<?xml version="1.0" encoding="UTF-8"?>
<clinicaldata:clinicalData xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:clinicaldata="Clinicaldata" xmlns:common="Common"
	requestType="READ" templateId="00041" vhimVersion="VHIM3400">
	<intoleranceCondition>
		<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111111.001" />
		<informationSourceCategory code="4500975" codeSet="99VA8985.1" displayName="HISTORICAL" />
		<mechanism code="4501004" codeSet="99VA8985.1" displayName="ALLERGY" nullFlavor="No Value" />
		<observationTime literal="Sun Jan 07 16:26:29 MST 2007" low="20070107162629" />
		<agent code="Not Standardized" codeSet="No Standard Codeset" displayName="IBUPROFEN" />
		<status code="F" codeSet="HL7" displayName="FINAL" />
		<subject vpid="test_vpid_55" />
		<dataEnterer comments="Symptoms not observed" practitionerParticipationType="DataEnterer" vpid="test_vpid_57">
			<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
			<signature xsi:type="common:SignatureImage" thumbnail="VGh1bWJuYWlsIEltYWdl" value="VmFsdWU=">
				<compressionCode code="CompressionCode" codeSet="CompressionCodeSet" displayName="CompressionDisplayName" />
				<mediaTypeCode code="MediaTypeCode" codeSet="MediaTypeCodeSet" displayName="MediaTypeDisplayName" />
			</signature>
		</dataEnterer>
		<author comments="Symptoms Not Observed" practitionerParticipationType="Author" vpid="test_vpid_17">
			<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
			<signature xsi:type="common:SignatureString" value="CDS Signature" />
		</author>
		<reactionObservationEvent description="Wheezing" noReaction="false">
			<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111110.A001" />
			<status code="F" codeSet="HL7" displayName="FINAL" />
			<reaction code="4637149" codeSet="99VA120.83" displayName="WHEEZING" nullFlavor="X NullFlavor 2" otherCode="X Other NCode 2"
				otherDisplayName="X Other NCode Display Name2" />
			<onsetDate literal="Sun Jan 07 16:26:29 MST 2007" low="20070107162629" />
			<author comments="Observed" practitionerParticipationType="Author" vpid="test_vpid_25">
				<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
				<signature xsi:type="common:SignatureImage" thumbnail="VGh1bWJuYWlsIEltYWdl" value="VmFsdWU=">
					<compressionCode code="CompressionCode" codeSet="CompressionCodeSet" displayName="CompressionDisplayName" />
					<mediaTypeCode code="MediaTypeCode" codeSet="MediaTypeCodeSet" displayName="MediaTypeDisplayName" />
				</signature>
			</author>
			<severityObservationEvent>
				<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111112.A011" />
				<value code="Nullable Code 1" codeSet="Nullable Code Set 1" displayName="Nullable Code Display Name1" nullFlavor="NullFlavor 1" />
			</severityObservationEvent>
		</reactionObservationEvent>
		<reactionObservationEvent description="DIARRHEA" noReaction="false">
			<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111111.A001" />
			<status code="F" codeSet="HL7" displayName="FINAL" />
			<reaction code="4637011" codeSet="99VA120.83" displayName="DIARRHEA" nullFlavor="X NullFlavor 2" otherCode="X Other NCode 2"
				otherDisplayName="X Other NCode Display Name2" />
			<onsetDate literal="Sun Jan 07 16:26:29 MST 2007" low="20070107162629" />
			<author comments="Symptom not observed" practitionerParticipationType="Author" vpid="test_vpid_79">
				<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
				<signature xsi:type="common:SignatureElectronic" integrityCheck="aW50ZWdyaXR5Q2hlY2s=" value="dmFsdWU=">
					<integrityCheckAlgorithmCode code="CompressionCode" codeSet="CompressionCodeSet" displayName="CompressionDisplayName" />
					<mediaTypeCode code="MediaTypeCode" codeSet="MediaTypeCodeSet" displayName="MediaTypeDisplayName" />
				</signature>
			</author>
			<severityObservationEvent>
				<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111111.A011" />
				<value code="S" codeSet="No Code Set" displayName="SEVERE" nullFlavor="Not Null" />
			</severityObservationEvent>
		</reactionObservationEvent>
		<severityObservationEvent>
			<id assigningAuthorityName="Default AA Name" extension="Default Extension" root="TH_11111113.A011" />
			<value code="M" codeSet="No code set" displayName="Minor" nullFlavor="Not Null" />
		</severityObservationEvent>
		<serviceLocation>
			<vlid>test_vlid_555</vlid>
		</serviceLocation>
		<verifiers comments=" " practitionerParticipationType="Verifier" vpid="test_vpid_71">
			<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
			<signature xsi:type="common:SignatureString" value="CDS Signature" />
		</verifiers>
		<verifiers comments="Entered corrections to observations" practitionerParticipationType="Verifier" vpid="test_vpid_35">
			<time high="20060202113015" literal="February 2, 2006 at 11:30:15" low="20060202093015" width_unit="minutes" width_value="120.0" />
			<signature xsi:type="common:SignatureElectronic" integrityCheck="aW50ZWdyaXR5Q2hlY2s=" value="dmFsdWU=">
				<integrityCheckAlgorithmCode code="CompressionCode" codeSet="CompressionCodeSet" displayName="CompressionDisplayName" />
				<mediaTypeCode code="MediaTypeCode" codeSet="MediaTypeCodeSet" displayName="MediaTypeDisplayName" />
			</signature>
		</verifiers>
	</intoleranceCondition>
</clinicaldata:clinicalData>
