/
data.xml.sample3
4832 lines (4830 loc) · 271 KB
/
data.xml.sample3
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<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CCD.xsl"?>
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 http://xreg2.nist.gov:11080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd">
<!--
********************************************************
CDA Header
********************************************************
-->
<!-- HITSP C32 V2.5: Add realmCode -->
<realmCode code="US"/>
<!-- Following template is HL7 CDA Release 2 -->
<!-- POCD_HD000040 is for Lab.Report.Clinical.Document -->
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
<!-- HITSP C32 V2.5: Template for IHE PCC Medical Documents specification -->
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
<!-- Following template is the CCD v1.0 Templates Root -->
<templateId root="2.16.840.1.113883.10.20.1"/>
<!-- HITSP C32 V2.5: Template for HL7 General Header constraints-->
<templateId root="2.16.840.1.113883.10.20.3"/>
<!-- Following template is the HITSP/C32 Registration and Medication Template -->
<templateId root="2.16.840.1.113883.3.88.11.32.1"/>
<!-- HITSP C32 V2.5: Template for HITSP C32 V2.5 -->
<templateId root="2.16.840.1.113883.3.88.11.83.1"/>
<!-- CDA Document Identifer, id=VA OID, extension=system-generated -->
<id extension="2.25.153967320391171260195869192743051876940" root="2.16.840.1.113883.4.349"/>
<!-- CDA Document Code -->
<code code="34133-9" codeSystem="2.16.840.1.113883.6.1" displayName="Summarization of Episode Note"/>
<!-- CDA Document Title -->
<title>Department of Veterans Affairs Summarization of Episode Note</title>
<!-- 1.01 DOCUMENT TIMESTAMP, REQUIRED -->
<effectiveTime value="20130315084710-0500"/>
<!-- CDA Confiedntiality Code -->
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<!-- CDA DOCUMENT LANGUAGE -->
<languageCode code="en-US"/>
<!--
********************************************************
PERSON INFORMATION CONTENT MODULE, REQUIRED
********************************************************
-->
<recordTarget>
<patientRole>
<!-- 1.02 PERSON ID, REQUIRED, id=VA OID, extension=GUID -->
<id extension="1012638924V546709" root="2.16.840.1.113883.4.349"/>
<!-- 1.03 PERSON ADDRESS-HOME PERMANENT, REQUIRED -->
<addr use="HP">
<streetAddressLine>123 Anywhere Road</streetAddressLine>
<city>Anywhere</city>
<state>DC</state>
<postalCode>00001</postalCode>
</addr>
<!-- 1.04 PERSON PHONE/EMAIL/URL, REQUIRED -->
<telecom use="HP" value="tel:+1-000-000-0001"/>
<patient>
<!-- 1.05 PERSON NAME LEGAL, REQUIRED -->
<name use="L">
<given>NWHINONE</given>
<family>NWHINZZZTESTPATIENT</family>
</name>
<!-- 1.05 PERSON NAME Alias Name, Optional -->
<name use="P">
<given nullFlavor="UNK"/>
<family nullFlavor="UNK"/>
</name>
<!-- HITSP C32 V2.5: 1.06 GENDER, REQUIRED AND REQUIRED Terminology -->
<!-- HITSP C32 V2.5: When Vista value is M, F, send as HL7AdminGenderCode -->
<!-- HITSP C32 V2.5: When Vista value is "Unknown", send as genderCode nullFlavor=UNK" -->
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGenderCode" displayName="Male">
<originalText>MALE</originalText>
</administrativeGenderCode>
<!-- 1.07 PERSON DATE OF BIRTH, REQUIRED -->
<birthTime value="19810101"/>
<!-- 1.08 MARITAL STATUS, Optional-R2 -->
<!-- VLER SEG 1B: Send as HL7 MaritalStatus -->
<maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" displayName="Married">
<originalText>MARRIED</originalText>
</maritalStatusCode>
<!-- 1.09 RELIGIOUS AFFILIATION, Optional, Removed b/c data not yet available via VA VIstA RPCs-->
<!-- 1.10 RACE, Optional -->
<!-- 1.10 RACE as originalText per NHIN Core Content Specification b/c VA code translation not yet available -->
<raceCode codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" nullFlavor="UNK">
</raceCode>
<!-- 1.11 ETHNICITY, Optional -->
<!-- 1.11 ETHNICITY as originalText per NHIN Core Content Specification b/c VA code translation not yet available -->
<ethnicGroupCode codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDC Race and Ethnicity" nullFlavor="UNK">
</ethnicGroupCode>
<!--
********************************************************
LANGUAGE SPOKEN CONTENT MODULE
********************************************************
-->
<languageCommunication>
<templateId root="2.16.840.1.113883.3.88.11.32.2"/>
<!-- 2.01 LANGUAGE, REQUIRED, languageCode as nullFlavor b/c data not yet available via VA VistA RPCs -->
<languageCode nullFlavor="UNK"/>
</languageCommunication>
</patient>
</patientRole>
</recordTarget>
<!--
********************************************************
INFORMATION SOURCE CONTENT MODULE, REQUIRED
********************************************************
-->
<!-- AUTHOR SECTION (REQUIRED) OF INFORMATION SOURCE CONTENT MODULE -->
<author>
<!-- 10.01 AUTHOR TIME (=Document Creation Date), REQUIRED -->
<time value="20130315084710-0500"/>
<assignedAuthor>
<!-- 10.02 AUTHOR ID (VA OID) (authorOID), REQUIIRED -->
<id root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Assigned Author Address Required, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Assigned Author Telecom Required, but VA VistA data not yet available -->
<telecom/>
<!-- 10.02 AUTHOR NAME REQUIRED -->
<!-- HITSP C32 V2.5: C83 assignedPerson/Author Name REQUIRED but provided as representedOrganization-->
<assignedPerson>
<name/>
</assignedPerson>
<!-- 10.02 AUTHOR NAME REQUIRED as representedOrganization-->
<representedOrganization>
<!-- 10.02 AUTHORING DEVICE ORGANIZATION OID (VA OID) (deviceOrgOID), REQUIIRED -->
<id root="2.16.840.1.113883.4.349"/>
<!-- 10.02 AUTHORING DEVICE ORGANIZATION NAME (deviceOrgName), REQUIIRED -->
<name>Department of Veterans Affairs</name>
<!-- HITSP C32 V2.5: Assigned Author Telecom Required, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Assigned Author Address Required, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedAuthor>
</author>
<!-- INFORMATION SOURCE SECTION (OPTIONAL)OF INFORMATION SOURCE CONTENT MODULE -->
<!-- 10.06 INFORMATION SOURCE AS AN ORGANIZATION, REQUIRED -->
<informant>
<assignedEntity>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for informant/assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for informant/assignedEntity, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: assignedPerson Required for informant/assignedEntity, but VA VistA data not yet available -->
<assignedPerson>
<!-- HITSP C32 V2.5: Name Required for informant/assignedEntity/assignedPerson -->
<name>Department of Veterans Affairs</name>
</assignedPerson>
<representedOrganization>
<!-- 10.06 INFORMATION SOURCE ORGANIZATION OID (VA OID) (sourceOrgOID), REQUIRED -->
<id root="2.16.840.1.113883.4.349"/>
<!-- 10.06 INFORMATION SOURCE ORGANIZATION NAME (sourceOrgName), REQUIRED -->
<name>Department of Veterans Affairs</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</informant>
<!--
********************************************************
CCD CDA R2 CUSTODIAN AS AN ORGANIZATION, REQUIRED
********************************************************
-->
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<!-- CCD CDA R2 CUSTODIAN OID (VA) (custodianOID) -->
<id root="2.16.840.1.113883.4.349"/>
<!-- CCD CDA R2 CUSTODIAN NAME (custodianName) -->
<name>Department of Veterans Affairs</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<!--
********************************************************
CCD CDA R2 LEGAL AUTHENTICATOR AS AN ORGANIZATION, REQUIRED
********************************************************
-->
<legalAuthenticator>
<!-- CCD CDA R2 TIME OF AUTHENTICATION -->
<time value="20130315084710-0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: assigned Person Required for legalAuthenticator/assignedEntity -->
<assignedPerson>
<name>Department of Veterans Affairs</name>
</assignedPerson>
<representedOrganization>
<!-- CCD CDA R2 LEGAL AUTHENTICATOR OID (VA) -->
<id root="2.16.840.1.113883.4.349"/>
<!-- CCD CDA R2 LEGAL AUTHENTICATOR NAME (authenticatorName) -->
<name>Department of Veterans Affairs</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</legalAuthenticator>
<!--
********************************************************
SUPPORT CONTENT MODULE, REQUIRED
********************************************************
-->
<participant typeCode="IND">
<!-- participant block repeated for NOK and ECON -->
<templateId root="2.16.840.1.113883.3.88.11.32.3"/>
<!-- HITSP C32 V2.5: IHE Support Template -->
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.4"/>
<!-- 3.01 DATE, REQUIRED -->
<!-- 3.01 DATE date as nullFlavor b/c data not yet available via VA VistA RPCs -->
<time nullFlavor="UNK"/>
<!-- 3.02 CONTACT TYPE, REQUIRED, classCode value determined by VistA value in contactType -->
<associatedEntity classCode="ECON">
<!-- 3.03 CONTACT RELATIONSHIP as originalText per NHIN Core Content Specification b/c VA code translation not yet available -->
<code code="UNK" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode">
<originalText>Sibling</originalText>
</code>
<!-- 3.04 CONTACT Addresss, Home Permanent, Optional-R2 -->
<addr use="HP">
<streetAddressLine>456 Anywhere Street</streetAddressLine>
<city>Anywhere</city>
<state>DC</state>
<postalCode>00001</postalCode>
</addr>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity -->
<!-- 3.05 CONTACT PHONE/EMAIL/URL, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<telecom use="HP" value="tel:+1-000-000-0001"/>
<associatedPerson>
<!-- 3.06 CONTACT NAME, REQUIRED -->
<name>
<given>EMERGENCY</given>
<family>NWHINZZZTESTPATIENT</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<participant typeCode="IND">
<!-- participant block repeated for NOK and ECON -->
<templateId root="2.16.840.1.113883.3.88.11.32.3"/>
<!-- HITSP C32 V2.5: IHE Support Template -->
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.4"/>
<!-- 3.01 DATE, REQUIRED -->
<!-- 3.01 DATE date as nullFlavor b/c data not yet available via VA VistA RPCs -->
<time nullFlavor="UNK"/>
<!-- 3.02 CONTACT TYPE, REQUIRED, classCode value determined by VistA value in contactType -->
<associatedEntity classCode="NOK">
<!-- 3.03 CONTACT RELATIONSHIP as originalText per NHIN Core Content Specification b/c VA code translation not yet available -->
<code code="UNK" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode">
<originalText>brother</originalText>
</code>
<!-- 3.04 CONTACT Addresss, Home Permanent, Optional-R2 -->
<addr use="HP">
<streetAddressLine>789 Anywhere Street</streetAddressLine>
<city>Anywhere</city>
<state>DC</state>
<postalCode>00001</postalCode>
</addr>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity -->
<!-- 3.05 CONTACT PHONE/EMAIL/URL, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<telecom use="HP" value="tel:+1-000-000-0001"/>
<associatedPerson>
<!-- 3.06 CONTACT NAME, REQUIRED -->
<name>
<given>NWHINONE</given>
<family>NWHINZZZNOK</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<!--
********************************************************
CCD CDA R2 DOCUMENTATION OF MODULE - QUERY META DATA, Optional
********************************************************
-->
<documentationOf>
<serviceEvent classCode="PCPR">
<effectiveTime>
<!-- QUERY META DATA, SERVICE START TIME, Optional -->
<low value="19000101000000-0600"/>
<!-- QUERY META DATA, SERVICE STOP TIME, Optional -->
<high value="20130315084710-0500"/>
</effectiveTime>
<!--
********************************************************
HEALTHCARE PROVIDER MODULE, OPTIONAL
********************************************************
-->
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider1" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>BRUUN,JESSE</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider2" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>CHDRAMDPROV,ALICIA M</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider3" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>Provider, One</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider4" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>Provider, One</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider5" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>Provider, One</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider6" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>POND,NEAL</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider7" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>POND,NEAL</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider8" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>POND,NEAL</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider9" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>POND,NEAL</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
<performer typeCode="PRF">
<!-- Provider Template Id -->
<templateId root="2.16.840.1.113883.3.88.11.32.4"/>
<!-- 4.02-PROVIDER ROLE CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.03-PROVIDER ROLE FREE TEXT, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<!-- 4.01-DATE RANGE, Required, nullFlavor b/c data not yet available via VA VistA RPCs -->
<time>
<high nullFlavor="UNK"/>
</time>
<assignedEntity>
<!-- Provider ID from Problems Module (7.05Treating Provider ID) -->
<id extension="provider10" root="2.16.840.1.113883.4.349"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for iassignedEntity, but VA VistA data not yet available -->
<telecom/>
<assignedPerson>
<name>POND,NEAL</name>
</assignedPerson>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="992" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>CHEYENNE HDR SQA</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!--
********************************************************
CDA BODY
********************************************************
-->
<component>
<structuredBody>
<!--
********************************************************
ALLERGY/DRUG SECTION SECTION
********************************************************
-->
<component>
<section>
<!-- CCD Alert Section Template-->
<templateId root="2.16.840.1.113883.10.20.1.2"/>
<!-- HITSP C32 V2.5: Allergy and Adverse Reaction Section Template -->
<templateId root="2.16.840.1.113883.3.88.11.83.102"/>
<!-- HITSP C32 V2.5: IHE Allergies and Other Adverse Reactions Section Template -->
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.13"/>
<!-- HITSP C32 V2.5: CCD Section Conformance code value , static -->
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" displayName="Allergies, adverse reactions, alerts"/>
<title>Allergies</title>
<!-- ALLERGIES NARRATIVE BLOCK -->
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.27"/>
<!-- HITSP C32 V2.5: Templates for Allergy/Drug Module/Entry -->
<templateId root="2.16.840.1.113883.3.88.11.83.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.3"/>
<!-- CCD Allergy Act ID as nullflavor -->
<id nullFlavor="UNK"/>
<code nullFlavor="NA"/>
<!-- HITSP C32 V2.5: IHE Concern Template Requires statusCode and effectiveTime -->
<statusCode code="active"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- INFORMATION SOURCE FOR ALLERGIES/DRUG, Optional -->
<author>
<!-- ADD TIME TO INFORMATION SOURCE FOR ALLERGIES/DRUG -->
<time nullFlavor="UNK"/>
<assignedAuthor>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity, but VA VistA data not yet available -->
<telecom/>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedAuthor>
</author>
<entryRelationship inversionInd="false" typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<!-- Alert observation template -->
<templateId root="2.16.840.1.113883.10.20.1.18"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<!-- HITSP C32 V2.5: IHE Observation Templates Require Id -->
<id nullFlavor="UNK"/>
<!-- 6.02 ADVERSE EVENT TYPE, REQUIRED; SNOMED CT -->
<!-- HITSP C32 V2.5: 6.02 ADVERSE EVENT TYPE SNOMED CT Terminology Required -->
<code code="419511003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Propensity to adverse reactions to drug">
<originalText>DRUG</originalText>
</code>
<!-- IHE Status Code fro Observation -->
<statusCode code="completed"/>
<!-- 6.01 ADVERSE EVENT DATE, Optional-R2 -->
<effectiveTime>
<low value="20120626141026"/>
</effectiveTime>
<!-- HITSP C32 V2.5: IHE Allergy Concern Template Requires value, When uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
<!-- HITSP C32 V2.5: Participant block for 6.04-Product Coded -->
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<!-- 6.04 PRODUCT CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<code code="UNK" nullFlavor="UNK">
<originalText>
<reference value="#andCodedAllergyName1"/>
</originalText>
</code>
<!-- 6.03 PRODUCT FREE TEXT, REQUIRED-->
<name>LATEX STRAP</name>
</playingEntity>
</participantRole>
</participant>
<!-- SEVERITY ENTRY RELATIONSHIP BLOCK optional, 0 or 1 per Allergy -->
<!-- REACTION ENTRYRELATIONSHIP BLOCK optional, repeatable -->
<entryRelationship inversionInd="true" typeCode="MFST">
<observation classCode="OBS" moodCode="EVN">
<!-- Reaction Template ID -->
<templateId root="2.16.840.1.113883.10.20.1.54"/>
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<id nullFlavor="UNK"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/>
<!-- 6.05 REACTION-FREE TEXT, optional,-->
<text>
<reference value="#andReaction1-1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- 6.06 REACTION CODED optional, when uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.27"/>
<!-- HITSP C32 V2.5: Templates for Allergy/Drug Module/Entry -->
<templateId root="2.16.840.1.113883.3.88.11.83.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.3"/>
<!-- CCD Allergy Act ID as nullflavor -->
<id nullFlavor="UNK"/>
<code nullFlavor="NA"/>
<!-- HITSP C32 V2.5: IHE Concern Template Requires statusCode and effectiveTime -->
<statusCode code="active"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- INFORMATION SOURCE FOR ALLERGIES/DRUG, Optional -->
<author>
<!-- ADD TIME TO INFORMATION SOURCE FOR ALLERGIES/DRUG -->
<time nullFlavor="UNK"/>
<assignedAuthor>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity, but VA VistA data not yet available -->
<telecom/>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedAuthor>
</author>
<entryRelationship inversionInd="false" typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<!-- Alert observation template -->
<templateId root="2.16.840.1.113883.10.20.1.18"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<!-- HITSP C32 V2.5: IHE Observation Templates Require Id -->
<id nullFlavor="UNK"/>
<!-- 6.02 ADVERSE EVENT TYPE, REQUIRED; SNOMED CT -->
<!-- HITSP C32 V2.5: 6.02 ADVERSE EVENT TYPE SNOMED CT Terminology Required -->
<code code="420134006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Propensity to adverse reactions">
<originalText>OTHER</originalText>
</code>
<!-- IHE Status Code fro Observation -->
<statusCode code="completed"/>
<!-- 6.01 ADVERSE EVENT DATE, Optional-R2 -->
<effectiveTime>
<low value="20121015105702"/>
</effectiveTime>
<!-- HITSP C32 V2.5: IHE Allergy Concern Template Requires value, When uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
<!-- HITSP C32 V2.5: Participant block for 6.04-Product Coded -->
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<!-- 6.04 PRODUCT CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<code code="UNK" nullFlavor="UNK">
<originalText>
<reference value="#andCodedAllergyName2"/>
</originalText>
</code>
<!-- 6.03 PRODUCT FREE TEXT, REQUIRED-->
<name>BEE VENOM</name>
</playingEntity>
</participantRole>
</participant>
<!-- SEVERITY ENTRY RELATIONSHIP BLOCK optional, 0 or 1 per Allergy -->
<!-- REACTION ENTRYRELATIONSHIP BLOCK optional, repeatable -->
<entryRelationship inversionInd="true" typeCode="MFST">
<observation classCode="OBS" moodCode="EVN">
<!-- Reaction Template ID -->
<templateId root="2.16.840.1.113883.10.20.1.54"/>
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<id nullFlavor="UNK"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/>
<!-- 6.05 REACTION-FREE TEXT, optional,-->
<text>
<reference value="#andReaction2-1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- 6.06 REACTION CODED optional, when uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.27"/>
<!-- HITSP C32 V2.5: Templates for Allergy/Drug Module/Entry -->
<templateId root="2.16.840.1.113883.3.88.11.83.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.3"/>
<!-- CCD Allergy Act ID as nullflavor -->
<id nullFlavor="UNK"/>
<code nullFlavor="NA"/>
<!-- HITSP C32 V2.5: IHE Concern Template Requires statusCode and effectiveTime -->
<statusCode code="active"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- INFORMATION SOURCE FOR ALLERGIES/DRUG, Optional -->
<author>
<!-- ADD TIME TO INFORMATION SOURCE FOR ALLERGIES/DRUG -->
<time nullFlavor="UNK"/>
<assignedAuthor>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity, but VA VistA data not yet available -->
<telecom/>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedAuthor>
</author>
<entryRelationship inversionInd="false" typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<!-- Alert observation template -->
<templateId root="2.16.840.1.113883.10.20.1.18"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<!-- HITSP C32 V2.5: IHE Observation Templates Require Id -->
<id nullFlavor="UNK"/>
<!-- 6.02 ADVERSE EVENT TYPE, REQUIRED; SNOMED CT -->
<!-- HITSP C32 V2.5: 6.02 ADVERSE EVENT TYPE SNOMED CT Terminology Required -->
<code code="418471000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Propensity to adverse reactions to food">
<originalText>FOOD</originalText>
</code>
<!-- IHE Status Code fro Observation -->
<statusCode code="completed"/>
<!-- 6.01 ADVERSE EVENT DATE, Optional-R2 -->
<effectiveTime>
<low value="20121016163425"/>
</effectiveTime>
<!-- HITSP C32 V2.5: IHE Allergy Concern Template Requires value, When uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
<!-- HITSP C32 V2.5: Participant block for 6.04-Product Coded -->
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<!-- 6.04 PRODUCT CODED, Optional-R2, Removed b/c data not yet available via VA VistA RPCs -->
<code code="UNK" nullFlavor="UNK">
<originalText>
<reference value="#andCodedAllergyName3"/>
</originalText>
</code>
<!-- 6.03 PRODUCT FREE TEXT, REQUIRED-->
<name>BEEF PRODUCTS</name>
</playingEntity>
</participantRole>
</participant>
<!-- SEVERITY ENTRY RELATIONSHIP BLOCK optional, 0 or 1 per Allergy -->
<!-- REACTION ENTRYRELATIONSHIP BLOCK optional, repeatable -->
<entryRelationship inversionInd="true" typeCode="MFST">
<observation classCode="OBS" moodCode="EVN">
<!-- Reaction Template ID -->
<templateId root="2.16.840.1.113883.10.20.1.54"/>
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<id nullFlavor="UNK"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/>
<!-- 6.05 REACTION-FREE TEXT, optional,-->
<text>
<reference value="#andReaction3-1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- 6.06 REACTION CODED optional, when uncoded only xsi:type=CD allowed -->
<value xsi:type="CD"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.27"/>
<!-- HITSP C32 V2.5: Templates for Allergy/Drug Module/Entry -->
<templateId root="2.16.840.1.113883.3.88.11.83.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5.3"/>
<!-- CCD Allergy Act ID as nullflavor -->
<id nullFlavor="UNK"/>
<code nullFlavor="NA"/>
<!-- HITSP C32 V2.5: IHE Concern Template Requires statusCode and effectiveTime -->
<statusCode code="active"/>
<effectiveTime>
<low nullFlavor="UNK"/>
</effectiveTime>
<!-- INFORMATION SOURCE FOR ALLERGIES/DRUG, Optional -->
<author>
<!-- ADD TIME TO INFORMATION SOURCE FOR ALLERGIES/DRUG -->
<time nullFlavor="UNK"/>
<assignedAuthor>
<id nullFlavor="NI"/>
<!-- HITSP C32 V2.5: Address Required for assignedEntity, but VA VistA data not yet available -->
<addr/>
<!-- HITSP C32 V2.5: Telecom Required for assignedEntity, but VA VistA data not yet available -->
<telecom/>
<representedOrganization>
<!-- INFORMATION SOURCE FOR FACILITY ID=VA OID, EXT= VAMC TREATING FACILITY NBR -->
<id extension="613" root="2.16.840.1.113883.4.349"/>
<!-- INFORMATION SOURCE FACILITY NAME (facilityName) -->
<name>MARTINSBURG VAMC</name>
<!-- HITSP C32 V2.5: Telecom Required for representedOrganization, but VA VistA data not yet available -->
<telecom/>
<!-- HITSP C32 V2.5: Address Required for representedOrganization, but VA VistA data not yet available -->
<addr/>
</representedOrganization>
</assignedAuthor>
</author>
<entryRelationship inversionInd="false" typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- HITSP C32 V2.5: Allergy Templates -->
<templateId root="2.16.840.1.113883.10.20.1.28"/>
<!-- Alert observation template -->
<templateId root="2.16.840.1.113883.10.20.1.18"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.5"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.6"/>
<!-- HITSP C32 V2.5: IHE Observation Templates Require Id -->
<id nullFlavor="UNK"/>
<!-- 6.02 ADVERSE EVENT TYPE, REQUIRED; SNOMED CT -->
<!-- HITSP C32 V2.5: 6.02 ADVERSE EVENT TYPE SNOMED CT Terminology Required -->
<code code="418038007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Propensity to adverse reactions to substance">
<originalText>DRUG, FOOD</originalText>
</code>
<!-- IHE Status Code fro Observation -->
<statusCode code="completed"/>
<!-- 6.01 ADVERSE EVENT DATE, Optional-R2 -->