390 lines
20 KiB
XML
390 lines
20 KiB
XML
<?xml version="1.0" encoding="utf-8"?>
|
|
<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">
|
|
<realmCode code="US"/>
|
|
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
|
|
<templateId root="2.16.840.1.113883.10.20.12"/>
|
|
<templateId root="2.16.840.1.113883.3.249.11.100.1"/>
|
|
<id root="2.16.840.1.113883.3.543" extension="@@@UUID-DOC@@@"/>
|
|
<code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
|
|
<title>QRDA Incidence Report</title>
|
|
<effectiveTime value="20100703"/>
|
|
<confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
|
|
<languageCode code="en-US"/>
|
|
<setId root="2.16.840.1.113883.3.543" extension="@@@UUID-SET@@@"/>
|
|
<versionNumber value="1"/>
|
|
<recordTarget>
|
|
<patientRole>
|
|
<id extension="345980099" root="SSN"/>
|
|
<addr use="H">
|
|
<streetAddressLine/>
|
|
<city/>
|
|
<state/>
|
|
<postalCode/>
|
|
</addr>
|
|
<telecom/>
|
|
<patient>
|
|
<name>
|
|
<given>MALE-C</given>
|
|
<family>MEASURE-ONE</family>
|
|
</name>
|
|
<administrativeGenderCode displayName="MALE" code="M" codeSystemName="HL7 AdministrativeGender" codeSystem=""/>
|
|
<birthTime value="19600101120000"/>
|
|
</patient>
|
|
</patientRole>
|
|
</recordTarget>
|
|
<author>
|
|
<time value="20100703"/>
|
|
<assignedAuthor>
|
|
<id root="2.16.840.1.113883.3.249.6" extension="100001"/>
|
|
<assignedPerson>
|
|
<name>
|
|
<given>Nancy</given>
|
|
<family>Anthracite</family>
|
|
<suffix>MD</suffix>
|
|
</name>
|
|
</assignedPerson>
|
|
<representedOrganization>
|
|
<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
|
|
<name>WorldVistA Test Clinic</name>
|
|
</representedOrganization>
|
|
</assignedAuthor>
|
|
</author>
|
|
<informant>
|
|
<assignedEntity>
|
|
<id nullFlavor="NA"/>
|
|
<representedOrganization>
|
|
<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
|
|
<name>World VistA Test Clinic</name>
|
|
</representedOrganization>
|
|
</assignedEntity>
|
|
</informant>
|
|
<custodian>
|
|
<assignedCustodian>
|
|
<representedCustodianOrganization>
|
|
<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
|
|
<name>WorldVistA Test Clinic</name>
|
|
</representedCustodianOrganization>
|
|
</assignedCustodian>
|
|
</custodian>
|
|
<legalAuthenticator>
|
|
<time value="20100703"/>
|
|
<signatureCode code="S"/>
|
|
<assignedEntity>
|
|
<id root="2.16.840.1.113883.3.543" extension="111111"/>
|
|
<assignedPerson>
|
|
<name>
|
|
<given>Nancy</given>
|
|
<family>Anthracite</family>
|
|
<suffix>MD</suffix>
|
|
</name>
|
|
</assignedPerson>
|
|
<representedOrganization>
|
|
<id root="2.16.840.1.113883.3.543" extension="1558574526"/>
|
|
<name>WorldVistA Test Clinic</name>
|
|
</representedOrganization>
|
|
</assignedEntity>
|
|
</legalAuthenticator>
|
|
<participant typeCode="PRF">
|
|
<functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88"/>
|
|
<associatedEntity classCode="PROV">
|
|
<id root="2.16.840.1.113883.3.249.6" extension="111111"/>
|
|
<associatedPerson>
|
|
<name>
|
|
<prefix>Dr.</prefix>
|
|
<given>Nancy</given>
|
|
<family>Anthracite</family>
|
|
</name>
|
|
</associatedPerson>
|
|
</associatedEntity>
|
|
</participant>
|
|
<component>
|
|
<structuredBody>
|
|
<component>
|
|
<section>
|
|
<templateId root="2.16.840.1.113883.3.249.11.50"/>
|
|
<code code="55185-3" codeSystem="2.16.840.1.113883.6.1"/>
|
|
<title>Measure set: CMS EHR Measure Set</title>
|
|
<text>2010 Measures Set Measures</text>
|
|
<component>
|
|
<section>
|
|
<templateId root="2.16.840.1.113883.3.249.11.2"/>
|
|
<code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
|
|
<title>Measure Section</title>
|
|
<text>
|
|
<list>
|
|
<item>CMS Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus</item>
|
|
</list>
|
|
</text>
|
|
<entry typeCode="DRIV">
|
|
<act classCode="ACT" moodCode="DEF">
|
|
<id root="2.16.840.1.113883.3.249.11.2"/>
|
|
<code code="PQRI-1" codeSystem="2.16.840.1.113883.3.249.12" displayName="Hemoglobin A1c Poor Control in Diabetes Mellitus"/>
|
|
<text>Percentage of patients 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1C greater than 9.0%</text>
|
|
<statusCode code="completed"/>
|
|
</act>
|
|
</entry>
|
|
<component>
|
|
<section>
|
|
<code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
|
|
<title>Reporting Parameters</title>
|
|
<text>
|
|
<list>
|
|
<item>Reporting Period Jan 1, 2010 to Dec 31, 2010</item>
|
|
</list>
|
|
</text>
|
|
<entry>
|
|
<act classCode="ACT" moodCode="EVN">
|
|
<code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
|
|
<effectiveTime>
|
|
<low value="20100101"/>
|
|
<high value="20101231"/>
|
|
</effectiveTime>
|
|
</act>
|
|
</entry>
|
|
</section>
|
|
</component>
|
|
<component>
|
|
<section>
|
|
<code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
|
|
<title>Patient Data</title>
|
|
</section>
|
|
</component>
|
|
<component>
|
|
<section>
|
|
<templateId root="2.16.840.1.113883.3.88.11.83.103" assigningAuthorityName="HITSP/C83"/>
|
|
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.6" assigningAuthorityName="IHE PCC"/>
|
|
<templateId root="2.16.840.1.113883.10.20.1.11" assigningAuthorityName="HL7 CCD"/>
|
|
<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem list"/>
|
|
<title>Problems</title>
|
|
<text>
|
|
<table>
|
|
<tbody>
|
|
<tr>
|
|
<th>Type</th>
|
|
<th>Date</th>
|
|
<th>Code</th>
|
|
<th>Description</th>
|
|
<th>Status</th>
|
|
<th>Source</th>
|
|
</tr>
|
|
<tr>
|
|
<td>Problem</td>
|
|
<td>
|
|
<table>
|
|
<tbody>
|
|
<tr xmlns="">
|
|
<td>Oct 13, 2010</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</td>
|
|
<td>250.02 (ICD9CM)
|
|
</td>
|
|
<td ID="PROBLEM1">Diabetes Mellitus without mention of Complication, type II or unspecified type,</td>
|
|
<td>Active</td>
|
|
<td>NANCY ANTHRACITE </td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</text>
|
|
<entry typeCode="DRIV">
|
|
<act classCode="ACT" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.10.20.1.27"/>
|
|
<id root="PROBLEM1" extension="CCRObjectID"/>
|
|
<code nullFlavor="NA"/>
|
|
<performer typeCode="PRF">
|
|
<assignedEntity>
|
|
<id extension="ACTORPROVIDER_10000000020" root="CCRActorID"/>
|
|
<addr use="WP">
|
|
<streetAddressLine>VA MEDICAL CENTER</streetAddressLine>
|
|
<city>ALBANY</city>
|
|
<state>NY</state>
|
|
<postalCode>12180</postalCode>
|
|
</addr>
|
|
<telecom/>
|
|
<assignedPerson>
|
|
<name>
|
|
<given>NANCY</given>
|
|
<family>ANTHRACITE</family>
|
|
</name>
|
|
</assignedPerson>
|
|
</assignedEntity>
|
|
</performer>
|
|
<entryRelationship typeCode="SUBJ">
|
|
<observation classCode="OBS" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.10.20.1.28" assigningAuthorityName="CCD"/>
|
|
<templateId root="2.16.840.1.113883.3.249.11.100.8"/>
|
|
<id root="PROBLEM1" extension="CCRObjectID"/>
|
|
<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
|
|
<statusCode code="completed"/>
|
|
<text>
|
|
<reference value="#PROBLEM1"/>
|
|
</text>
|
|
<effectiveTime>
|
|
<low value="20101013"/>
|
|
<high nullFlavor="UNK"/>
|
|
</effectiveTime>
|
|
<value displayName="Diabetes Mellitus without mention of Complication, type II or unspecified type," code="250.02" codeSystemName="ICD9CM" codeSystem=""/>
|
|
<entryRelationship typeCode="REFR">
|
|
<observation classCode="OBS" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.10.20.1.50"/>
|
|
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
|
|
<statusCode code="completed"/>
|
|
<value>
|
|
<originalText>Active</originalText>
|
|
</value>
|
|
</observation>
|
|
</entryRelationship>
|
|
</observation>
|
|
</entryRelationship>
|
|
</act>
|
|
</entry>
|
|
</section>
|
|
</component>
|
|
<component>
|
|
<section>
|
|
<templateId root="2.16.840.1.113883.10.20.1.12"/>
|
|
<code code="47519-4" codeSystem="2.16.840.1.113883.6.1"/>
|
|
<title>Procedures</title>
|
|
<text>
|
|
<table>
|
|
<tbody>
|
|
<tr>
|
|
<th>Type</th>
|
|
<th>Date</th>
|
|
<th>Code</th>
|
|
<th>Description</th>
|
|
<th>Location</th>
|
|
<th>Substance</th>
|
|
<th>Method</th>
|
|
<th>Position</th>
|
|
<th>Site</th>
|
|
<th>Status</th>
|
|
<th>Source</th>
|
|
</tr>
|
|
<tr id="PROCEDURE_4130_7">
|
|
<td/>
|
|
<table>
|
|
<tbody>
|
|
<tr xmlns="">
|
|
<td>Procedure Date:
|
|
</td>
|
|
<td>Oct 14, 2010</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
<td>99202 (CPT-4)
|
|
</td>
|
|
<td>INTERMEDIATE (20min)</td>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td>Completed</td>
|
|
<td>NANCY ANTHRACITE </td>
|
|
</tr>
|
|
<tr id="PROCEDURE_4113_4">
|
|
<td/>
|
|
<table>
|
|
<tbody>
|
|
<tr xmlns="">
|
|
<td>Procedure Date:
|
|
</td>
|
|
<td>Oct 13, 2010</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
<td>99202 (CPT-4)
|
|
</td>
|
|
<td>INTERMEDIATE (20min)</td>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td/>
|
|
<td>Completed</td>
|
|
<td>NANCY ANTHRACITE </td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
</text>
|
|
<entry typeCode="DRIV">
|
|
<procedure classCode="PROC" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
|
|
<templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
|
|
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
|
|
<id root="PROCEDURE_4130_7" extension="CCRObjectID"/>
|
|
<code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
|
|
<text>
|
|
<reference value="#PROCEDURE_4130_7"/>
|
|
</text>
|
|
<statusCode code="completed"/>
|
|
<effectiveTime>
|
|
<low value="20101014"/>
|
|
<high nullFlavor="UNK"/>
|
|
</effectiveTime>
|
|
</procedure>
|
|
</entry>
|
|
<entry typeCode="DRIV">
|
|
<procedure classCode="PROC" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
|
|
<templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
|
|
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
|
|
<id root="PROCEDURE_4113_4" extension="CCRObjectID"/>
|
|
<code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
|
|
<text>
|
|
<reference value="#PROCEDURE_4113_4"/>
|
|
</text>
|
|
<statusCode code="completed"/>
|
|
<effectiveTime>
|
|
<low value="20101013"/>
|
|
<high nullFlavor="UNK"/>
|
|
</effectiveTime>
|
|
</procedure>
|
|
</entry>
|
|
</section>
|
|
</component>
|
|
<component>
|
|
<section>
|
|
<templateId root="2.16.840.1.113883.10.20.1.9"/>
|
|
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment Sources"/>
|
|
<title>Payers</title>
|
|
<text/>
|
|
<entry typeCode="DRIV">
|
|
<act classCode="ACT" moodCode="DEF">
|
|
<templateId root="2.16.840.1.113883.10.20.1.20"/>
|
|
<id root="2.16.840.1.113883.3.543" extension="@@@UUID-PAYER@@@"/>
|
|
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/>
|
|
<statusCode code="completed"/>
|
|
<entryRelationship typeCode="COMP">
|
|
<act classCode="ACT" moodCode="EVN">
|
|
<templateId root="2.16.840.1.113883.10.20.1.26"/>
|
|
<templateId root="2.16.840.1.113883.3.249.11.100.7"/>
|
|
<id root="dbbb6311-8a4d-11df-a4ee-0800200c9c66"/>
|
|
<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4" displayName="Public Healthcare"/>
|
|
<statusCode code="completed"/>
|
|
<performer typeCode="PRF">
|
|
<assignedEntity>
|
|
<id root="2.16.840.1.113883.12.86" extension="MC"/>
|
|
</assignedEntity>
|
|
</performer>
|
|
<participant typeCode="COV">
|
|
<participantRole>
|
|
<id root="2.16.840.1.113883.4.1" extension="@@SSN@@"/>
|
|
<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
|
|
</participantRole>
|
|
</participant>
|
|
</act>
|
|
</entryRelationship>
|
|
</act>
|
|
</entry>
|
|
</section>
|
|
</component>
|
|
</section>
|
|
</component>
|
|
</section>
|
|
</component>
|
|
</structuredBody>
|
|
</component>
|
|
</ClinicalDocument> |