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VistA-Miscellaneous/qrda/CCR/M1-QRDA/M1-PAT_100855_QRDA_V1_0_0Ve...

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<?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"/>
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<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="21164d44-e5e8-11df-98ed-cf2671499652"/>
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<addr use="H">
<streetAddressLine/>
<city/>
<state/>
<postalCode/>
</addr>
<telecom/>
<patient>
<name>
<given>FEMALE-E</given>
<family>MEASURE-ONE</family>
</name>
<administrativeGenderCode displayName="FEMALE" code="F" codeSystemName="HL7 AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"/>
<birthTime value="19600101120000"/>
<raceCode code="2076-8" codeSystem="2.16.840.1.113883.5.104"/>
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</patient>
<providerOrganization>
<!-- NPI for the provider and this is a real number-->
<id root="2.16.840.1.113883.4.6" extension="1558574525" />
<name>WorldVistA Test Clinic</name>
<!--WVV Address of organization is optional except for the STATE-->
<addr>
<state>MD</state>
<postalCode>20877</postalCode>
</addr>
<!--WVP required asOrganizationPartOf added to sample-->
<asOrganizationPartOf>
<wholeOrganization>
<!-- Tax ID is the extension and this is a dummy numbers-->
<id root="2.16.840.1.113883.4.2" extension="226864459"/>
</wholeOrganization>
</asOrganizationPartOf>
</providerOrganization>
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<author>
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<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>
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</legalAuthenticator>
<participant typeCode="PRF">
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<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>
<documentationOf>
<serviceEvent>
<code displayName="INTERMEDIATE (20min)" code="99202" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
<effectiveTime>
<low value="20101013"/>
<high value="20101013"/>
</effectiveTime>
<performer typeCode="PRF">
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="1558574525"/>
<code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
<addr>
<streetAddressLine>123 Maple Ave</streetAddressLine>
<city>Gaithersburg</city>
<state>MD</state>
<postalCode>20877</postalCode>
</addr>
<assignedPerson>
<name>
<given>Nancy</given>
<family>Anthracite</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<documentationOf>
<serviceEvent>
<code displayName="LIMITED (10min)" code="99212" codeSystemName="CPT-4" codeSystem="2.16.840.1.113883.6.12"/>
<effectiveTime>
<low value="20101014"/>
<high value="20101014"/>
</effectiveTime>
<performer typeCode="PRF">
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="1558574525"/>
<code code="62247001" codeSystem="2.16.840.1.113883.6.69" codeSystemName="SNM CT" displayName="Internal Medician Specialist"/>
<addr>
<streetAddressLine>123 Maple Ave</streetAddressLine>
<city>Gaithersburg</city>
<state>MD</state>
<postalCode>20877</postalCode>
</addr>
<assignedPerson>
<name>
<given>Nancy</given>
<family>Anthracite</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<component>
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<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/>
<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="SNM"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20101014"/>
<high value="20101014"/>
</effectiveTime>
<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"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.50"/>
<templateId root="2.16.840.1.113883.3.249.11.100.12"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.27"/>
<id root="PROBLEM2" 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"/>
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<id root="PROBLEM2" extension="CCRObjectID"/>
<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20101014"/>
<high value="20101014"/>
</effectiveTime>
<value xsi:type="CD" displayName="Diabetes (ICD-9-CM 250.00)" code="250.00" codeSystemName="I9" codeSystem="2.16.840.1.113883.6.103"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
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<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
</observation>
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</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.27"/>
<id root="PROBLEM3" 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="PROBLEM3" extension="CCRObjectID"/>
<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNM"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20101013"/>
<high value="20101013"/>
</effectiveTime>
<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"/>
<entryRelationship typeCode="REFR">
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<statusCode code="completed"/>
<value xsi:type="CE" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNM" />
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</section>
</component>
<component>
<section>
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<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="21164d44-e5e8-11df-98ed-cf2671499652"/>
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<statusCode code="completed"/>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
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<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">
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<id root="2.16.840.1.113883.4.1" extension="498212298"/>
<code code="SELF" codeSystem="2.16.840.1.113883.5.111" displayName="Self"/>
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</section>
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</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>
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