list>
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<item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
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</list>
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</text>
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<entry>
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<act classCode="ACT" moodCode="EVN">
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<code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
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<effectiveTime>
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<low value="20100101"/>
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<high value="20101231"/>
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</effectiveTime>
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</act>
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</entry>
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</section>
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</component>
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<component>
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<section>
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<code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
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<title>Patient Data</title>
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</section>
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</component>
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<component>
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<section>
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<templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
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<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
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<templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
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<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
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<title>Problems</title>
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<text/>
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<entry typeCode="DRIV">
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<act classCode="ACT" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.27"/>
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<id root="PROBLEM1" extension="CCRObjectID"/>
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<code nullFlavor="NA"/>
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<performer typeCode="PRF">
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<assignedEntity>
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<id extension="ACTORPROVIDER_991" root="CCRActorID"/>
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<addr use="WP">
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<streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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<city>ALBANY</city>
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<state>NY</state>
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<postalCode>12180</postalCode>
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</addr>
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<telecom/>
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<assignedPerson>
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<name>
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<prefix>Scholar Extraordinaire</prefix>
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<given>EIGHT</given>
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<family>PROVIDER</family>
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</name>
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</assignedPerson>
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</assignedEntity>
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</performer>
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<entryRelationship typeCode="SUBJ">
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<observation classCode="OBS" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.8"/>
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<id root="PROBLEM1" extension="CCRObjectID"/>
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<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
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<statusCode code="completed"/>
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<effectiveTime>
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<low value="20101013"/>
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<high value="20101013"/>
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</effectiveTime>
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<value xsi:type="CD" displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.00" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
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<entryRelationship typeCode="REFR">
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<observation classCode="OBS" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.50"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
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<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
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<statusCode code="completed"/>
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<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
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</observation>
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</entryRelationship>
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</observation>
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</entryRelationship>
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</act>
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</entry>
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<entry typeCode="DRIV">
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<act classCode="ACT" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.27"/>
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<id root="PROBLEM2" extension="CCRObjectID"/>
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<code nullFlavor="NA"/>
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<performer typeCode="PRF">
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<assignedEntity>
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<id extension="ACTORPROVIDER_10000000183" root="CCRActorID"/>
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<addr use="WP">
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<streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
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<city>ALBANY</city>
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<state>NY</state>
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<postalCode>12180</postalCode>
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</addr>
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<telecom/>
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<assignedPerson>
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<name>
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<given>MATTHEW</given>
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<given>M</given>
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<family>KING</family>
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</name>
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</assignedPerson>
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</assignedEntity>
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</performer>
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<entryRelationship typeCode="SUBJ">
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<observation classCode="OBS" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.8"/>
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<id root="PROBLEM2" extension="CCRObjectID"/>
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<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
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<statusCode code="completed"/>
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<effectiveTime>
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<low value="20101005"/>
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<high value="20101005"/>
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</effectiveTime>
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<value xsi:type="CD" displayName="Sprains (ICD-9-CM 848.9)" code="848.9" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
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<entryRelationship typeCode="REFR">
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<observation classCode="OBS" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.50"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
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<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
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<statusCode code="completed"/>
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<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
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</observation>
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</entryRelationship>
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</observation>
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</entryRelationship>
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</act>
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</entry>
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</section>
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</component>
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<component>
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<section>
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<templateId root="2.16.840.1.113883.10.20.1.9"/>
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<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
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<title>Payers</title>
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<text/>
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<entry typeCode="DRIV">
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<act classCode="ACT" moodCode="DEF">
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<templateId root="2.16.840.1.113883.10.20.1.20"/>
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<id root="2.16.840.1.113883.3.543" extension="f263785a-e5e7-11df-a618-dfa9ba05e083"/>
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<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
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<statusCode code="completed"/>
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<entryRelationship typeCode="COMP">
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<act classCode="ACT" moodCode="EVN">
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<templateId root="2.16.840.1.113883.10.20.1.26"/>
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<templateId root="2.16.840.1.113883.3.249.11.100.7"/>
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<id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
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<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
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<statusCode code="completed"/>
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<performer typeCode="PRF">
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<assignedEntity>
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<id root="2.16.840.1.113883.12.86" extension="MC"/>
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</assignedEntity>
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</performer>
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<participant typeCode="COV">
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<participantRole>
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<id root="2.16.840.1.113883.4.1" extension="345097898"/>
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<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
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</participantRole>
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</participant>
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</act>
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</entryRelationship>
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</act>
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</entry>
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</section>
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</section>
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</component>
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</section>
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</structuredBody>
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</component>
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</ClinicalDocument> |