Validate a CCDA file and tell me the possible errors considering the national standards

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ani...@meditab.com

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Mar 22, 2016, 6:18:54 AM3/22/16
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Hello All,

Can you please verify the below ccda file and let me what can be the possible errors in it.

<?xml version="1.0" encoding="UTF-8" standalone="yes"?><?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xmlns:sdtc="urn:hl7-org:sdtc"
xsi:schemaLocation="urn:hl7-org:v3 http://xreg2.nist.gov:8080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd">

<realmCode
code="US"/>

<!-- CONF 5361 -->
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>

<!-- US General Header Template -->
<!-- CONF 5252 -->
<templateId root="2.16.840.1.113883.10.20.22.1.1"/>

<!-- *** Note: The next templateId, code and title will differ depending on what type of document is being sent. *** -->
<!-- conforms to the document specific requirements -->
<templateId
root="2.16.840.1.113883.10.20.22.1.2"/>

<!-- CONF 5363 -->
<id
extension="IMS_Clinical Summary"
root="1.1.1.1.1.24.7394"/>

<!-- CONF 5253 "CCD document" -->
<code
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
code="34133-9"
displayName="Summarization of Episode Note"/>

<!-- CONF 5254 -->
<title>Clinical Summary: Consolidated CDA</title>

<!-- CONF 5256 -->
<effectiveTime
value="20160224150203-0500"/>

<!-- 5259 -->
<confidentialityCode
code="N"
codeSystem="2.16.840.1.113883.5.25"/>

<!-- 5372 -->
<languageCode
code="en-US"/>

<!-- CONF 5266 -->
<recordTarget>

<!-- CONF 5267 -->
<patientRole>

<!-- CONF 5268-->
<id extension= "PT00003447" root="2.16.840.1.113883.4.6"/>

<!-- Fake ID using HL7 example OID. -->

<!-- Patient SSN recorded as an ID -->
<id extension="UNK" root="2.16.840.1.113883.4.1"/>

<!-- CONF 5271 -->
<addr
use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>Test Street</streetAddressLine>
<city>Southborough</city>
<state>MA</state>
<postalCode>01772</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>

<!-- CONF 5280 -->
<telecom nullFlavor="UNK" />

<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->

<!-- CONF 5283 -->
<patient>

<!-- CONF 5284 -->
<name use="L">
<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
<given>Test</given>
<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family>Test123</family>
</name>

<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"
displayName="Male"/>

<birthTime value="20100302"/>

<maritalStatusCode code="UNK" displayName="UNK" codeSystem="2.16.840.1.113883.5.2"
codeSystemName="MaritalStatusCode"/>

<!-- Need to Fix the Race Code to be from the OMB Standards -->
<raceCode
code="1002-5"
displayName="American Indian/Alaska Native"
codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race and Ethnicity - CDC"/>
<ethnicGroupCode code="2135-2" displayName="Hispanic/Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race and Ethnicity - CDC"/>
<languageCommunication> <languageCode nullFlavor="UNK"/> </languageCommunication>


<!-- FIX the Code System to be 639.2 -->

</patient>
<providerOrganization>
<id
root="1.1.1.1.1.1.1.1.4"/>
<name>Senior Health</name>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>

<author>
<time
value="20160224150203-0500"/>
<assignedAuthor>
<id
extension="1760722029"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>


<dataEnterer>
<assignedEntity>
<id
root="2.16.840.1.113883.4.6"
extension="1760722029"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<assignedPerson>
<name>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>


<informant>
<assignedEntity>
<id
extension="1760722029"
root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<assignedPerson>
<name>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</informant>



<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id
extension="1023155728"
root="2.16.840.1.113883.4.6"/>
<name>Senior Health</name>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<addr
use="WP">
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>


<informationRecipient>
<intendedRecipient>
<informationRecipient>
<name>
<given>Alan </given>
<family>Brown</family>
</name>
</informationRecipient>
<receivedOrganization>
<name>Senior Health</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>


<legalAuthenticator>
<time
value="20160224150203-0500"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="1760722029"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<assignedPerson>
<name>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>


<authenticator>
<time
value="20160224150203-0500"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="1760722029"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803-699-9073)" use="WP"/>
<assignedPerson>
<name>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>



<documentationOf
typeCode="DOC">
<serviceEvent
classCode="PCPR">
<code
code="1234"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT"
displayName="Protein-Calorie Malnutrition Not Otherwise Specified"/>
<effectiveTime>
<low
value="20150302"/>

</effectiveTime>

<performer
typeCode="PRF">
<functionCode
code="PP"
displayName="Primary Care Provider"
codeSystem="2.16.840.1.113883.12.443"
codeSystemName="Provider Role">
<originalText>Primary Care Provider</originalText>
</functionCode>
<time>
<low
value="20100302"/>
<high
value="20160224"/>
</time>
<assignedEntity>
<id
extension="PseudoMD-1"
root="2.16.840.1.113883.4.6"/>
<code
code="208D00000X"
displayName="General Practice"
codeSystemName="Provider Codes"
codeSystem="2.16.840.1.113883.6.101"/>
<addr>
<streetAddressLine>Secondary Phone: 846-</streetAddressLine>
<city> </city>
<state> </state>
<postalCode> </postalCode>
<country>US</country>
</addr>
<telecom nullFlavor="UNK"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
<representedOrganization>
<id
root="2.16.840.1.113883.19.5.9999.1393"/>
<name>Senior Health</name>
<telecom value ="tel:(803-699-9073)" use="WP" />
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>

<componentOf>
<encompassingEncounter>
<id extension="1" root="2.16.840.1.113883.4.6"/>
<effectiveTime>
<low
value="20150302"/>
</effectiveTime>
<responsibleParty>
<assignedEntity>
<id root="2.16.840.1.113883.4.6"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</responsibleParty>
<encounterParticipant typeCode="ATND">
<assignedEntity>
<id root="2.16.840.1.113883.4.6"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Alan </given>
<family>Brown</family>
</name>
</assignedPerson>
</assignedEntity>
</encounterParticipant>

<location>
<healthCareFacility>
<id extension = "9985647" root = "2.16.840.1.113883.19"/>
<code code = "261QU0200X" codeSystem = "2.16.840.1.113883.6.101" codeSystemName = "NUCC" displayName = "Urgent Care"/>
<location>
<name>Senior Health</name>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
</location>
</healthCareFacility>
</location>

</encompassingEncounter>
</componentOf>

<component>
<structuredBody>


<component>
<section>
<!-- conforms to Allergies section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.6"/>
<!-- Allergies section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"/>
<title>ALLERGIES, ADVERSE REACTIONS, ALERTS</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>
<content ID="Substance1">tolazoline</content>
</td>
<td>
<content ID="Reaction1"> </content>
</td>
<td>
<content ID="Severity1">Moderate</content>
</td>
<td>Active</td>
</tr>

<tr>
<td>
<content ID="Substance2">Phyllanthus Amarus</content>
</td>
<td>
<content ID="Reaction2"> </content>
</td>
<td>
<content ID="Severity2">Mild</content>
</td>
<td>Active</td>
</tr>

<tr>
<td>
<content ID="Substance3">Vitamin A Analogues</content>
</td>
<td>
<content ID="Reaction3"> </content>
</td>
<td>
<content ID="Severity3">Mild</content>
</td>
<td>Active</td>
</tr>

<tr>
<td>
<content ID="Substance4">Vitamin D Analogue</content>
</td>
<td>
<content ID="Reaction4"> </content>
</td>
<td>
<content ID="Severity4">Mild</content>
</td>
<td>Active</td>
</tr>

<tr>
<td>
<content ID="Substance5">Petrolatum</content>
</td>
<td>
<content ID="Reaction5"> </content>
</td>
<td>
<content ID="Severity5">Mild</content>
</td>
<td>Active</td>
</tr>

<tr>
<td>
<content ID="Substance6">Lanolin</content>
</td>
<td>
<content ID="Reaction6"> </content>
</td>
<td>
<content ID="Severity6">Mild</content>
</td>
<td>Active</td>
</tr>

</tbody>
</table>
</text>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="419199007"
displayName="Allergy to substance (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction1"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction1"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity1"/>
</text>
<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"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="416098002"
displayName="Drug allergy (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction2"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction2"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity2"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="416098002"
displayName="Drug allergy (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction3"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction3"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction3"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity3"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="416098002"
displayName="Drug allergy (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction4"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction4"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction4"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity4"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="416098002"
displayName="Drug allergy (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction5"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction5"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction5"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity5"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">

<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"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
</effectiveTime>
<value xsi:type="CD" code="416098002"
displayName="Drug allergy (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<originalText>
<reference value="#Reaction6"/>
</originalText>
</value>

<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="UNK">
<originalText>
<reference value="#Reaction6"/>
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>


<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Allergy status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.28"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Reaction observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code nullFlavor="NA"/>
<text>
<reference value="#Reaction6"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="NA"/>
</effectiveTime>
<value xsi:type="CE" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Severity observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<code xsi:type="CE" code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<text>
<reference value="#Severity6"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="255604002"
displayName="Mild"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode code="S"
displayName="Suceptible"
codeSystem="2.16.840.1.113883.1.11.78"
codeSystemName="Observation Interpretation"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>

</act>
</entry>

</section>
</component>



<component>
<section>
<templateId
root="2.16.840.1.113883.10.20.22.2.22.1"/>
<!-- Encounters Section - required entries -->
<code
code="46240-8"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="History of encounters"/>
<title>ENCOUNTERS</title>
<!-- Unstructured text field -->
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Encounter</th>
<th>Diagnosis</th>
<th>Performer</th>
<th>Location</th>
<th>Date</th>
</tr>
</thead>
<tbody>

<tr>
<td>
<content ID="Encounter1"/>11721 - DBRDMT NAIL ANY METH 6/&amp;gt;</td>
<td>Protein-Calorie Malnutrition Not Otherwise Specified</td>
<td>Alan Brown</td>
<td>Senior Health</td>
<td>Feb 24, 2016</td>
</tr>

<tr>
<td>
<content ID="Encounter2"/>69210 - RMVL IMPACTED CERUMEN SPX 1/BTH EARS</td>
<td>Protein-Calorie Malnutrition Not Otherwise Specified</td>
<td>Alan Brown</td>
<td>Senior Health</td>
<td>Feb 24, 2016</td>
</tr>

</tbody>
</table>
</text>

<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<!-- Encounter Activities -->
<!-- ******** Encounter activity template ******** -->
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="11721" displayName="DBRDMT NAIL ANY METH 6/&amp;gt;" codeSystemName="CPT"
codeSystem="2.16.840.1.113883.6.12" codeSystemVersion="4">
<originalText>DBRDMT NAIL ANY METH 6/&amp;gt;<reference value="#Encounter1"/>
</originalText>
</code>
<effectiveTime
value="20160224"/>
<performer>
<assignedEntity>
<id root="2a620155-9d11-439e-92a3-5d9815ff4de8"/>
<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="HealthcareServiceLocation"
displayName="Senior Health"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803)699-9073" use="HP"/>
<playingEntity classCode="PLC">
<name>Senior Health</name>
</playingEntity>
</participantRole>
</participant>

<entryRelationship typeCode="SUBJ" inversionInd="false"> <act classCode="ACT" moodCode="EVN"> <!--Encounter diagnosis act --> <templateId root="2.16.840.1.113883.10.20.22.4.80"/> <id root="5a784260-6856-4f38-9638-80c751aff2fb"/> <code xsi:type="CE" code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="ENCOUNTER DIAGNOSIS" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/> <statusCode code="active"/> <effectiveTime> <low value="20160224"/> </effectiveTime> <entryRelationship typeCode="SUBJ" inversionInd="false"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <!-- Problem Observation --> <id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/> <code code="409586006" codeSystem="2.16.840.1.113883.6.96" displayName="Complaint"/> <statusCode code="completed"/> <effectiveTime> <low value="20160224"/> </effectiveTime> <value xsi:type="CD" code="1234" codeSystem="2.16.840.1.113883.6.96" displayName="Protein-Calorie Malnutrition Not Otherwise Specified" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/> </observation> </entryRelationship> </act> </entryRelationship>

</encounter>
</entry>

<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<!-- Encounter Activities -->
<!-- ******** Encounter activity template ******** -->
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="69210" displayName="RMVL IMPACTED CERUMEN SPX 1/BTH EARS" codeSystemName="CPT"
codeSystem="2.16.840.1.113883.6.12" codeSystemVersion="4">
<originalText>RMVL IMPACTED CERUMEN SPX 1/BTH EARS<reference value="#Encounter2"/>
</originalText>
</code>
<effectiveTime
value="20160224"/>
<performer>
<assignedEntity>
<id root="2a620155-9d11-439e-92a3-5d9815ff4de8"/>
<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="HealthcareServiceLocation"
displayName="Senior Health"/>
<addr>
<streetAddressLine>335 Pleasant Point DR</streetAddressLine>
<city>Beaufort</city>
<state>SC</state>
<postalCode>299071164</postalCode>
<country>US</country>
</addr>
<telecom value ="tel:(803)699-9073" use="HP"/>
<playingEntity classCode="PLC">
<name>Senior Health</name>
</playingEntity>
</participantRole>
</participant>

<entryRelationship typeCode="SUBJ" inversionInd="false"> <act classCode="ACT" moodCode="EVN"> <!--Encounter diagnosis act --> <templateId root="2.16.840.1.113883.10.20.22.4.80"/> <id root="5a784260-6856-4f38-9638-80c751aff2fb"/> <code xsi:type="CE" code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="ENCOUNTER DIAGNOSIS" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/> <statusCode code="active"/> <effectiveTime> <low value="20160224"/> </effectiveTime> <entryRelationship typeCode="SUBJ" inversionInd="false"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <!-- Problem Observation --> <id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/> <code code="409586006" codeSystem="2.16.840.1.113883.6.96" displayName="Complaint"/> <statusCode code="completed"/> <effectiveTime> <low value="20160224"/> </effectiveTime> <value xsi:type="CD" code="1234" codeSystem="2.16.840.1.113883.6.96" displayName="Protein-Calorie Malnutrition Not Otherwise Specified" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/> </observation> </entryRelationship> </act> </entryRelationship>

</encounter>
</entry>

</section>
</component>



<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.7.1"/>
<code displayName="Procedures" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="47519-4"/>
<title>Procedures</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Procedure</th>
<th>Date</th>
</tr>
</thead>

<tbody>

<tr>
<td>Debridement</td>
<td>02/24/2016</td>
</tr>

<tr>
<td>Ear Irrigation</td>
<td>02/24/2016</td>
</tr>

</tbody>
</table>
</text>

<entry>
<act moodCode="INT" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.22.4.12"/>
<id root="c2ee9ee9-ae31-4628-a919-fec1cbb58686"/>
<code code="1234" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Debridement"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="UNK"/>
</effectiveTime>
</act>
</entry>

<entry>
<act moodCode="INT" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.22.4.12"/>
<id root="c2ee9ee9-ae31-4628-a919-fec1cbb58686"/>
<code code="1234" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Ear Irrigation"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160224"/>
<high nullFlavor="UNK"/>
</effectiveTime>
</act>
</entry>

</section>
</component>





<component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.2.1"/> <!-- Entries Required --> <!-- ******** Immunizations section template ******** --> <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations"/> <title>IMMUNIZATIONS</title> <!-- Unstructured text field --> <text> <content ID="immunSect"/> <table border="1" width="100%"> <thead> <tr> <th>Vaccine</th> <th>Date</th> <th>Status</th> </tr> </thead> <tbody> <tr> <td><content ID="immi1"/></td> <td/> <td/> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <!-- ******** Immunization activity template ******** --> <id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/> <text> <reference nullFlavor="UNK"/> </text> <statusCode nullFlavor="UNK"/> <effectiveTime nullFlavor="UNK"/> <routeCode nullFlavor="UNK"/> <doseQuantity nullFlavor="UNK"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <!-- ******** Immunization Medication Information ******** --> <manufacturedMaterial> <code nullFlavor="UNK"/> </manufacturedMaterial> <manufacturerOrganization nullFlavor="UNK"/> </manufacturedProduct> </consumable> <entryRelationship typeCode="SUBJ" inversionInd="true"> <act classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <!-- ** Instructions Template ** --> <code xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="CE" code="171044003" codeSystem="2.16.840.1.113883.6.96" displayName="immunization education"/> <text> <reference nullFlavor="UNK"/> </text> <statusCode nullFlavor="UNK"/> </act> </entryRelationship> </substanceAdministration> </entry> </section> </component>



<component> <section> <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> <!-- Unstructured text field --> <text> <table border="1" width="100%"> <thead> <tr> <th>Medication</th> <th>Directions</th> <th>Start Date</th> <th>Status</th> <th>Indications</th> <th>Fill Instructions</th> </tr> </thead> <tbody> <tr> <td> <content ID="Rx1"/> </td> <td/> <td/> <td/> <td/> <td> <content ID="FillIns1"> </content> </td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <!-- ** MEDICATION ACTIVITY --> <id root="cdbd33f0-6cde-11db-9fe1-0800200c9a66"/> <text nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <effectiveTime 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</performer> <entryRelationship typeCode="RSON"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.19"/> <id root="db734647-fc99-424c-a864-7e3cda82e703" extension="45665"/> <code nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <value xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="CD" code="1234" displayName="Hypoxemia" codeSystem="2.16.840.1.113883.6.96"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode nullFlavor="UNK"/> <effectiveTime xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <repeatNumber nullFlavor="UNK"/> <quantity nullFlavor="UNK"/> <product> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <id root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/> <manufacturedMaterial> <code nullFlavor="UNK"/> </manufacturedMaterial> <manufacturerOrganization nullFlavor="UNK"/> </manufacturedProduct> </product> <performer> <assignedEntity> <id extension="2981823" root="2.16.840.1.113883.19.5.9999.456"/> <addr> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> </assignedEntity> </performer> <author> <time nullFlavor="UNK"/> <assignedAuthor> <id root="2a620155-9d11-439e-92b3-5d9815fe4de8"/> <addr nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <assignedPerson> <name> <prefix nullFlavor="UNK"/> <given nullFlavor="UNK"/> <family nullFlavor="UNK"/> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="SUBJ" inversionInd="true"> <act classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <!-- ** Instructions Template ** --> <code nullFlavor="UNK"/> <text> <reference nullFlavor="UNK"/> </text> <statusCode nullFlavor="UNK"/> </act> </entryRelationship> </supply> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.18"/> <!-- ** Medication Dispense Template ** --> <id root="1.2.3.4.56789.1" extension="cb734647-fc99-424c-a864-7e3cda82e704"/> <statusCode nullFlavor="UNK"/> <effectiveTime nullFlavor="UNK"/> <repeatNumber nullFlavor="UNK"/> <product> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <id root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/> <manufacturedMaterial> <code nullFlavor="UNK"/> </manufacturedMaterial> <manufacturerOrganization nullFlavor="UNK"/> </manufacturedProduct> </product> <performer> <time nullFlavor="UNK"/> <assignedEntity> <id root="2.16.840.1.113883.19.5.9999.456" extension="2981823"/> <addr> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name> <prefix nullFlavor="UNK"/> <given nullFlavor="UNK"/> <family nullFlavor="UNK"/> </name> </assignedPerson> <representedOrganization> <id root="2.16.840.1.113883.19.5.9999.1393"/> <name nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <addr nullFlavor="UNK"/> </representedOrganization> </assignedEntity> </performer> </supply> </entryRelationship> </substanceAdministration> </entry> </section> </component>



<component>
<section>
<!-- conforms to Problems section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.5"/>
<!-- Problems section with entries required -->
<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>
<content ID="problems"/>
<list listType="ordered">












<item>
<content ID="Problem1"> Protein-Calorie Malnutrition Not Otherwise Specified </content>
<content ID="Stat1">Active</content>






<content ID="Date1">Mar 02, 2015</content>
</item>



<item>
<content ID="Problem2"> Chronic Ischemic Heart Disease Not Otherwise Specified </content>
<content ID="Stat2">Active</content>






<content ID="Date2">Mar 02, 2015</content>
</item>



</list>



</text>


<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Problem concern act ** -->
<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="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code code="409586006" codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference value="#Problem1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value xsi:type="CD" code="1234"
codeSystem="2.16.840.1.113883.6.96" displayName="Protein-Calorie Malnutrition Not Otherwise Specified" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
displayName="Status"/>
<text>
<reference value="#Stat1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value xsi:type="CD" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

</observation>
</entryRelationship>
</act>
</entry>

<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<!-- ** Problem concern act ** -->
<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="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code code="409586006" codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference value="#Problem2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value xsi:type="CD" code="1234"
codeSystem="2.16.840.1.113883.6.96" displayName="Chronic Ischemic Heart Disease Not Otherwise Specified" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem status observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
displayName="Status"/>
<text>
<reference value="#Stat2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20150302"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value xsi:type="CD" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
displayName="Active" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
</observation>
</entryRelationship>

</observation>
</entryRelationship>
</act>
</entry>

</section>
</component>

<component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.14"/> <code code="47420-5" codeSystem="2.16.840.1.113883.6.1"/> <title>COGNITIVE AND FUNCTIONAL STATUS</title> <text>NONE</text> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <!-- Problem observation template --> <templateId root="2.16.840.1.113883.10.20.22.4.68"/> <id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/> <code nullFlavor="NA"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK" /> <high nullFlavor="UNK" /> </effectiveTime> <value xsi:type="CD" code="1234" codeSystem="2.16.840.1.113883.6.96" displayName="None"/> </observation> </entry> </section> </component>

<component> <section> <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> <table border="1" width="100%"> <thead> <tr> <th>Name</th> <th>Actual Result</th> <th>Date</th> </tr> </thead> <tbody> <tr> <td> <content ID="Result1"/> </td> <td/> <td/> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <organizer classCode="BATTERY" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.1" /> <id root="7d5a02b0-67a4-11db-bd13-0800200c9a66" /> <code nullFlavor="UNK"/> <statusCode nullFlavor="UNK"/> <component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.2" /> <id root="107c2dc0-67a5-11db-bd13-0800200c9a66" /> <code nullFlavor="UNK"/> <text> <reference nullFlavor="UNK"/> </text> <statusCode nullFlavor="UNK"/> <effectiveTime value="20120806" /> <value xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="PQ" value="0.000000" unit="NA" /> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83" /> <methodCode /> <targetSiteCode /> <author> <time /> <assignedAuthor> <id root="2a620155-9d11-439e-92b3-5d9816ff4de8" /> </assignedAuthor> </author> </observation> </component> </organizer> </entry> </section></component>


<component> <!-- Social History ******** --> <section> <templateId root="2.16.840.1.113883.10.20.22.2.17"/> <!-- ******** Social history section template ******** --> <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" displayName="Social History"/> <title>SOCIAL HISTORY</title> <!-- Unstructured text field --> <text> <table border="1" width="100%"> <thead> <tr> <th>Social History Element</th> <th>Description</th> <th>Effective Dates</th> </tr> </thead> <tbody> <tr> <td><content ID="smok1"/></td> <td/> <td/> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <!-- Smoking status observation template --> <templateId root="2.16.840.1.113883.10.20.22.4.78"/> <id extension="123456789" root="2.16.840.1.113883.19"/> <code nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> <value xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="CD" code="449868002" displayName="Smoking History" codeSystem="2.16.840.1.113883.6.96"/> </observation> </entry> </section> </component>


<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.4"/>
<code displayName="Vital Signs" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="8716-3"/>
<title>Vital Signs</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th align="right">Date: </th>

<th>Feb 24, 2016</th>

</tr>
</thead>
<tbody>
<tr>
<th align="left">Height</th>

<td>
<content ID="vit1">154.9400 CM</content>
</td>

</tr>
<tr>
<th align="left">Weight</th>

<td>
<content ID="vit2">36.287 Kg</content>
</td>

</tr>
<tr>
<th align="left">Diastolic BP</th>

<td>
<content ID="vit3">0 mm Hg</content>
</td>

</tr>
<tr>
<th align="left">Systolic BP</th>

<td>
<content ID="vit4">0 mm Hg</content>
</td>

</tr>
<tr>
<th align="left">BMI</th>

<td>
<content ID="vit5">15.11kg/m2</content>
</td>

</tr>
</tbody>
</table>
</text>

<entry typeCode="DRIV">
<organizer moodCode="EVN" classCode="CLUSTER">
<templateId root="2.16.840.1.113883.10.20.22.4.26"/>
<id root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code displayName="Vital Sign" codeSystemName="SNOMED -CT" codeSystem="2.16.840.1.113883.6.96" code="46680005"/>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<component>
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8302-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Height" />
<text>
<reference value="#vit1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<value xsi:type="PQ" unit="CM" value="154.9400" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode codeSystem="2.16.840.1.113883.5.83" code="8302-2"/>
</observation>
</component>
<component>
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="3141-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Weight" />
<text>
<reference value="#vit2"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<value xsi:type="PQ" unit="Kg" value="36.287" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode codeSystem="2.16.840.1.113883.5.83" code="29463-7"/>
</observation>
</component>

<component>
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8480-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BP Systolic" />
<text>
<reference value="#vit3"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<value xsi:type="PQ" unit="mm Hg" value="0" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode codeSystem="2.16.840.1.113883.5.83" code="8480-6"/>
</observation>
</component>
<component>
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8462-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BP Diastolic" />
<text>
<reference value="#vit4"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<value xsi:type="PQ" unit="mm Hg" value="0" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode codeSystem="2.16.840.1.113883.5.83" code="8462-4"/>
</observation>
</component>
<component>
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="39156-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BMI (Body Mass Index)" />
<text>
<reference value="#vit5"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20160224"/>
<value xsi:type="PQ" unit="kg/m2" value="15.11" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
<interpretationCode codeSystem="2.16.840.1.113883.5.83" code="39156-5"/>
</observation>
</component>
</organizer>
</entry>

</section>
</component>


<component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.10"/> <code displayName="Plan of Care" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="18776-5"/> <title>Plan of Care</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Planned Activity</th> <th>Planned Date</th> <th>Code</th> <th>Code System</th> </tr> </thead> <tbody> <tr> <td/> <td/> <td/> <td/> </tr> </tbody> </table> </text> <entry> <act moodCode="RQO" classCode="ACT"> <templateId root="2.16.840.1.113883.10.20.22.4.39"/> <id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/> <code nullFlavor="NA"/> <statusCode nullFlavor="UNK"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> </act> </entry> <entry> <encounter moodCode="INT" classCode="ENC"> <templateId root="2.16.840.1.113883.10.20.22.4.40"/> <id root="9a6d1bac-17d3-4195-89a4-1121bc809b4d"/> </encounter> </entry> <entry> <procedure moodCode="RQO" classCode="PROC"> <templateId root="2.16.840.1.113883.10.20.22.4.41"/> <id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/> <code nullFlavor="UNK"/> <statusCode nullFlavor="UNK"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> </procedure> </entry> </section> </component>

<component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.45"/> <code displayName="Instructions" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="69730-0"/> <title>Instructions</title> <text> <content>Clinical Instructions</content> <list listType="ordered"> <item>Not recorded</item> </list> </text> <entry nullFlavor="NA"> <act moodCode="INT" classCode="ACT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <code nullFlavor="NA"/> <statusCode nullFlavor="NA"/> </act> </entry> </section> </component>


<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.12"/>
<code displayName="Reason for Visit" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="29299-5"/>
<title>Reason for Visit</title>
<text>

<paragraph></paragraph>

</text>
</section>
</component>



<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.18" />
<!-- ******** Payers section template ******** -->
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payments" />
<title>Insurance Providers</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Payer Name</th>
<th>Coverage Type</th>
</tr>
</thead>
<tbody>

<tr>
<td ID="PayerType_1">Medicaid SC_Primary</td>
<td>Self</td>
</tr>

</tbody>
</table>
</text>


<entry typeCode="DRIV">
<act classCode="ACT" moodCode="DEF">
<templateId root="2.16.840.1.113883.10.20.22.60" />
<!-- ******** Coverage entry template ******** -->
<id root="1fe2cdd0-7aad-11db-9fe1-0800200c9a66" />
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment sources" />
<statusCode code="completed" />
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.61" />
<!-- ******** Policy Activity template ******** -->
<id root="3e676a50-7aac-11db-9fe1-0800200c9a66" />
<code code="1" codeSystem="2.16.840.1.113883.3.221.5" codeSystemName="Source of Payment Typology (PHDSC)"/>
<statusCode code="completed" />
<!-- Insurance Company Information -->
<performer typeCode="PRF">
<time />
<assignedEntity>
<id root="2.16.840.1.113883.19" />
<code code="PAYOR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="HL7 RoleClassRelationship" />
<addr>
<streetAddressLine> PO Box 5547</streetAddressLine>
<city> Hauppauge</city>
<state> NY</state>


<postalCode> 117885547</postalCode>
<country> USA</country>
</addr>
<telecom value ="8882890709" use="HP"/>
<representedOrganization classCode="ORG">
<name>Medicaid SC_Primary</name>
<telecom value ="8882890709" use="HP"/>
<addr>
<streetAddressLine> </streetAddressLine>
<city> </city>


<state> </state>
<postalCode> </postalCode>
<country> </country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>

<participant typeCode="COV">
<participantRole classCode="PAT">
<id root="xxx" extension="yyy"/>
<code code="SELF" displayName="Self"
codeSystem="2.16.840.1.113883.5.111"
codeSystemName="RoleCode"/>
</participantRole>
</participant>
</act>
</entryRelationship>
</act>
</entry>

</section>
</component>


</structuredBody>
</component>
</ClinicalDocument>
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