Getting error on validation of ccd xml file on edge test tool.
Gulshan Dhiman
Result Description: The scenario contains Sex Observation data with code asked-declined , however there is no matching data in the submitted CCDA.
Result Description: The scenario requires the submitted document type to be either a Continuity of Care Document, or a Referral Note, but the submitted C-CDA does not contain the relevant template Ids.
Getting above errors with my xml. don't get how to fix these issues Please someone guide.
<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
Title: Continuity of Care Document (CCD).
-->
<ClinicalDocument
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xmlns="urn:hl7-org:v3"
xmlns:voc="urn:hl7-org:v3/voc"
xmlns:sdtc="urn:hl7-org:sdtc">
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<templateId root="2.16.840.1.113883.10.20.22.1.6"/>
<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2023-07-01"/>
<!-- Referral Note (V2) template ID -->
<templateId root="2.16.840.1.113883.10.20.22.1.14"/>
<templateId root="2.16.840.1.113883.10.20.22.1.14" extension="2015-08-01"/>
<!-- UNIQUE DOCUMENT IDENTIFIER -->
<id extension="TT660" root="2.16.840.1.113883.19.5.99999.1"/>
<code code="57133-1" displayName="Referral Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>HEALTH HISTORY & PHYSICAL</title>
<effectiveTime value="20230722051435-0500"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en-US"/>
<recordTarget>
<patientRole>
<id root="bdd85808-5390-427d-b769-a2518f238af8" extension="249655"/>
<addr use="HP">
<streetAddressLine>1357, Death Dr, Beaverton, OR-97006</streetAddressLine>
<streetAddressLine nullFlavor="NI"/>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<!--Cures Update Previous address-->
<addr use="H">
<streetAddressLine nullFlavor="UNK" />
<city nullFlavor="UNK" />
<state nullFlavor="UNK" />
<postalCode nullFlavor="UNK" />
<country nullFlavor="UNK" />
</addr>
<telecom value="tel:+1555-723-6666" use="HP"/>
<telecom value="tel:+1555-777-6666" use="MC"/>
<patient>
<name>
<given qualifier="CL">David</given>
<family>Hollow</family>
<suffix nullFlavor="UNK" />
</name>
<!--Cures Update Previous Name-->
<name>
<given nullFlavor="UNK" />
<family nullFlavor="UNK" />
</name>
<administrativeGenderCode nullFlavor="ASKU"/>
<birthTime value="19800801"/>
<sdtc:deceasedInd value="true"/>
<sdtc:deceasedTime value="20230722"/>
<maritalStatusCode nullFlavor="UNK" />
<raceCode nullFlavor="NI"/>
<ethnicGroupCode nullFlavor="NI"/>
<languageCommunication>
<languageCode code="en"/>
<modeCode code="ESP" displayName="Expressed spoken" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
<proficiencyLevelCode code="G" displayName="Good" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency" />
<preferenceInd value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<id root="1.1.1.1.1.1.1.1.4"/>
<name>Neighborhood Physicians Practice</name>
<telecom use="WP" value="tel:+1555-555-1002"/>
<addr use="WP">
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<!-- The author represents the person who provides the content in the document -->
<author>
<time value="20230722051435-0500"/>
<assignedAuthor>
<id extension="62663mkr15466" root="2.16.840.1.113883.4.6"/>
<addr use="WP">
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1-555-555-1002"/>
<assignedPerson>
<name>
<given qualifier="CL">John</given>
<family>Doe</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="78A150ED-B890-49dc-B716-5EC0027B3982" />
<name>Neighborhood Physicians Practice</name>
<telecom use="WP" value="tel:+1-555-555-1002"/>
<addr use="WP">
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedAuthor>
</author>
<!-- The dataEnterer transferred the content created by the author into the document -->
<dataEnterer>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="62663mkr15466"/>
<addr>
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1-555-555-1002"/>
<assignedPerson>
<name>
<given>John</given>
<family>Doe</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id extension="99998899" root="2.16.840.1.113883.4.6"/>
<name>pNhlrShi tbcOeMthoe n</name>
<telecom use="WP" value="tel:+1-154-478-2340"/>
<addr use="WP">
<streetAddressLine> CS t1t0htv3treneree</streetAddressLine>
<city>North Muskegon</city>
<state>MI</state>
<postalCode>59puc444</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<!-- The informationRecipient represents the intended recipient of the document -->
<informationRecipient>
<intendedRecipient classCode="ASSIGNED">
<informationRecipient>
<name>
<given nullFlavor="UNK" />
<family nullFlavor="UNK" />
</name>
</informationRecipient>
<receivedOrganization>
<name nullFlavor="UNK" />
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time value="20230722051435-0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="999998899" root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1-555-555-1002"/>
<assignedPerson>
<name>
<given>ECL</given>
<family>iMedicWare</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<participant typeCode="IND">
<templateId root="2.16.840.1.113883.10.20.22.5.8" extension="2023-05-01"/>
<associatedEntity classCode="PRS">
<code code="SPS"
codeSystem="2.16.840.1.113883.5.111"/>
<addr use="HP">
<streetAddressLine>1357, Death Dr, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
</addr>
<telecom nullFlavor="UNK"/>
<associatedPerson>
<name>
<given>Romario</given>
<family>Hollow</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<documentationOf>
<serviceEvent classCode="PCPR">
<effectiveTime>
<low value="20230722051435-0500"/>
<high value="20230722051435-0500" />
</effectiveTime>
<performer typeCode="PRF">
<functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="Primary Care Provider">
<originalText>Primary Care Provider</originalText>
</functionCode>
<assignedEntity>
<id extension="1000000080" root="2.16.840.1.113883.4.6"/>
<!-- <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/> -->
<addr>
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1-555-555-1002"/>
<assignedPerson>
<name>
<given>Albert</given>
<family>Davis</family>
</name>
</assignedPerson>
<representedOrganization>
<id root="78A150ED-B890-49dc-B716-5EC0027B3982" />
<name>Neighborhood Physicians Practice</name>
<addr>
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<component>
<structuredBody>
<!-- SOCIAL HISTORY SECTION -->
<component>
<section >
<templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.17"/>
<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History"/>
<title>SOCIAL HISTORY</title>
<text></text>
</section>
</component>
<!-- MEDICATIONS SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.2.1.1"/>
<code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of medications"/>
<title>MEDICATIONS</title>
<text>No known Medications</text>
<entry>
<substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="true">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
<!-- ** MEDICATION ACTIVITY -->
<id root="3f8ace17-8e20-4238-96d9-5f5b10bee74f"/>
<text>
<reference value="#Medication_None"/>
</text>
<statusCode code="active"/>
<effectiveTime nullFlavor="NA"/>
<doseQuantity nullFlavor="NA"/>
<consumable>
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
<manufacturedMaterial>
<code nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.88">
<translation code="410942007" displayName="Drug or medicament"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entry>
</section>
</component>
<!-- ALLERGIES SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-01"/>
<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" codeSystemName="LOINC" displayName="History of allergies"/>
<title>ALLERGIES & REACTIONS</title>
<text>No allergy data.</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id nullFlavor="NI"/>
<!-- Allergy Problem Act template -->
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low nullFlavor="NI"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN" >
<templateId root="2.16.840.1.113883.10.20.22.4.7" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id nullFlavor="NI"/>
<!-- Allergy - intolerance observation template -->
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime nullFlavor="UNK"/>
<value xsi:type="CD" nullFlavor="NI"/>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="NI"/>
</playingEntity>
</participantRole>
</participant>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- IMMUNIZATION SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.2.1" />
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations" />
<title>IMMUNIZATIONS</title>
<text>No immunization data found.</text>
</section>
</component>
<!-- VITAL SIGN SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.4.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.4.1"/>
<code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="VITAL SIGNS"/>
<title>VITAL SIGNS</title>
<text>No Vital Signs Information</text>
</section>
</component>
<!-- PROBLEM SECTION -->
<!-- ***************** PROBLEM LIST *********************** -->
<!-- edited as per test doc - all data relevant -db -->
<component>
<section >
<!-- *** Problem Section (entries required) (V3) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.5.1"/>
<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROBLEM LIST"/>
<title>PROBLEMS</title>
<text>
<table border = "1" width = "100%">
<thead>
<tr>
<th>Problem</th>
<th>Effective Dates</th>
<th>Problem Status</th>
</tr>
</thead>
<tbody>
<tr ID = "PROBSUMMARY_714113">
<td ID = "PROBKIND_714113">DEATH DURING ENCOUNTER (R99) [SNOMED-CT: 87309006]</td>
<td>Jul 22,2023</td>
<td ID = "PROBSTATUS_714113">Active</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<!-- ** Problem Concern Act (V3) ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.3" />
<id root="ec8a6ff8-ed4b-4f7e-89c3-e98e58b45df9" />
<code code="CONC" codeSystem="2.16.840.1.113883.5.6" displayName="Concern" />
<!-- The statusCode represents the need to continue tracking the problem -->
<!-- This is of ongoing concern to the provider -->
<!-- The concern is not active, in terms of there being an active condition to be managed.-->
<statusCode code="completed"/>
<effectiveTime>
<!-- The low value represents when the problem was first recorded in the patients chart -->
<!-- since no test data was given for this information,
and a low element is required to exist, used nullFlavor -db -->
<low value="20230722"/>
<!-- The high value reflects when there was no longer a need to track the problem -->
<!-- since no test data was given for this information, used nullFlavor -db -->
<high nullFlavor="UNK"/>
</effectiveTime>
<!-- removed author as not required -db -->
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation (V3)** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2022-06-01" />
<id root="ab1791b0-5c71-11db-b0de-0800200c2601"/>
<code code="282291009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Diagnosis">
<!-- a. This code SHALL contain at least one [1..*] translation, which SHOULD be selected from ValueSet Problem Type (LOINC) -->
<!-- Diagnosis seems like the best option:
No EXACT requirement was given in the test data -db -->
<translation code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis" />
</code>
<!-- The statusCode reflects the status of the observation itself -->
<statusCode code="completed"/>
<effectiveTime>
<!-- The low value reflects the date of onset -->
<low value="20230722"/>
<!-- The high value reflects when the problem was known to be resolved -->
<high value="20230722"/>
</effectiveTime>
<value xsi:type="CD" code="R99" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10" displayName="Encounter death" />
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.502" extension="2022-06-01"/>
<code code="77975-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Earliest date of diagnosis"/>
<statusCode code="completed"/>
<effectiveTime value="20230722"/>
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- LAB TESTS SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.3.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.3.1"/>
<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="RESULTS"/>
<title>RESULTS</title>
<text>Laboratory Test: None. Laboratory Values/Results: No Lab Result data</text>
</section>
</component>
<component>
<!--Cures Update Progress Note-->
<section>
<!-- Notes Section -->
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01"/>
<code code="18842-5" displayName="Discharge Summary Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Discharge Summary Note</title>
<text>No discharge summary note found.</text>
</section>
</component>
<!-- ASSESSMENT SECTION -->
<!-- ASSESSMENT SECTION -->
<!-- There is no R2.1 (R2.0) version of assessment section, using R1.1 templateId only -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.8"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="51848-0" displayName="ASSESSMENTS"/>
<title>ASSESSMENTS</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Assessment</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>DEATH DURING ENCOUNTER (R99)</td>
<td>Jul 22, 2023</td>
</tr>
</tbody>
</table>
</text>
</section>
</component>
<!-- PLAN OF TREATMENT SECTION -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
<templateId root="2.16.840.1.113883.10.20.22.2.10" extension="2014-06-09"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="18776-5" displayName="PLAN OF TREATMENT"/>
<title>PLAN OF TREATMENT</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Plan of Treatment</th>
</tr>
</thead>
<tbody>
<tr>
<td>No data.</td>
</tr>
</tbody>
</table>
</text>
</section>
</component>
<!-- GOALS SECTION -->
<!-- GOAL SECTION -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.60"/>
<code code="61146-7" displayName="Goals"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Goals Section</title>
<text>No goal information</text>
</section>
</component>
<!-- HEALTH CONCERNS SECTION -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.58" extension="2015-08-01"/>
<code code="75310-3" displayName="Health Concerns Document" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Health Concerns Section</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Observations (Health Status)</th>
<th>Status</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="3" ID="HealthObservation_1">No Health Observation</td>
</tr>
</tbody>
</table>
<br/>
<table border="1" width="100%">
<thead>
<tr>
<th>Concern - HealthCare Concerns refer to underlying clinical facts</th>
<th>Status</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="3" ID="HealthConcern_1">No Health Concern.</td>
</tr>
</tbody>
</table>
<br/>
<table border="1" width="100%">
<thead>
<tr>
<th>Related observation</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="2">No Related Observation.</td>
</tr>
</tbody>
</table>
<br/>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.5" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.5"/>
<id root="3e9e86ae-56ee-4fef-a599-46681134e046"/>
<code code="11323-3" displayName="Health status" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#HealthObservation_1"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" nullFlavor="NI"/>
</observation>
</entry>
<entry>
<act classCode="ACT" moodCode="EVN" negationInd="true">
<templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2015-08-01"/>
<id root="98c7ea96-c4cb-4be5-b249-6e32b9e9de69"/>
<code code="75310-3" displayName="Health Concern" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#HealthConcern_1"/>
</text>
<statusCode code="completed"/>
</act>
</entry>
</section>
</component>
<!-- FAMILY HEALTH SECTION -->
<!-- ENCOUNTERS SECTION -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>
<code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of encounters"/>
<title>ENCOUNTERS</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Encounter Type</th>
<th>Location</th>
<th>Encounter Time</th>
<th>Encounter Disposition</th>
</tr>
</thead>
<tbody>
<tr ID="encounterData1285072">
<td>Cataract Evaluation</td>
<td>Neighborhood Physicians Practice - 2472, Rocky place, Beaverton, OR-97006,Aloha OR - 97006</td>
<td>2023-07-22 10:40:00</td>
<td>Expired in a medical facility</td>
</tr>
<tr>
<th colspan="4">Encounter Diagnosis</th>
</tr>
<tr>
<td colspan="4">DEATH DURING ENCOUNTER (R99)</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" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<id root="13c98e49-a291-4c1d-b9de-b0ad1f370851"/>
<code code="92002" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4">
<originalText>
<reference value="#encounterData1285072"/>
</originalText>
<translation code="AMB" codeSystem="2.16.840.1.113883.5.4"
displayName="Ambulatory" codeSystemName="HL7 ActEncounterCode"/>
</code>
<effectiveTime value="20230722"/>
<sdtc:dischargeDispositionCode code="41"
codeSystem="2.16.840.1.113883.12.112"
codeSystemName="HL7 Discharge Disposition"
displayName="Expired in a medical facility">
<originalText>
<reference value="#encounterData1285072"/>
</originalText>
</sdtc:dischargeDispositionCode>
<performer>
<assignedEntity>
<id nullFlavor="NI"/>
<code code="309343006" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Physician"/>
</assignedEntity>
</performer>
<participant typeCode="LOC">
<participantRole classCode="SDLOC">
<templateId root="2.16.840.1.113883.10.20.22.4.32"/>
<code nullFlavor="NI"/>
<addr>
<streetAddressLine>2472, Rocky place, Beaverton, OR-97006</streetAddressLine>
<city>Aloha</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1555-555-1002"/>
<playingEntity classCode="PLC">
<name>Neighborhood Physicians Practice</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="SUBJ">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.80" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.80"/>
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id root="4b2ba957-5c33-4be0-b7f6-1c16d8faa157"/>
<code xsi:type="CE" code="29308-4" codeSystem="2.16.840.1.113883.6.1" displayName="ENCOUNTER DIAGNOSIS"/>
<effectiveTime>
<low value="20230722"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="false">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="ef45b302-d01f-4da5-88b8-1106b6c71138"/>
<code code="282291009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Diagnosis">
<translation code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis"/>
</code>
<statusCode code="completed"/>
<effectiveTime>
<low value="20230722"/>
</effectiveTime>
<value xsi:type="CD" code="10001005" codeSystem="2.16.840.1.113883.6.96" displayName="DEATH DURING ENCOUNTER (R99)"/>
</observation>
</entryRelationship>
</act>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
<!-- PLAN OF CARE SECTION -->
<component>
<section>
<!-- ** Plan of Care Section Template -->
<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
<!-- CCDA Plan of Care Section definition requires this code -->
<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Treatment plan"/>
<title>PLAN OF CARE</title>
<text>
<table border = "1" width = "100%">
<thead>
<tr>
<th>Name</th>
<th>Result</th>
<th>Status</th>
<th>Date / Reason</th>
</tr>
</thead>
<tbody>
<tr>
<td colspan="4"></td>
</tr>
</tbody>
</table>
</text>
</section>
</component>
<!-- INSTRICTIONS SECTION -->
<!-- FUNCTIONAL STATUS SECTION -->
<!-- ********************************************************
FUNCTIONAL STATUS
******************************************************** -->
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.14" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.2.14"/>
<code code="47420-5" codeSystem="2.16.840.1.113883.6.1"/>
<title>FUNCTIONAL STATUS</title>
<text>No functional or disability status information available</text>
</section>
</component>
<!-- ********************************************************
COGNITIVE STATUS (MENTAL STATUS)
******************************************************** -->
<component>
<section nullFlavor="NI">
<!-- There is no R1.1 version of this template -db -->
<templateId root="2.16.840.1.113883.10.20.22.2.56" extension="2015-08-01"/>
<!-- Mental Status Section -->
<code code="10190-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="MENTAL STATUS"/>
<title>MENTAL STATUS</title>
<text>No COGNITIVE STATUS information</text>
</section>
</component>
<!-- CHIEF COMPLAINT AND REASON FOR VISIT SECTION -->
<component>
<section>
<templateId root = "2.16.840.1.113883.10.20.22.2.13"/>
<code code = "46239-0" codeSystem = "2.16.840.1.113883.6.1" codeSystemName = "LOINC" displayName = "CHIEF COMPLAINT AND REASON FOR VISIT"/>
<title>CHIEF COMPLAINT</title>
<text>
<table border = "1" width = "100%">
<thead>
<tr>
<th>Reason for Visit/Chief Complaint</th>
</tr>
</thead>
<tbody>
<tr>
<td>A 45 Yr. old patient
The patient died during the encounter</td>
</tr>
</tbody>
</table>
</text>
</section>
</component>
<!-- MEDICATIONS ADMINISTERED SECTION -->
<!-- PROCEDURES SECTION -->
<!-- ************** PROCEDURES ***************** -->
<component>
<section nullFlavor="NI" >
<!-- Procedures Section (entries required) (V2) -->
<templateId root="2.16.840.1.113883.10.20.22.2.7.1" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.2.7.1"/>
<code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF PROCEDURES"/>
<title>PROCEDURES</title>
<text ID="Sx_proc">No procedure data found</text>
<entry>
<procedure classCode="PROC" moodCode="EVN">
<!-- Procedure Activity Procedure V2-->
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
<id nullFlavor="NI"/>
<code nullFlavor="NI"/>
<text>
<reference value="#Sx_proc"/>
</text>
<statusCode code="completed" />
<effectiveTime nullFlavor="NI" />
</procedure>
</entry>
</section>
</component>
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.23" />
<templateId root="2.16.840.1.113883.10.20.22.2.23" extension="2014-06-09" />
<code code="46264-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medical Equipment" />
<title>Implantable Device</title>
<text>
<paragraph ID="Proc">Patient has no history of implantable devices</paragraph>
</text>
<entry>
<procedure classCode="PROC" moodCode="EVN" negationInd="true">
<!-- Procedure Activity Procedure V2-->
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
<id root="d5b614bd-01ce-410d-8726-e1fd01dcc72a" />
<code code="71388002" codeSystem="2.16.840.1.113883.6.96" displayName="Procedure"/>
<text>
<reference value="#Proc"/>
</text>
<statusCode code="completed" />
<effectiveTime nullFlavor="NA" />
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<!-- UDI is not applicable since no procedure -->
<id nullFlavor="NA" root="2.16.840.1.113883.3.3719"/>
<playingDevice classCode="DEV">
<code code="40388003" codeSystem="2.16.840.1.113883.6.96" displayName="Implant"/>
</playingDevice>
<scopingEntity classCode="DEV">
<id root="2.16.840.1.113883.3.3719"/>
</scopingEntity>
</participantRole>
</participant>
</procedure>
</entry>
</section>
</component>
<!-- REASON FOR REFERRAL SECTION -->
<component>
<section>
<!-- Reason for Referral Section (V2) -->
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.1" extension="2014-06-09"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.1"/>
<code code="42349-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Reason for Referral"/>
<title>REASON FOR REFERRAL</title>
<text>No Reason for Referral information</text>
</section>
</component>
<!-- CLINICAL NOTES SECTION -->
<component>
<!--Cures Update Progress Note-->
<section>
<!-- Notes Section -->
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Laboratory note" code="11502-2"/>
<title>Laboratory Narrative</title>
<text>No Laboratory Narrative information found</text>
</section>
</component>
<component>
<!--Cures Update Progress Note-->
<section>
<!-- Notes Section -->
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Pathology Study" code="11526-1"/>
<title>Pathology Study</title>
<text>No Pathology Study information found</text>
</section>
</component>
<component>
<!-- Cures Update Consultation Note -->
<section>
<!-- Notes Section -->
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01"/>
<code code="11488-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Consultation note"/>
<title>Consultation Notes</title>
<text>
<list>
<item>Consultation notes information restricted by the patient.</item>
</list>
</text>
</section>
</component>
<component>
<!--Cures Update Procedure Note-->
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01" />
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure note" code="28570-0" />
<title>Procedure Note</title>
<text>No Procedure Notes information found</text>
</section>
</component>
<component>
<!-- Cures Update Progress Note -->
<section>
<!-- Notes Section -->
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01"/>
<code codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Progress note"
code="11506-3"/>
<title>Progress Note</title>
</section>
</component>
<component>
<!--Cures Update Procedure Note-->
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01" />
<code
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
code="34117-2"
displayName="History and Physical Note"
/>
<title>History and Physical Note</title>
<text>No History and Physical information found</text>
<entry>
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.202"/>
<code
code="34117-2"
displayName="History and Physical Note"
codeSystem="2.16.840.1.113883.6.1"
/>
<statusCode code="completed"/>
</act>
</entry>
</section>
</component>
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.500" extension="2019-07-01"/>
<templateId root="2.16.840.1.113883.10.20.22.2.500" extension="2022-06-01"/>
<code code="85847-2" codeSystem="2.16.840.1.113883.6.1"/>
<title>Care Teams</title>
<text>No care team information available</text>
</section>
</component>
<component>
<section nullFlavor="NI">
<!-- *** Payers Section (V2) *** -->
<templateId root="2.16.840.1.113883.10.20.22.2.18" extension="2014-06-09" />
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Payer" />
<title>INSURANCE PROVIDERS</title>
<text>No Insurance Information</text>
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>
