<?xml version="1.0" encoding="UTF-8"?>
<ClinicalData xmlns="Clinicaldata" xmlns:saxon="http://saxon.sf.net/" xmlns:hthsurvey="HT_DMP_RESPONSE" xmlns:basedatatypes="Basedatatypes" xmlns:common="Common" xmlns:surveys="Surveys">
	<templateId xmlns="">DMPSurveyCreate40020</templateId>
	<patient xmlns="">
		<dmpSurveyResponseWithScore>
			<xmlVersion>String</xmlVersion>
			<patient>
				<identifier>
					<identity>000000026827</identity>
					<assigningFacility>402</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
				<name>
					<prefix/>
					<given>TIM</given>
					<middle/>
					<family>HUMBUG</family>
					<suffix/>
					<title/>
				</name>
			</patient>
			<icn>1234567890V123456</icn>
			<vendorMRN>String</vendorMRN>
			<facility>
				<facilityNumber>402</facilityNumber>
			</facility>
			<vendor>
				<vendorName>String</vendorName>
				<vendorNumber>200T5</vendorNumber>
			</vendor>
			<survey>
				<title>VHA.DMP</title>
				<version>1.0</version>
			</survey>
			<scheduledDate>1967-08-13</scheduledDate>
			<completedDate>2001-12-17T09:30:47-07:00</completedDate>
			<programName>String</programName>
			<deviceName>String</deviceName>
			<responseStatus>ACCEPTED</responseStatus>
			<recordSource>
				<namespaceId>200T5</namespaceId>
				<universalId>LOCALHOST</universalId>
				<universalIdType>DNS</universalIdType>
			</recordSource>
			<recordUpdateTime>
				<literal>20040621104503 05 00</literal>
			</recordUpdateTime>
			<surveyQuestionsAndAnswers>
				<surveyQuestionAndAnswerWithScore>
					<questionNumber>1</questionNumber>
					<answer>0</answer>
				</surveyQuestionAndAnswerWithScore>
				<surveyQuestionAndAnswerWithScore>
					<questionNumber>2</questionNumber>
					<answer>0</answer>
				</surveyQuestionAndAnswerWithScore>
				<surveyQuestionAndAnswerWithScore>
					<questionNumber>3</questionNumber>
					<answer>0</answer>
				</surveyQuestionAndAnswerWithScore>
			</surveyQuestionsAndAnswers>
		</dmpSurveyResponseWithScore>
	</patient>
</ClinicalData>
