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<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.23" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.2.23"/>
<code code="46264-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medical Equipment"/>
<title>Implants</title>
<text>
<table>
<thead>
<tr>
<th>Implanted</th>
<th>Area</th>
<th>Manufacturer</th>
<th>Device Identifier</th>
<th>Details</th>
<th>Model</th>
<th>Serial</th>
<th>Lot</th>
</tr>
</thead>
<tbody>
<tr>
<td ID="implant1">Patellofemoral Component</td>
<td>Left: Knee</td>
<td>MCK</td>
<td>00848486000400</td>
<td>Implanted: Qty: 1 on 04/13/2016 by Fleming, Barry</td>
<td/>
<td>123777</td>
<td>ABC634</td>
</tr>
<tr>
<td ID="implant2">Inlay Tibial Component</td>
<td>Left: Knee</td>
<td>MCK</td>
<td>00848486001032</td>
<td>Implanted: Qty: 1 on 04/13/2016 by Fleming, Barry</td>
<td>MCK7712</td>
<td/>
<td>ABC124</td>
</tr>
<tr>
<td ID="implant3">Patella Component</td>
<td ID="implant3site">Left: Knee</td>
<td>MCK</td>
<td>00848486000349</td>
<td>Implanted: Qty: 1 on 04/13/2016 by Fleming, Barry</td>
<td>MCK912</td>
<td/>
<td>ABC721</td>
</tr>
</tbody>
</table>
</text>
<entry>
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id extension="2744" root="1.2.840.114350.1.13.5552.1.7.2.737780"/>
<code nullFlavor="UNK"/>
<!-- Procedure is completed, even though the implant is still active -->
<statusCode code="completed"/>
<effectiveTime>
<!-- Placed Date -->
<low value="20160413"/>
</effectiveTime>
<!-- Example with qualifier to explicitly convey laterality
See example #2 for an alternative which does not use qualifier
See example #3 for an alternative which does not include any code at all, but still conveys the original site text -->
<targetSiteCode code="72696002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Knee region structure">
<qualifier>
<name code="272741003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="laterality" />
<value code="7771000" codeSystem="2.16.840.1.113883.9.96" codeSystemName="SNOMED CT" displayName="left" />
</qualifier>
</targetSiteCode>
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<id assigningAuthorityName="FDA" extension="(01)00848486000400(11)160330(10)ABC634(21)123777" root="2.16.840.1.113883.3.3719"/>
<playingDevice>
<code nullFlavor="UNK">
<originalText>
<reference value="#implant1"/>
</originalText>
</code>
</playingDevice>
<!-- From Product Instance template:
The scopingEntity/id should correspond to FDA or the appropriate issuing agency. -->
<scopingEntity>
<id root="2.16.840.1.113883.3.3719"/>
</scopingEntity>
</participantRole>
</participant>
</procedure>
</entry>
<entry>
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id extension="2745" root="1.2.840.114350.1.13.5552.1.7.2.737780"/>
<code nullFlavor="UNK"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160413"/>
</effectiveTime>
<!-- Example without qualifier -->
<targetSiteCode code="82169009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Structure of left knee"/>
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<id assigningAuthorityName="FDA" extension="(01)00848486001032(11)160330(10)ABC124" root="2.16.840.1.113883.3.3719"/>
<playingDevice>
<code nullFlavor="UNK">
<originalText>
<reference value="#implant2"/>
</originalText>
</code>
</playingDevice>
<!-- From Product Instance template:
The scopingEntity/id should correspond to FDA or the appropriate issuing agency. -->
<scopingEntity>
<id root="2.16.840.1.113883.3.3719"/>
</scopingEntity>
</participantRole>
</participant>
</procedure>
</entry>
<entry>
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id extension="2746" root="1.2.840.114350.1.13.5552.1.7.2.737780"/>
<code nullFlavor="UNK"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20160413"/>
</effectiveTime>
<!-- Example where targetSiteCode is not mapped -->
<targetSiteCode nullFlavor="UNK">
<originalText>
<reference value="#implant3site" />
</originalText>
</targetSiteCode>
<participant typeCode="DEV">
<participantRole classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
<id assigningAuthorityName="FDA" extension="(01)00848486000349(11)160330(10)ABC721" root="2.16.840.1.113883.3.3719"/>
<playingDevice>
<code nullFlavor="UNK">
<originalText>
<reference value="#implant3"/>
</originalText>
</code>
</playingDevice>
<!-- From Product Instance template:
The scopingEntity/id should correspond to FDA or the appropriate issuing agency. -->
<scopingEntity>
<id root="2.16.840.1.113883.3.3719"/>
</scopingEntity>
</participantRole>
</participant>
</procedure>
</entry>
</section>
</component>