<?xml version="1.0" encoding="UTF-8"?>
<clinicaldata:ClinicalData xmlns:clinicaldata="Clinicaldata">
	<templateId>RDIAllergiesPharmacyRead40013</templateId>
	<requestId>F5E567C9-86FC-5401-9F86-A6C9383ABF64</requestId>
	<patient>
		<requestedResolvedIdentifiers>
			<identity>1</identity>
			<assigningFacility>578</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</requestedResolvedIdentifiers>
		<requestedResolvedIdentifiers>
			<identity>test_sourceid_5000</identity>
			<assigningFacility>605</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</requestedResolvedIdentifiers>
		<requestedResolvedIdentifiers>
			<identity>test_sourceid_10000</identity>
			<assigningFacility>200CH</assigningFacility>
			<assigningAuthority>USDOD</assigningAuthority>
		</requestedResolvedIdentifiers>
		<requestedResolvedIdentifiers>
			<identity>test_sourceid_10000</identity>
			<assigningFacility>660</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</requestedResolvedIdentifiers>
		<resultantIdentifiers>
			<identity>1</identity>
			<assigningFacility>578</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</resultantIdentifiers>
		<resultantIdentifiers>
			<identity>test_sourceid_5000</identity>
			<assigningFacility>605</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</resultantIdentifiers>
		<resultantIdentifiers>
			<identity>test_sourceid_10000</identity>
			<assigningFacility>200CH</assigningFacility>
			<assigningAuthority>USDOD</assigningAuthority>
		</resultantIdentifiers>
		<resultantIdentifiers>
			<identity>test_sourceid_10000</identity>
			<assigningFacility>660</assigningFacility>
			<assigningAuthority>USVHA</assigningAuthority>
		</resultantIdentifiers>
		<intoleranceConditions>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>200CH</assigningFacility>
					<assigningAuthority>USDOD</assigningAuthority>
				</identifier>
			</patient>
			<observationTime>
				<literal>20070609020755</literal>
			</observationTime>
			<allergyType>
				<code>98548</code>
				<displayText>DRUG</displayText>
			</allergyType>
			<gmrAllergyAgent>
				<code>879452</code>
				<displayText>COUGH</displayText>
				<codingSystem>99VA</codingSystem>
			</gmrAllergyAgent>
			<informationSourceCategory>
				<code>1002</code>
				<displayText>OBSERVED</displayText>
			</informationSourceCategory>
			<mechanism>
				<code>1028</code>
				<displayText>PHARMACOLOGIC</displayText>
			</mechanism>
			<verified>T</verified>
			<reaction>
				<reaction>
					<code>1020</code>
					<displayText>KIDNEY DAMAGE</displayText>
				</reaction>
				<observationTime>
					<literal>20070617033531</literal>
				</observationTime>
			</reaction>
			<author>
				<time>
					<literal>20070615091942</literal>
				</time>
				<practitioner>
					<name>
						<family>KDEWCOYEQLSRAZFMQHYSJWJBVZ</family>
					</name>
				</practitioner>
			</author>
			<drugClass>
				<code>
					<code>1727</code>
					<displayText>NONSTEROIDAL ANTI-INFLAMMATORY DRUGS</displayText>
				</code>
			</drugClass>
			<facilityIdentifier>
				<name>JAMES J. PETERS VA MEDICAL CENTER</name>
			</facilityIdentifier>
			<agent>
				<code>1044</code>
			</agent>
		</intoleranceConditions>
		<intoleranceConditions>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>200CH</assigningFacility>
					<assigningAuthority>USDOD</assigningAuthority>
				</identifier>
			</patient>
			<observationTime>
				<literal>20070608081410</literal>
			</observationTime>
			<allergyType>
				<code>98549</code>
				<displayText>OTHER</displayText>
			</allergyType>
			<gmrAllergyAgent>
				<code>879454</code>
				<displayText>RASH</displayText>
				<codingSystem>99VA</codingSystem>
			</gmrAllergyAgent>
			<informationSourceCategory>
				<code>1003</code>
				<displayText>HISTORICAL</displayText>
			</informationSourceCategory>
			<mechanism>
				<code>1028</code>
				<displayText>PHARMACOLOGIC</displayText>
			</mechanism>
			<verified>T</verified>
			<reaction>
				<reaction>
					<code>1016</code>
					<displayText>COUGHING</displayText>
				</reaction>
				<observationTime>
					<literal>20070616140101</literal>
				</observationTime>
			</reaction>
			<author>
				<time>
					<literal>20070610041149</literal>
				</time>
				<practitioner>
					<name>
						<family>K</family>
					</name>
				</practitioner>
			</author>
			<drugIngredient>
				<code>
					<code>98461</code>
					<displayText>ASCORBIC ACID</displayText>
				</code>
			</drugIngredient>
			<drugIngredient>
				<code>
					<code>98464</code>
					<displayText>TENOXICAM</displayText>
				</code>
			</drugIngredient>
			<facilityIdentifier>
				<name>VA GULF COAST VETERANS HEALTH CARE SYSTEM</name>
			</facilityIdentifier>
			<agent>
				<code>1035</code>
			</agent>
		</intoleranceConditions>
		<intoleranceConditions>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>200CH</assigningFacility>
					<assigningAuthority>USDOD</assigningAuthority>
				</identifier>
			</patient>
			<observationTime>
				<literal>20070604231605</literal>
			</observationTime>
			<allergyType>
				<code>98549</code>
				<displayText>OTHER</displayText>
			</allergyType>
			<gmrAllergyAgent>
				<code>879454</code>
				<displayText>RASH</displayText>
				<codingSystem>99VA</codingSystem>
			</gmrAllergyAgent>
			<informationSourceCategory>
				<code>1003</code>
				<displayText>HISTORICAL</displayText>
			</informationSourceCategory>
			<mechanism>
				<code>1026</code>
				<displayText>UNKNOWN</displayText>
			</mechanism>
			<verified>T</verified>
			<reaction>
				<reaction>
					<code>1014</code>
					<displayText>ECZEMA</displayText>
				</reaction>
				<observationTime>
					<literal>20070617091811</literal>
				</observationTime>
			</reaction>
			<author>
				<time>
					<literal>20070613124504</literal>
				</time>
				<practitioner>
					<name>
						<family>FJREWXKNASELSXOES</family>
					</name>
				</practitioner>
			</author>
			<drugClass>
				<code>
					<code>1726</code>
					<displayText>CENTRAL PAIN SYNDROME</displayText>
				</code>
			</drugClass>
			<drugClass>
				<code>
					<code>1720</code>
					<displayText>GENERAL  ANALGESIC</displayText>
				</code>
			</drugClass>
			<facilityIdentifier>
				<name>VA GULF COAST VETERANS HEALTH CARE SYSTEM</name>
			</facilityIdentifier>
			<agent>
				<code>1035</code>
			</agent>
		</intoleranceConditions>
		<outpatientMedicationPromises>
			<prescriptionId>JCBZAJBWJSIKVGOJQOWDRUEI</prescriptionId>
			<pharmacyRequest>
				<orderedMedication>
					<medicationCode>
						<code>60703572</code>
						<displayText>SHSFWWINIQOCPIADAPMIUYCZUBZJWQCXHMHAXRXUTVFHFVFWRLBTKSSNISPTNLLPCVCMZXXTLS</displayText>
						<codingSystem>99VHA_ERT</codingSystem>
					</medicationCode>
				</orderedMedication>
				<orderDate>
					<literal>20070621221233</literal>
				</orderDate>
				<statusModifier>
					<code>37</code>
					<displayText>WAIT</displayText>
				</statusModifier>
			</pharmacyRequest>
			<patient>
				<identifier>
					<identity>test_sourceid_5000</identity>
					<assigningFacility>605</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<expirationDate>
				<literal>20070428214116</literal>
			</expirationDate>
			<numberOfRefillsAuthorized>6</numberOfRefillsAuthorized>
			<sig>BAMGPENNQWJZVHNVQVXVDGHQLNBWQUTJ</sig>
			<sig>IIUXIIMGFLAYYGQWLRZAEYNONCFYGWPFRUSPVHXBIVBFOGHZTVQZRWMWKAVOEBLXGSOUONXUNBGTFVNHYWXXTBBCVNEAJ</sig>
			<sig>ZPOPZDTFTGWWSWRZDIXTMYDNABGSUYVWJB</sig>
			<originalDispense>
				<fillDate>
					<literal>20070703063252</literal>
				</fillDate>
				<quantityDispensed>
					<value>89</value>
				</quantityDispensed>
				<currentProvider>
					<name>
						<family>B</family>
					</name>
				</currentProvider>
				<daysSupply>19</daysSupply>
				<dispensedDrug>
					<drugUnitPrice>
						<value>290.59</value>
					</drugUnitPrice>
				</dispensedDrug>
			</originalDispense>
		</outpatientMedicationPromises>
		<outpatientMedicationPromises>
			<prescriptionId>TXIHATMAOWEECUMZKYN</prescriptionId>
			<pharmacyRequest>
				<orderedMedication>
					<medicationCode>
						<code>59581846</code>
						<displayText>RLDHQPDJMXQVPYZLKUMYVGXTPJBRPVHEFPSLJTKWIVLSWQPVIQUCBAOGUFYGKLNSNJHZSJITPXRSWM</displayText>
						<codingSystem>99VHA_ERT</codingSystem>
					</medicationCode>
				</orderedMedication>
				<orderDate>
					<literal>20070615153650</literal>
				</orderDate>
				<statusModifier>
					<code>11</code>
					<displayText>OPEN</displayText>
				</statusModifier>
			</pharmacyRequest>
			<patient>
				<identifier>
					<identity>test_sourceid_5000</identity>
					<assigningFacility>605</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<expirationDate>
				<literal>20070507124055</literal>
			</expirationDate>
			<numberOfRefillsAuthorized>5</numberOfRefillsAuthorized>
			<sig>YWCRZLYSIGQ</sig>
			<sig>TWTCWMZTHOJWHOZHACCRPTGAWWGCHIWYLKTPYYRJGIZGLBZANAJXZXRQSZEDUWRTZ</sig>
			<sig>LFMRQGKBXBVF</sig>
			<originalDispense>
				<fillDate>
					<literal>20070703060804</literal>
				</fillDate>
				<quantityDispensed>
					<value>12</value>
				</quantityDispensed>
				<currentProvider>
					<name>
						<family>OKNRSYKNFVJWXXCWMSRUZLU</family>
					</name>
				</currentProvider>
				<daysSupply>60</daysSupply>
				<dispensedDrug>
					<drugUnitPrice>
						<value>196.8</value>
					</drugUnitPrice>
				</dispensedDrug>
			</originalDispense>
			<refillDispense>
				<fillDate>
					<literal>20070703021833</literal>
				</fillDate>
				<quantityDispensed>
					<value>75</value>
				</quantityDispensed>
				<currentProvider>
					<name>
						<family>KXBMPINJWYACSTLEOQTIDKUYZDRZHHZVMOC</family>
					</name>
				</currentProvider>
				<daysSupply>95</daysSupply>
				<dispensedDrug>
					<drugUnitPrice>
						<value>105</value>
					</drugUnitPrice>
				</dispensedDrug>
			</refillDispense>
		</outpatientMedicationPromises>
		<outpatientMedicationPromises>
			<prescriptionId>HAMJRXUCBQSDUZOQGBXROLG</prescriptionId>
			<pharmacyRequest>
				<orderedMedication>
					<medicationCode>
						<code>21288997</code>
						<displayText>UAAMCQOZUBFDOJQAQCQKCFHTTECVNJIKPJUXFWHIDBDBHETIPXXICCLOFCHQAXJKKZAU</displayText>
						<codingSystem>99VHA_ERT</codingSystem>
					</medicationCode>
				</orderedMedication>
				<orderDate>
					<literal>20070623164408</literal>
				</orderDate>
				<statusModifier>
					<code>11</code>
					<displayText>OPEN</displayText>
				</statusModifier>
			</pharmacyRequest>
			<patient>
				<identifier>
					<identity>test_sourceid_5000</identity>
					<assigningFacility>605</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<expirationDate>
				<literal>20070518060308</literal>
			</expirationDate>
			<numberOfRefillsAuthorized>1</numberOfRefillsAuthorized>
			<originalDispense>
				<fillDate>
					<literal>20070703111316</literal>
				</fillDate>
				<quantityDispensed>
					<value>63</value>
				</quantityDispensed>
				<currentProvider>
					<name>
						<family>BAJZKCWYQFVUMNMNO</family>
					</name>
				</currentProvider>
				<daysSupply>50</daysSupply>
				<dispensedDrug>
					<drugUnitPrice>
						<value>175.37</value>
					</drugUnitPrice>
				</dispensedDrug>
			</originalDispense>
			<refillDispense>
				<fillDate>
					<literal>20070703013744</literal>
				</fillDate>
				<quantityDispensed>
					<value>82</value>
				</quantityDispensed>
				<daysSupply>68</daysSupply>
				<dispensedDrug>
					<drugUnitPrice>
						<value>64.27</value>
					</drugUnitPrice>
				</dispensedDrug>
			</refillDispense>
		</outpatientMedicationPromises>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159753</code>
				<displayText>SEASONAL - FALL</displayText>
			</assessmentValue>
		</allergyAssessments>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159750</code>
				<displayText>SEASONAL - SPRING</displayText>
			</assessmentValue>
		</allergyAssessments>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159751</code>
				<displayText>DUST</displayText>
			</assessmentValue>
		</allergyAssessments>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159752</code>
				<displayText>PENICILAN</displayText>
			</assessmentValue>
		</allergyAssessments>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159753</code>
				<displayText>SEASONAL - FALL</displayText>
			</assessmentValue>
		</allergyAssessments>
		<allergyAssessments>
			<patient>
				<identifier>
					<identity>test_sourceid_10000</identity>
					<assigningFacility>660</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
			</patient>
			<assessmentValue>
				<code>159753</code>
				<displayText>SEASONAL - FALL</displayText>
			</assessmentValue>
		</allergyAssessments>
	</patient>
</clinicaldata:ClinicalData>
