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CCDA_CCD_b1_Ambulatory_v2.xml
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CCDA_CCD_b1_Ambulatory_v2.xml
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<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
Title: US_Realm_Header_Template
Revision History:
01/31/2011 bam created
07/29/2011 RWM modified
11/26/2011 RWM modified
08/12/2012 RWM modified
09/12/2012 BNR(Dragon) modified
-->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xsi:schemaLocation="urn:hl7-org:v3 ../../../CDA%20R2/cda-schemas-and-samples/infrastructure/cda/CDA.xsd"
xmlns="urn:hl7-org:v3"
xmlns:cda="urn:hl7-org:v3"
xmlns:sdtc="urn:hl7-org:sdtc">
<!--
********************************************************
CDA Header
********************************************************
-->
<!-- CONF 16791 -->
<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="Test CCDA"
root="1.1.1.1.1.1.1.1.1"/>
<!-- 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>Community Health and Hospitals: Health Summary</title>
<!-- CONF 5256 -->
<effectiveTime
value="20120912000000-0000"/>
<!-- 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="1"
root="2.16.840.1.113883.4.6"/>
<!-- Fake ID using HL7 example OID. -->
<!-- Patient SSN recorded as an ID -->
<id
extension="123-101-5230"
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>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<!-- CONF 5280 -->
<telecom
value="tel:(816)276-6909"
use="HP"/>
<!-- 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>Myra</given>
<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family>Jones</family>
</name>
<administrativeGenderCode
code="F"
codeSystem="2.16.840.1.113883.5.1"
displayName="Female"/>
<birthTime
value="19470501"/>
<maritalStatusCode
code="M"
displayName="Married"
codeSystem="2.16.840.1.113883.5.2"
codeSystemName="MaritalStatusCode"/>
<religiousAffiliationCode
code="1013"
displayName="Christian (non-Catholic, non-specific)"
codeSystemName="HL7 Religious Affiliation "
codeSystem="2.16.840.1.113883.5.1076"/>
<!-- Need to Fix the Race Code to be from the OMB Standards -->
<raceCode
code="2106-3"
displayName="White"
codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race and Ethnicity - CDC"/>
<ethnicGroupCode
code="2186-5"
displayName="Not Hispanic or Latino"
codeSystem="2.16.840.1.113883.6.238"
codeSystemName="Race and Ethnicity - CDC"/>
<guardian>
<code
code="GPARNT"
displayName="Grandfather"
codeSystem="2.16.840.1.113883.5.111"
codeSystemName="HL7 Role code"/>
<addr
use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom
value="tel:(816)276-6909"
use="HP"/>
<guardianPerson>
<name>
<given>Ralph</given>
<family>Jones</family>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
</addr>
</place>
</birthplace>
<!-- FIX the Code System to be 639.2 -->
<languageCommunication>
<languageCode
code="eng"/>
<modeCode
code="ESP"
displayName="Expressed spoken"
codeSystem="2.16.840.1.113883.5.60"
codeSystemName="LanguageAbilityMode"/>
<preferenceInd
value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<id
root="1.1.1.1.1.1.1.1.4"/>
<name>Community Health and Hospitals</name>
<telecom
use="WP"
value="tel: 555-555-5000"/>
<addr>
<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time
value="20050813000000+0500"/>
<assignedAuthor>
<id
extension="111111"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="tel:555-555-1002"/>
<assignedPerson>
<name>
<prefix>Dr</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<dataEnterer>
<assignedEntity>
<id
root="2.16.840.1.113883.4.6"
extension="999999943252"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Mary</given>
<family>McDonald</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<informant>
<assignedEntity>
<id
extension="KP00017"
root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</informant>
<informant>
<relatedEntity
classCode="PRS">
<!-- classCode PRS represents a person with personal relationship with the patient. -->
<code
code="SPS"
displayName="SPOUSE"
codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<relatedPerson>
<name>
<given>Frank</given>
<family>Jones</family>
</name>
</relatedPerson>
</relatedEntity>
</informant>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id
extension="99999999"
root="2.16.840.1.113883.4.6"/>
<name>Community Health and Hospitals</name>
<telecom
value="tel: 555-555-1002"
use="WP"/>
<addr
use="WP">
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<informationRecipient>
<intendedRecipient>
<informationRecipient>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</informationRecipient>
<receivedOrganization>
<name>Community Health and Hospitals</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time
value="20120813"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="999999999"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time
value="20120813"/>
<signatureCode
code="S"/>
<assignedEntity>
<id
extension="999999999"
root="2.16.840.1.113883.4.6"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
use="WP"
value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<participant typeCode="IND">
<associatedEntity classCode="PRS">
<code
code="GPARNT"
displayName="Grand Parent"
codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<addr
use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value='tel:(555)555-2006' use='WP'/>
<associatedPerson>
<name>
<prefix>Mr.</prefix>
<given>Ralph</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<participant typeCode="IND">
<associatedEntity classCode="PRS">
<code
code="SPS"
displayName="SPOUSE"
codeSystem="2.16.840.1.113883.1.11.19563"
codeSystemName="Personal Relationship Role Type Value Set"/>
<addr
use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>1357 Amber Drive</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97006</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value='tel:(555)555-2006' use='WP'/>
<associatedPerson>
<name>
<prefix>Mr.</prefix>
<given>Frank</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<documentationOf
typeCode="DOC">
<serviceEvent
classCode="PCPR">
<code
code="233604007"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT"
displayName="Pnuemonia"/>
<effectiveTime>
<low
value="20120806"/>
<high
value="20120813"/>
</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="20120806"/>
<high
value="20120813"/>
</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>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
value="tel:+1-555-555-5000"
use="WP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
<representedOrganization>
<id
root="2.16.840.1.113883.19.5.9999.1393"/>
<name>Community Health and Hospitals</name>
<telecom
value="tel:+1-555-555-5000"
use="WP"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
<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="20120806"/>
<high
value="20120813"/>
</time>
<assignedEntity>
<id
extension="PseudoMD-3"
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>1002 Healthcare Dr</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
<telecom
value="tel:+1-555-555-5000"
use="HP"/>
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
<representedOrganization>
<id
root="2.16.840.1.113883.19.5.9999.1393"/>
<name>Community Health and Hospitals</name>
<telecom
value="tel:+1-555-555-5000"
use="HP"/>
<addr>
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>97266</postalCode>
<country>US</country>
</addr>
</representedOrganization>
</assignedEntity>
</performer>
</serviceEvent>
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code="233604007"
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codeSystemName="SNOMED-CT"
displayName="Pnuemonia"/>
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<low
value="20120806"/>
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</effectiveTime>
<responsibleParty>
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<id root="2.16.840.1.113883.4.6"/>
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<given>Henry</given>
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<name>
<prefix>Dr</prefix>
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</healthCareFacility>
</location>
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<!-- ********************************************************
CDA Body
******************************************************** -->
<component>
<structuredBody>
<!-- *********************** -->
<!--
********************************************************
Allergies, Adverse Reactions, Alerts
********************************************************
-->
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root="2.16.840.1.113883.10.20.22.2.6.1"/>
<!-- Alerts section template -->
<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>
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</thead>
<tbody>
<tr>
<td>Penicillin G benzathine</td>
<td><content
ID="reaction1">Hives</content></td>
<td><content
ID="severity1">Moderate to severe</content></td>
<td>Inactive</td>
</tr>
<tr>
<td>Codeine</td>
<td><content
ID="reaction2">Shortness of Breath</content></td>
<td><content
ID="severity2">Moderate</content></td>
<td>Active</td>
</tr>
<tr>
<td>Aspirin</td>
<td><content
ID="reaction3">Hives</content></td>
<td><content
ID="severity3">Mild to moderate</content></td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
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moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
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codeSystemName="LOINC"
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value="20070501"/>
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value="20120806"/>
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moodCode="EVN">
<!-- allergy observation template -->
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<id
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code="419511003"
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codeSystemName="SNOMED CT">
<originalText>
<reference
value="#reaction1"/>
</originalText>
</value>
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typeCode="CSM">
<participantRole
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<playingEntity
classCode="MMAT">
<code
code="7982"
displayName="Penicillin G benzathine"
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codeSystemName="RxNorm">
<originalText>
<reference
value="#reaction1"/>
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</code>
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<entryRelationship
typeCode="SUBJ"
inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Allergy status observation template -->
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code="33999-4"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Status"/>
<statusCode
code="completed"/>
<value
xsi:type="CE"
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displayName="Inactive"/>
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inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code
nullFlavor="NA"/>
<text>
<reference
value="#reaction1"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20070501"/>
</effectiveTime>
<value
xsi:type="CD"
code="247472004"
codeSystem="2.16.840.1.113883.6.96"
displayName="Hives"/>
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inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code xsi:type="CE"
code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference
value="#severity1"/>
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<statusCode
code="completed"/>
<value
xsi:type="CD"
code="371924009"
displayName="Moderate to severe"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
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</observation>
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</act>
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classCode="ACT"
moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.30"/>
<!-- ** Allergy problem act ** -->
<id
root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code
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codeSystemName="LOINC"
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value="20060501"/>
<high
value="20120806"/>
</effectiveTime>
<entryRelationship
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<observation
classCode="OBS"
moodCode="EVN">
<!-- allergy observation template -->
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root="2.16.840.1.113883.10.20.22.4.7"/>
<id
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<code
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code="419511003"
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codeSystemName="SNOMED CT">
<originalText>
<reference
value="#reaction2"/>
</originalText>
</value>
<participant
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<participantRole
classCode="MANU">
<playingEntity
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<code
code="2670"
displayName="Codeine"
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codeSystemName="RxNorm">
<originalText>
<reference
value="#reaction2"/>
</originalText>
</code>
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inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.28"/>
<!-- Allergy status observation template -->
<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"/>
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inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
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root="2.16.840.1.113883.10.20.22.4.9"/>
<!-- Reaction observation template -->
<id
root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
<code
nullFlavor="NA"/>
<text>
<reference
value="#reaction2"/>
</text>
<statusCode
code="completed"/>
<effectiveTime>
<low
value="20060501"/>
</effectiveTime>
<value
xsi:type="CD"
code="267036007"
codeSystem="2.16.840.1.113883.6.96"
displayName="Shortness of Breath"/>
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<entryRelationship
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inversionInd="true">
<observation
classCode="OBS"
moodCode="EVN">
<templateId
root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- ** Severity observation template ** -->
<code xsi:type="CE"
code="SEV"
displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>
<reference
value="#severity2"/>
</text>
<statusCode
code="completed"/>
<value
xsi:type="CD"
code="6736007"
displayName="Moderate"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
</observation>
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</observation>
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