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<?xml version="1.0" encoding="UTF-8"?>
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 http://xreg2.nist.gov:8080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd">
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<code code="34133-9" displayName="Summarization of episode note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Cypress C32 Patient Test Record: Nelson Tuff</title>
<effectiveTime value="20120706201823"/>
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<id root="Cypress" extension="4ff7480f1d41c8778e000e11"/>
<addr use="HP">
<streetAddressLine>202 Burlington Rd.</streetAddressLine>
<city>Bedford</city>
<state>MA</state>
<postalCode>01730</postalCode>
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<name>
<given>Nelson</given>
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<author>
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<id/>
<addr/>
<telecom value="tel:+1-781-271-3000"/>
<assignedPerson>
<name>Auto Generated</name>
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<custodian>
<assignedCustodian>
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<id/>
<name>Cypress</name>
<telecom value="tel:+1-781-271-3000"/>
<addr>
<streetAddressLine>202 Burlington Rd.</streetAddressLine>
<city>Bedford</city>
<state>MA</state>
<postalCode>01730</postalCode>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
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<structuredBody>
<component> <!-- Allergies: patient has no allergies --> <section> <templateId root="2.16.840.1.113883.3.88.11.83.102" assigningAuthorityName="HITSP/C83"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.13" assigningAuthorityName="IHE PCC"/>
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<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem List"/> <title>Allergies and Adverse Reactions</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Description</th> <th>Code</th> <th>Time</th> </tr> </thead> <tbody> <tr ID="noallergies_summary"> <td ID="noallergies">No Known allergies</td>
<td>160244002</td> <td>20120706201823</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV">
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<component>
<!--Medications-->
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<code code="10160-0" displayName="History of medication use" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Medications - Prescription and Non-Prescription</title>
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<table border="1" width="100%">
<thead>
<tr>
<th>Description</th>
<th>Codes</th>
<th>Time</th>
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<tbody>
<tr>
<td ID="medications-desc-0">Antidiabetic agents</td>
<td ID="medications-code-0">RxNorm: 744863<br/><i>C1635056:exenatide 0.25 MG/ML Injectable Solution;</i></td>
<td>March 31st, 2010 04:00</td>
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<tr>
<td ID="medications-desc-1">Antidiabetic agents</td>
<td ID="medications-code-1">RxNorm: 744863<br/><i>C1635056:exenatide 0.25 MG/ML Injectable Solution;</i></td>
<td>January 15th, 2011 05:00</td>
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<!--CCD Medication activity - Required-->
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<name>Antidiabetic agents</name>
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<title>Encounters</title>
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<table border="1" width="100%">
<thead>
<tr>
<th>Description</th>
<th>Codes</th>
<th>Time</th>
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<tbody>
<tr>
<td ID="encounters-desc-0">Encounter Outpatient</td>
<td ID="encounters-code-0">CPT: 99213 ICD-9-CM: V70.0<br/><i>C0374559:Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.;</i></td>
<td>January 15th, 2011 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-1">encounter outpatient-children</td>
<td ID="encounters-code-1">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>October 2nd, 2010 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-2">Encounter Outpatient</td>
<td ID="encounters-code-2">CPT: 99213 ICD-9-CM: V70.0<br/><i>C0374559:Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.;</i></td>
<td>July 9th, 2010 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-3">encounter outpatient-children</td>
<td ID="encounters-code-3">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>May 20th, 2010 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-4">Encounter Outpatient</td>
<td ID="encounters-code-4">CPT: 99213 ICD-9-CM: V70.0<br/><i>C0374559:Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.;</i></td>
<td>March 31st, 2010 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-5">Encounter Outpatient</td>
<td ID="encounters-code-5">CPT: 99213 ICD-9-CM: V70.0<br/><i>C0374559:Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.;</i></td>
<td>February 6th, 2008 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-6">encounter outpatient-children</td>
<td ID="encounters-code-6">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>September 26th, 2006 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-7">encounter outpatient-children</td>
<td ID="encounters-code-7">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>February 18th, 2006 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-8">encounter outpatient-children</td>
<td ID="encounters-code-8">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>November 10th, 2005 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-9">encounter outpatient-children</td>
<td ID="encounters-code-9">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>August 22nd, 2005 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-10">encounter outpatient-children</td>
<td ID="encounters-code-10">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>February 16th, 2005 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-11">encounter outpatient-children</td>
<td ID="encounters-code-11">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>December 15th, 2004 05:00</td>
</tr>
<tr>
<td ID="encounters-desc-12">encounter outpatient-children</td>
<td ID="encounters-code-12">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>October 30th, 2004 04:00</td>
</tr>
<tr>
<td ID="encounters-desc-13">encounter outpatient-children</td>
<td ID="encounters-code-13">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>August 21st, 2004 04:00</td>
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<tr>
<td ID="encounters-desc-14">encounter outpatient-children</td>
<td ID="encounters-code-14">ICD-10-CM: Z00.1<br/><i>C2910449:Encounter for newborn, infant and child health examinations;</i></td>
<td>July 7th, 2004 04:00</td>
</tr>
</tbody>
</table>
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<td ID="vitals-desc-0">Systolic Blood Pressure</td>
<td ID="vitals-code-0">SNOMED-CT: 271649006 LOINC: 8480-6<br/><i>C0871470:Systolic Pressure;</i></td>
<td>January 15th, 2011 05:00</td>
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<td ID="vitals-desc-1">Diastolic Blood Pressure</td>
<td ID="vitals-code-1">SNOMED-CT: 271650006 LOINC: 8462-4<br/><i>C0428883:Diastolic blood pressure;</i></td>
<td>January 15th, 2011 05:00</td>
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<td ID="vitals-desc-2">Systolic Blood Pressure</td>
<td ID="vitals-code-2">SNOMED-CT: 271649006 LOINC: 8480-6<br/><i>C0871470:Systolic Pressure;</i></td>
<td>October 2nd, 2010 04:00</td>
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<td ID="vitals-desc-3">Diastolic Blood Pressure</td>
<td ID="vitals-code-3">SNOMED-CT: 271650006 LOINC: 8462-4<br/><i>C0428883:Diastolic blood pressure;</i></td>
<td>October 2nd, 2010 04:00</td>
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<td ID="vitals-desc-4">Systolic Blood Pressure</td>
<td ID="vitals-code-4">SNOMED-CT: 271649006 LOINC: 8480-6<br/><i>C0871470:Systolic Pressure;</i></td>
<td>July 9th, 2010 04:00</td>
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<td ID="vitals-desc-5">Diastolic Blood Pressure</td>
<td ID="vitals-code-5">SNOMED-CT: 271650006 LOINC: 8462-4<br/><i>C0428883:Diastolic blood pressure;</i></td>
<td>July 9th, 2010 04:00</td>
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<td ID="vitals-desc-6">Systolic Blood Pressure</td>
<td ID="vitals-code-6">SNOMED-CT: 271649006 LOINC: 8480-6<br/><i>C0871470:Systolic Pressure;</i></td>
<td>May 20th, 2010 04:00</td>
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<td ID="vitals-desc-7">Diastolic Blood Pressure</td>
<td ID="vitals-code-7">SNOMED-CT: 271650006 LOINC: 8462-4<br/><i>C0428883:Diastolic blood pressure;</i></td>
<td>May 20th, 2010 04:00</td>
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<td ID="vitals-desc-8">Systolic Blood Pressure</td>
<td ID="vitals-code-8">SNOMED-CT: 271649006 LOINC: 8480-6<br/><i>C0871470:Systolic Pressure;</i></td>
<td>March 31st, 2010 04:00</td>
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<td ID="vitals-desc-9">Diastolic Blood Pressure</td>
<td ID="vitals-code-9">SNOMED-CT: 271650006 LOINC: 8462-4<br/><i>C0428883:Diastolic blood pressure;</i></td>
<td>March 31st, 2010 04:00</td>
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<td ID="vitals-desc-10">BMI</td>
<td ID="vitals-code-10">SNOMED-CT: 60621009 LOINC: 39156-5<br/><i>C1542867:Body mass index:Relative Density:Point in time:^Patient:Quantitative;</i></td>
<td>January 15th, 2011 05:00</td>
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<td ID="vitals-desc-11">BMI</td>
<td ID="vitals-code-11">SNOMED-CT: 60621009 LOINC: 39156-5<br/><i>C1542867:Body mass index:Relative Density:Point in time:^Patient:Quantitative;</i></td>
<td>October 2nd, 2010 04:00</td>
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<td ID="vitals-desc-12">BMI</td>
<td ID="vitals-code-12">SNOMED-CT: 60621009 LOINC: 39156-5<br/><i>C1542867:Body mass index:Relative Density:Point in time:^Patient:Quantitative;</i></td>
<td>March 31st, 2010 04:00</td>
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<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a911efe0-a9d5-012f-03d7-000c297b3103"/>
<code code="8462-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>Diastolic Blood Pressure</originalText><translation code="271650006" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-7"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100520040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a911f610-a9d5-012f-03d7-000c297b3103"/>
<code code="8480-6" codeSystem="2.16.840.1.113883.6.1" ><originalText>Systolic Blood Pressure</originalText><translation code="271649006" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-8"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100331040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a911fbd0-a9d5-012f-03d7-000c297b3103"/>
<code code="8462-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>Diastolic Blood Pressure</originalText><translation code="271650006" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-9"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100331040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a9120190-a9d5-012f-03d7-000c297b3103"/>
<code code="39156-5" codeSystem="2.16.840.1.113883.6.1" ><originalText>BMI</originalText><translation code="60621009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-10"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20110115050000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a9120730-a9d5-012f-03d7-000c297b3103"/>
<code code="39156-5" codeSystem="2.16.840.1.113883.6.1" ><originalText>BMI</originalText><translation code="60621009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-11"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20101002040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.14" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13.2" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a9120cb0-a9d5-012f-03d7-000c297b3103"/>
<code code="39156-5" codeSystem="2.16.840.1.113883.6.1" ><originalText>BMI</originalText><translation code="60621009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="vitals-desc-12"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100331040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<component>
<!--Surgeries-->
<section>
<templateId root="2.16.840.1.113883.10.20.1.12" assigningAuthorityName="HL7 CCD"/>
<templateId root="2.16.840.1.113883.3.88.11.83.108" assigningAuthorityName="HITSP/C83"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.12" assigningAuthorityName="IHE PCC"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.11" assigningAuthorityName="IHE PCC"/>
<!--Surgeries section template-->
<code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="List of surgeries"/>
<title>Surgeries</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Description</th>
<th>Codes</th>
<th>Time</th>
</tr>
</thead>
<tbody>
<tr>
<td ID="procedures-desc-0">dietary consultation order</td>
<td ID="procedures-code-0">SNOMED-CT: 103699006<br/><i>C0420347:Patient referral to dietitian;</i></td>
<td>March 31st, 2010 04:00</td>
</tr>
<tr>
<td ID="procedures-desc-1">dietary consultation order</td>
<td ID="procedures-code-1">SNOMED-CT: 103699006<br/><i>C0420347:Patient referral to dietitian;</i></td>
<td>January 15th, 2011 05:00</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
<!-- Procedure activity template -->
<id root="a9124620-a9d5-012f-03d7-000c297b3103"/>
<code code="103699006" codeSystem="2.16.840.1.113883.6.96" displayName="dietary consultation order">
<originalText><reference value="#procedures-desc-0"/></originalText>
</code>
<text>
<reference value="#procedures-desc-0"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100331040000'/>
</procedure>
</entry>
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
<!-- Procedure activity template -->
<id root="a9125b60-a9d5-012f-03d7-000c297b3103"/>
<code code="103699006" codeSystem="2.16.840.1.113883.6.96" displayName="dietary consultation order">
<originalText><reference value="#procedures-desc-1"/></originalText>
</code>
<text>
<reference value="#procedures-desc-1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20110115050000'/>
</procedure>
</entry>
</section>
</component>
<component>
<!--Diagnostic Results-->
<section>
<templateId root="2.16.840.1.113883.3.88.11.83.122" assigningAuthorityName="HITSP/C83"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.28" assigningAuthorityName="IHE PCC"/>
<!--Diagnostic Results section template-->
<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Results"/>
<title>Diagnostic Results</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Description</th>
<th>Codes</th>
<th>Time</th>
<th>Value</th>
</tr>
</thead>
<tbody>
<tr>
<td ID="results-desc-0">Foot Exam</td>
<td ID="results-code-0">SNOMED-CT: 401191002<br/><i>C1303165:Diabetic foot examination;</i></td>
<td>January 15th, 2011 05:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-1">Foot Exam</td>
<td ID="results-code-1">SNOMED-CT: 401191002<br/><i>C1303165:Diabetic foot examination;</i></td>
<td>July 9th, 2010 04:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-2">Foot Exam</td>
<td ID="results-code-2">SNOMED-CT: 401191002<br/><i>C1303165:Diabetic foot examination;</i></td>
<td>February 10th, 2010 05:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-3">HbA1c test</td>
<td ID="results-code-3">CPT: 83036 LOINC: 4548-4 SNOMED-CT: 43396009<br/><i>C0474680:Hemoglobin A1c measurement;</i></td>
<td>January 15th, 2011 05:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-4">HbA1c test</td>
<td ID="results-code-4">CPT: 83036 LOINC: 4548-4 SNOMED-CT: 43396009<br/><i>C0474680:Hemoglobin A1c measurement;</i></td>
<td>October 2nd, 2010 04:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-5">HbA1c test</td>
<td ID="results-code-5">CPT: 83036 LOINC: 4548-4 SNOMED-CT: 43396009<br/><i>C0474680:Hemoglobin A1c measurement;</i></td>
<td>July 9th, 2010 04:00</td>
<td></td>
</tr>
<tr>
<td ID="results-desc-6">HbA1c test</td>
<td ID="results-code-6">CPT: 83036 LOINC: 4548-4 SNOMED-CT: 43396009<br/><i>C0474680:Hemoglobin A1c measurement;</i></td>
<td>March 31st, 2010 04:00</td>
<td></td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<organizer classCode="BATTERY" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.32"/>
<!--Result organizer template -->
<id root="a912dae0-a9d5-012f-03d7-000c297b3103"/>
<code nullFlavor="NA"/>
<statusCode code="completed"/>
<effectiveTime value="20120706201823"/>
<component>
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.17" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.29" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.19" assigningAuthorityName="IHE PCC"/>
<id root="a912dca0-a9d5-012f-03d7-000c297b3103"/>
<code nullFlavor="UNK">
<originalText><reference value="Unknown"/></originalText>
</code>
<text>
<reference value="Unknown"/>
</text>
<statusCode code="completed"/>
<effectiveTime nullFlavor="UNK"/>
</procedure>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912dda0-a9d5-012f-03d7-000c297b3103"/>
<code code="401191002" codeSystem="2.16.840.1.113883.6.96" ><originalText>Foot Exam</originalText></code>
<text>
<reference value="#results-desc-0"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20110115050000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912e3b0-a9d5-012f-03d7-000c297b3103"/>
<code code="401191002" codeSystem="2.16.840.1.113883.6.96" ><originalText>Foot Exam</originalText></code>
<text>
<reference value="#results-desc-1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100709040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912e930-a9d5-012f-03d7-000c297b3103"/>
<code code="401191002" codeSystem="2.16.840.1.113883.6.96" ><originalText>Foot Exam</originalText></code>
<text>
<reference value="#results-desc-2"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100210050000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912f3a0-a9d5-012f-03d7-000c297b3103"/>
<code code="4548-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>HbA1c test</originalText><translation code="83036" codeSystem="2.16.840.1.113883.6.12"/>
<translation code="43396009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="#results-desc-3"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20110115050000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912f9d0-a9d5-012f-03d7-000c297b3103"/>
<code code="4548-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>HbA1c test</originalText><translation code="83036" codeSystem="2.16.840.1.113883.6.12"/>
<translation code="43396009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="#results-desc-4"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20101002040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a912ffe0-a9d5-012f-03d7-000c297b3103"/>
<code code="4548-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>HbA1c test</originalText><translation code="83036" codeSystem="2.16.840.1.113883.6.12"/>
<translation code="43396009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="#results-desc-5"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100709040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.3.88.11.83.15.1" assigningAuthorityName="HITSP C83"/>
<templateId root="2.16.840.1.113883.10.20.1.31" assigningAuthorityName="CCD"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.13" assigningAuthorityName="IHE PCC"/>
<!-- Result observation template -->
<id root="a91305e0-a9d5-012f-03d7-000c297b3103"/>
<code code="4548-4" codeSystem="2.16.840.1.113883.6.1" ><originalText>HbA1c test</originalText><translation code="83036" codeSystem="2.16.840.1.113883.6.12"/>
<translation code="43396009" codeSystem="2.16.840.1.113883.6.96"/>
</code>
<text>
<reference value="#results-desc-6"/>
</text>
<statusCode code="completed"/>
<effectiveTime value='20100331040000'/>
<value xsi:type="PQ" value="" />
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<component>
<!--Immunizations-->
<section>
<templateId root="2.16.840.1.113883.3.88.11.83.117" assigningAuthorityName="HITSP/C83"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.23" assigningAuthorityName="IHE PCC"/>
<templateId root="2.16.840.1.113883.10.20.1.6" assigningAuthorityName="HL7 CCD"/>
<!--Immunizations section template-->
<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations"/>
<title>Immunizations</title>
<text>
<table border="1" width="100%">
<thead>
<tr>
<th>Description</th>
<th>Codes</th>
<th>Time</th>
</tr>
</thead>
<tbody>
<tr>
<td ID="immunizations-desc-0">Hepatitis A Vaccine</td>
<td ID="immunizations-code-0">RxNorm: 798481<br/><i>C0995082:0.5 ML Hepatitis A Vaccine (Inactivated) Strain HM175 1440 UNT/ML Prefilled Syringe;</i></td>
<td>September 26th, 2006 04:00</td>
</tr>
<tr>
<td ID="immunizations-desc-1">DTAP Vaccine</td>
<td ID="immunizations-code-1">RxNorm: 795926<br/><i>C1697230:Diphtheria Toxoid Vaccine 13.4 UNT/ML / Tetanus Toxoid Vaccine 10 UNT/ML Injectable Solution;</i></td>
<td>February 18th, 2006 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-2">IPV Vaccination</td>
<td ID="immunizations-code-2">CPT: 90713 CVX: 10<br/><i></i></td>
<td>February 18th, 2006 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-3">MMR Vaccine</td>
<td ID="immunizations-code-3">RxNorm: 804186<br/><i>C0710716:Measles Virus Vaccine Live, Enders' attenuated Edmonston strain 2000 UNT/ML / Mumps Virus Vaccine Live, Jeryl Lynn Strain 25000 UNT/ML / Rubella Virus Vaccine Live (Wistar RA 27-3 Strain) 2000 UNT/ML Injectable Solution [M-M-R II];</i></td>
<td>November 10th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-4">VZV Vaccine</td>
<td ID="immunizations-code-4">RxNorm: 759609<br/><i>C1814392:Varicella Virus Vaccine Live (Oka-Merck) strain 29800 UNT/ML Injectable Suspension [Zostavax];</i></td>
<td>November 10th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-5">Hepatitis A Vaccine</td>
<td ID="immunizations-code-5">RxNorm: 798481<br/><i>C0995082:0.5 ML Hepatitis A Vaccine (Inactivated) Strain HM175 1440 UNT/ML Prefilled Syringe;</i></td>
<td>November 10th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-6">Pneumococcal Vaccine</td>
<td ID="immunizations-code-6">RxNorm: 854969<br/><i>C2709773:pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML;</i></td>
<td>August 22nd, 2005 04:00</td>
</tr>
<tr>
<td ID="immunizations-desc-7">Influenza Vaccine</td>
<td ID="immunizations-code-7">RxNorm: 857942<br/><i>C2718407:Influenza Virus Vaccine, Inactivated A-Brisbane-59-2007, IVR-148 (H1N1) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated A-Uruguay-716-2007, NYMC X-175C (H3N2) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated B-Brisbane-60-2008 strain 0.03 MG/ML Injectable Suspension;</i></td>
<td>August 22nd, 2005 04:00</td>
</tr>
<tr>
<td ID="immunizations-desc-8">Hepatitis B Vaccine</td>
<td ID="immunizations-code-8">RxNorm: 763313<br/><i>C1302891:0.5 ML Hepatitis B Vaccine 0.02 MG/ML Prefilled Syringe;</i></td>
<td>February 16th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-9">DTAP Vaccine</td>
<td ID="immunizations-code-9">RxNorm: 795926<br/><i>C1697230:Diphtheria Toxoid Vaccine 13.4 UNT/ML / Tetanus Toxoid Vaccine 10 UNT/ML Injectable Solution;</i></td>
<td>February 16th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-10">Pneumococcal Vaccine</td>
<td ID="immunizations-code-10">RxNorm: 854969<br/><i>C2709773:pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML;</i></td>
<td>February 16th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-11">Influenza Vaccine</td>
<td ID="immunizations-code-11">RxNorm: 857942<br/><i>C2718407:Influenza Virus Vaccine, Inactivated A-Brisbane-59-2007, IVR-148 (H1N1) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated A-Uruguay-716-2007, NYMC X-175C (H3N2) strain 0.03 MG/ML / Influenza Virus Vaccine, Inactivated B-Brisbane-60-2008 strain 0.03 MG/ML Injectable Suspension;</i></td>
<td>February 16th, 2005 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-12">DTAP Vaccine</td>
<td ID="immunizations-code-12">RxNorm: 795926<br/><i>C1697230:Diphtheria Toxoid Vaccine 13.4 UNT/ML / Tetanus Toxoid Vaccine 10 UNT/ML Injectable Solution;</i></td>
<td>December 15th, 2004 05:00</td>
</tr>
<tr>
<td ID="immunizations-desc-13">HiB Vaccine</td>
<td ID="immunizations-code-13">CPT: 90721 CVX: 51<br/><i></i></td>
<td>December 15th, 2004 05:00</td>
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<tr>
<td ID="immunizations-desc-14">Pneumococcal Vaccine</td>
<td ID="immunizations-code-14">RxNorm: 854969<br/><i>C2709773:pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML;</i></td>
<td>December 15th, 2004 05:00</td>
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<td ID="immunizations-desc-15">IPV Vaccination</td>
<td ID="immunizations-code-15">CPT: 90713 CVX: 10<br/><i></i></td>
<td>December 15th, 2004 05:00</td>
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<td ID="immunizations-desc-16">DTAP Vaccine</td>
<td ID="immunizations-code-16">RxNorm: 795926<br/><i>C1697230:Diphtheria Toxoid Vaccine 13.4 UNT/ML / Tetanus Toxoid Vaccine 10 UNT/ML Injectable Solution;</i></td>
<td>October 30th, 2004 04:00</td>
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<tr>
<td ID="immunizations-desc-17">HiB Vaccine</td>
<td ID="immunizations-code-17">CPT: 90721 CVX: 51<br/><i></i></td>
<td>October 30th, 2004 04:00</td>
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<td ID="immunizations-desc-18">Pneumococcal Vaccine</td>
<td ID="immunizations-code-18">RxNorm: 854969<br/><i>C2709773:pneumococcal capsular polysaccharide type 7F vaccine 0.05 MG/ML;</i></td>
<td>October 30th, 2004 04:00</td>
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<tr>
<td ID="immunizations-desc-19">IPV Vaccination</td>
<td ID="immunizations-code-19">CPT: 90713 CVX: 10<br/><i></i></td>
<td>October 30th, 2004 04:00</td>
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<tr>
<td ID="immunizations-desc-20">Hepatitis B Vaccine</td>
<td ID="immunizations-code-20">RxNorm: 763313<br/><i>C1302891:0.5 ML Hepatitis B Vaccine 0.02 MG/ML Prefilled Syringe;</i></td>
<td>August 21st, 2004 04:00</td>
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<tr>
<td ID="immunizations-desc-21">Hepatitis B Vaccine</td>
<td ID="immunizations-code-21">RxNorm: 763313<br/><i>C1302891:0.5 ML Hepatitis B Vaccine 0.02 MG/ML Prefilled Syringe;</i></td>
<td>July 7th, 2004 04:00</td>
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