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CCD_Transition_of_Care_Ambulatory_Complete_NoInformation_Problems
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CCD_Transition_of_Care_Ambulatory_Complete_NoInformation_Problems
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<?xml version="1.0" encoding="UTF-8" standalone="yes"?><?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!-- Title: US_Realm_Header_Template -->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
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<!-- ******************************************************** CDA Header
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<!-- US General Header Template -->
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<!-- *** Note: The next templateId, code and title will differ depending
on what type of document is being sent. *** -->
<!-- conforms to the document specific requirements -->
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<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9"
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<title>Community Health and Hospitals: Health Summary</title>
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<!-- Fake ID using HL7 example OID. -->
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<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
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<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
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<telecom value="tel:(816)276-6909" use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<patient>
<name use="L">
<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
<given>Isabella</given>
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<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
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codeSystemName="HL7 Religious Affiliation" codeSystem="2.16.840.1.113883.5.1076"/>
<!-- CDC Race and Ethnicity code set contains the minimum race and ethnicity categories defined by OMB Standards for Race and Ethnicity -->
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<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
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<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
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<guardianPerson>
<name>
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<country>US</country>
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</place>
</birthplace>
<languageCommunication>
<languageCode code="eng"/>
<!-- EN is "English" as in the IG -->
<modeCode code="ESP" displayName="Expressed spoken"
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<proficiencyLevelCode code="G" displayName="Good"
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<providerOrganization>
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<telecom use="WP" value="tel: 555-555-5000"/>
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<author>
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<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
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<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
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</assignedAuthor>
</author>
<dataEnterer>
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<id root="2.16.840.1.113883.4.6" extension="999999943252"/>
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<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
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<informant>
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<addr>
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<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
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<family>Seven</family>
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</informant>
<informant>
<relatedEntity classCode="PRS">
<!-- classCode PRS represents a person with personal relationship with
the patient. -->
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<relatedPerson>
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<given>Frank</given>
<family>Jones</family>
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</relatedPerson>
</relatedEntity>
</informant>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id extension="99999999" root="2.16.840.1.113883.4.6"/>
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<telecom value="tel: 555-555-1002" use="WP"/>
<addr use="WP">
<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<informationRecipient>
<intendedRecipient>
<informationRecipient>
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<given>Henry</given>
<family>Seven</family>
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<name>Community Health and Hospitals</name>
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</informationRecipient>
<legalAuthenticator>
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<assignedPerson>
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<given>Henry</given>
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</legalAuthenticator>
<authenticator>
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<assignedEntity>
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<country>US</country>
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<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
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</assignedEntity>
</authenticator>
<documentationOf>
<serviceEvent classCode="PCPR">
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<effectiveTime>
<low value="201209080000-0400"/>
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<performer typeCode="PRF">
<functionCode code="PP" displayName="Primary Performer"
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<originalText>Primary Care Provider</originalText>
</functionCode>
<assignedEntity>
<!-- Provider NPI "PseudoMD-1" -->
<id extension="PseudoMD-1" root="2.16.840.1.113883.4.6"/>
<code code="207RG0100X" displayName="Gastroenterologist"
codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</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>
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<representedOrganization>
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<telecom value="tel:+1-555-555-5000" use="HP"/>
<addr>
<streetAddressLine>1001 Village Avenue</streetAddressLine>
<city>Portland</city>
<state>OR</state>
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<country>US</country>
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</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!-- ******************************************************** CDA Body ******************************************************** -->
<component>
<structuredBody>
<!-- *************************************** ADVANCE DIRECTIVES************************** -->
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<section>
<!-- conforms to Advance Directives section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.21"/>
<!-- Advance Directives section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.21.1"/>
<code code="42348-3" codeSystem="2.16.840.1.113883.6.1"/>
<title>ADVANCE DIRECTIVES</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Directive</th>
<th>Description</th>
<th>Verification</th>
<th>Supporting Document(s)</th>
</tr>
</thead>
<tbody>
<tr>
<td>Resuscitation status</td>
<td>
<content ID="AD1">Do not resuscitate</content>
</td>
<td>Dr. Robert Dolin, Feb 13, 2011</td>
<td>
<linkHtml
href="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf"
>Advance directive</linkHtml>
</td>
</tr>
</tbody>
</table>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
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<!-- ** Advance Directive Observation ** -->
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<participant typeCode="VRF">
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<given>Robert</given>
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</participantRole>
</participant>
<participant typeCode="CST">
<participantRole classCode="AGNT">
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(555)555-1003"/>
<playingEntity>
<name>
<prefix>Dr.</prefix>
<family>Dolin</family>
<given>Robert</given>
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<reference typeCode="REFR">
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</text>
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</observation>
</entry>
</section>
</component>
<!-- ********************************* Allergies, Adverse Reactions, Alerts ****************************** -->
<component>
<section>
<!-- conforms to Allergies section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.6"/>
<!-- Allergies section with entries required -->
<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"/>
<title>ALLERGIES, ADVERSE REACTIONS, ALERTS</title>
<text>No Known Allergies 10/03/2010 </text>
<entry typeCode="DRIV">
<!-- Allergy Concern Act -->
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<!-- Review use of 48765-2 with SDWG, consider consistency with problem concern act -->
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/> <!--currently tracked concerns are active concerns-->
<effectiveTime>
<low value="20091201"/> <!--show time when the concern first began being tracked-->
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<!-- No Known Allergies -->
<observation classCode="OBS" moodCode="EVN" negationInd="true">
<!-- allergy - intolerance observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<!-- date/time the patient made the assertion -->
<effectiveTime>
<low value="20100103"/>
</effectiveTime>
<value xsi:type="CD" code="419199007"
displayName="Allergy to substance (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
</observation>
</entryRelationship>
</act>
</entry>
<entry typeCode="DRIV">
<!-- Allergy Concern Act -->
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<!-- Review use of 48765-2 with SDWG, consider consistency with problem concern act -->
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/> <!--currently tracked concerns are active concerns-->
<effectiveTime>
<low value="20091201"/> <!--show time when the concern first began being tracked-->
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<!-- No Known Allergies -->
<observation classCode="OBS" moodCode="EVN" negationInd="true">
<!-- allergy - intolerance observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<!-- date/time the patient made the assertion -->
<effectiveTime nullFlavor="NA"/>
<value xsi:type="CD" code="419199007"
displayName="Allergy to substance (disorder)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<author>
<time value="20100103"/>
<assignedAuthor>
<id extension="99999999" root="2.16.840.1.113883.4.6"/>
<code code="200000000X" codeSystem="2.16.840.1.113883.6.101"
displayName="Allopathic & Osteopathic Physicians"/>
<telecom use="WP" value="tel:555-555-1002"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- ************************************ ASSESSMENT ************************************ -->
<component>
<section>
<!-- Assessment 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="ASSESSMENT"/>
<title>ASSESSMENT</title>
<text>
<list listType="ordered" ID="problem15">
<item>Recurrent GI bleed of unknown etiology; hypotension perhaps
secondary to this but as likely secondary to polypharmacy.</item>
<item>Acute on chronic anemia secondary to #1.</item>
<item>Azotemia, acute renal failure with volume loss secondary to
#1.</item>
<item>Hyperkalemia secondary to #3 and on ACE and K+ supplement.</item>
<item>Other chronic diagnoses as noted above, currently stable.</item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<!-- ** Problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
<code code="409586006" codeSystem="2.16.840.1.113883.6.96"
displayName="Complaint"/>
<text>
<reference value="#problem15"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20080103"/>
<high value="20080103"/>
</effectiveTime>
<value xsi:type="CD" code="233604007"
codeSystem="2.16.840.1.113883.6.96" displayName="Pneumonia"/>
</observation>
</entry>
</section>
</component>
<!-- ******************************* ENCOUNTERS ***************************** -->
<component>
<section>
<!-- conforms to Encounters section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.22"/>
<!-- Encounters section with entries required -->
<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</th>
<th>Performer</th>
<th>Location</th>
<th>Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="Encounter1"/> Checkup Examination </td>
<td>Performer Name</td>
<td>Community Urgent Care Center</td>
<td>20090227130000+0500</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<encounter classCode="ENC" moodCode="EVN">
<!-- ** Encounter activities ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
<code code="99213" displayName="Office outpatient visit 15 minutes"
codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12"
codeSystemVersion="4">
<originalText> Checkup Examination <reference value="#Encounter1"/>
</originalText>
<translation code="AMB" codeSystem="2.16.840.1.113883.5.4"
displayName="Ambulatory" codeSystemName="HL7 ActEncounterCode"/>
</code>
<!-- February 27, 2009 at 1:00PM EST -->
<effectiveTime value="20090227130000+0500"/>
<performer>
<assignedEntity>
<!-- Provider NPI "PseduoMD-3" -->
<id root="PseduoMD-3"/>
<code code="59058001" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="General Physician"/>
</assignedEntity>
</performer>
<participant typeCode="LOC">
<participantRole classCode="SDLOC">
<templateId root="2.16.840.1.113883.10.20.22.4.32"/>
<!-- Service Delivery Location template -->
<code code="1160-1" codeSystem="2.16.840.1.113883.6.259"
codeSystemName="HealthcareServiceLocation"
displayName="Urgent Care Center"/>
<addr>
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom nullFlavor="UNK"/>
<playingEntity classCode="PLC">
<name>Community Urgent Care Center</name>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="RSON">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id root="db734647-fc99-424c-a864-7e3cda82e703"
extension="45665"/>
<code code="404684003" displayName="Finding"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20070103"/>
</effectiveTime>
<value xsi:type="CD" code="233604007" displayName="Pneumonia"
codeSystem="2.16.840.1.113883.6.96"/>
</observation>
</entryRelationship>
</encounter>
</entry>
</section>
</component>
<!-- ************************ FAMILY HISTORY ********************************** -->
<component>
<section>
<!-- Family history section -->
<templateId root="2.16.840.1.113883.10.20.22.2.15"/>
<code code="10157-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>FAMILY HISTORY</title>
<text>
<paragraph>Father (deceased)</paragraph>
<table border="1" width="100%">
<thead>
<tr>
<th>Diagnosis</th>
<th>Age At Onset</th>
</tr>
</thead>
<tbody>
<tr>
<td>Myocardial Infarction (cause of death)</td>
<td>57</td>
</tr>
<tr>
<td>Diabetes</td>
<td>40</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer moodCode="EVN" classCode="CLUSTER">
<!-- ** Family history organizer ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.45"/>
<statusCode code="completed"/>
<subject>
<relatedSubject classCode="PRS">
<code code="FTH" displayName="Father"
codeSystemName="FamilyRelationshipRoleType"
codeSystem="2.16.840.1.113883.5.111">
<translation code="9947008" displayName="Biological father"
codeSystemName="SNOMED"
codeSystem="2.16.840.1.113883.6.96"/>
</code>
<subject>
<!--<sdtc:id root="2.16.840.1.113883.19.5.99999.2"
extension="99999999"/>-->
<administrativeGenderCode code="M"
codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="1910"/>
<!-- Example use of sdtc extensions included below in comments -->
<!-- <sdtc:deceasedInd value="true"/> <sdtc:deceasedTime value="1967"/> -->
</subject>
</relatedSubject>
</subject>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- ** Family history observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.46"/>
<id root="d42ebf70-5c89-11db-b0de-0800200c9a66"/>
<code code="64572001" displayName="Condition"
codeSystemName="SNOMED CT"
codeSystem="2.16.840.1.113883.6.96"/>
<statusCode code="completed"/>
<effectiveTime value="1967"/>
<value xsi:type="CD" code="22298006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Myocardial infarction"/>
<entryRelationship typeCode="CAUS">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Family history death observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.47"/>
<id root="6898fae0-5c8a-11db-b0de-0800200c9a66"/>
<code code="ASSERTION"
codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="419099009"
codeSystem="2.16.840.1.113883.6.96"
displayName="Dead"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Age observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
<code code="445518008"
codeSystem="2.16.840.1.113883.6.96"
displayName="Age At Onset"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="57" unit="a"/>
</observation>
</entryRelationship>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- ** Family history observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.46"/>
<id root="5bfe3ec0-5c8b-11db-b0de-0800200c9a66"/>
<code code="64572001" displayName="Condition"
codeSystemName="SNOMED CT"
codeSystem="2.16.840.1.113883.6.96"/>
<statusCode code="completed"/>
<effectiveTime value="1950"/>
<value xsi:type="CD" code="44054006"
codeSystem="2.16.840.1.113883.6.96"
displayName="Diabetes mellitus type 2"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Age observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
<code code="445518008"
codeSystem="2.16.840.1.113883.6.96"
displayName="Age At Onset"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="40" unit="a"/>
</observation>
</entryRelationship>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!-- **************************** FUNCTIONAL STATUS ************************************ -->
<component>
<section>
<!-- Functional status section -->
<templateId root="2.16.840.1.113883.10.20.22.2.14"/>
<code code="47420-5" codeSystem="2.16.840.1.113883.6.1"/>
<title>Functional Status</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Functional or Cognitive Finding</th>
<th>Observation</th>
<th>Observation Date</th>
<th>Condition Status</th>
</tr>
</thead>
<tbody>
<tr>
<td><content ID="FUNC1">Ambulation(Dependent to
Independent)</content></td>
<td>Independently able</td>
<td>March 11, 2009</td>
<td>Active</td>
</tr>
<tr>
<td><content ID="FUNC2">Finding of Functional Performance and
Activity</content></td>
<td>Dyspnea</td>
<td>February 2007</td>
<td>Active</td>
</tr>
<tr>
<td>Cognitive Function Finding</td>
<td><content ID="COG2">Memory impairment</content></td>
<td>April 2007</td>
<td>Active</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.1"/>
<!-- ** conforms to Result Organizer ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.66"/>
<!-- Functional Status Result Organizer template -->
<id root="9295dba4-df05-46bb-b94e-f2c4e4b156f8"/>
<code code="d5" displayName="Self-Care"
codeSystem="2.16.840.1.113883.6.254" codeSystemName="ICF"/>
<statusCode code="completed"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- ** conforms to Result observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<!-- ** Functional status result observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.67"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0a"/>
<code code="57251-1" displayName="Ambulation"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#FUNC1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="200903111230"/>
<value xsi:type="CD" code="371153006"
displayName="Independently able"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
<interpretationCode code="B" codeSystem="2.16.840.1.113883.5.83"/>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Assessment scale observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.69"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0b"/>
<code code="54614-3"
displayName="Brief Interview for Mental Status"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<derivationExpr>Text description of the
calculation</derivationExpr>
<statusCode code="completed"/>
<effectiveTime value="20120214"/>
<!-- Summed score of the component values -->
<value xsi:type="INT" value="7"/>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Assessment scale supporting observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.86"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a33"/>
<code code="52731-7"
displayName="Repetition of Three Words"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA6395-3"
displayName="Three"
codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<!-- ** Assessment scale supporting observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.86"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a22"/>
<code code="52732-5"
displayName="Temporal orientation - current year"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA10966-2"
displayName="Missed by 2-5 years"
codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<!--
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
** Caregiver characteristics **
<templateId root="2.16.840.1.113883.10.20.22.4.72"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0c"/>
<code code="ASSERTION"
codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="422615001"
codeSystem="2.16.840.1.113883.6.96"
displayName="caregiver difficulty providing physical care"/>
<participant typeCode="IND">
<participantRole classCode="IND">
<code code="MTH"
codeSystem="2.16.840.1.113883.5.111"
displayName="Mother"/>
</participantRole>
</participant>
</observation>
</entryRelationship> -->
</observation>
</entryRelationship>
</observation>
</component>
</organizer>
</entry>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<!-- ** conforms to Problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<!-- ** Functional status problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.68"/>
<id root="08edb7c0-2111-43f2-a784-9a5fdfaa67f0"/>
<code code="248536006" codeSystem="2.16.840.1.113883.6.96"
displayName="Finding of Functional Performance and Activity"/>
<text>
<reference value="#FUNC2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="200702"/>
<high value="200704"/>
</effectiveTime>
<value xsi:type="CD" code=" 162891007"
codeSystem="2.16.840.1.113883.6.96" displayName="dyspnea"/>
</observation>
</entry>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<!-- ** conforms to Problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<!-- ** Cognitive status problem observation ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.73"/>
<id root="08edb7c0-2111-43f2-a784-9a5fdfaa67f0"/>
<code code="373930000" codeSystem="2.16.840.1.113883.6.96"
displayName="Cognitive Function Finding"/>
<text>
<reference value="#COG2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="200704"/>
<high value="200706"/>
</effectiveTime>
<value xsi:type="CD" code="386807006"
codeSystem="2.16.840.1.113883.6.96" displayName="Memory impairment"
/>
</observation>
</entry>
</section>
</component>
<!-- ******************** IMMUNIZATIONS ********************* -->
<component>
<section>
<!-- conforms to Immunizations section with entries optional -->
<templateId root="2.16.840.1.113883.10.20.22.2.2"/>
<!-- Immunizations section with entries required -->
<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>
<content ID="immunSect"/>
<table border="1" width="100%">
<thead>
<tr>
<th>Vaccine</th>
<th>Date</th>
<th>Status</th>
</tr>
</thead>
<tbody>
<tr ID="immun1">
<td> Unknown Immunization Status</td>
<td>Nov 1999</td>
<td>Completed</td>
</tr>
</tbody>
</table>
</text>
<entry>
<substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="false" nullFlavor="NI">
<!-- We selected NI for this example, C-CDA R2 may describe other appropriate nullFlavors -->
<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
<!-- **** Immunization activity template **** -->
<id root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f88"/>
<!-- No information on whether the patient received a vaccination -->
<text>
<reference value="#immun1"/>
</text>
<!-- Link to narrative stating no information on whether the patient received a vaccination -->
<statusCode code="completed"/>
<effectiveTime value="199911"/>
<!-- Date which you do not know whether or not patient received a vaccination -->
<consumable>
<manufacturedProduct classCode="MANU">
<!-- ** Immunization medication information ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
<manufacturedMaterial>