<?xml version="1.0" encoding="UTF-8"?>
<ClinicalData xmlns="Clinicaldata" xmlns:hthsurvey="HTHSurvey" xmlns:saxon="http://saxon.sf.net/" xmlns:basedatatypes="Basedatatypes" xmlns:surveys="Surveys" xmlns:common="Common">
	<templateId xmlns="">PSSurveyCreate40020</templateId>
	<patient xmlns="">
		<psSurveyResponse>
			<patient>
				<identifier>
					<identity>1234567890V123456</identity>
					<assigningFacility>540</assigningFacility>
					<assigningAuthority>USVHA</assigningAuthority>
				</identifier>
				<name>
					<prefix>Dr</prefix>
					<given>Veterans</given>
					<middle>Administration</middle>
					<family>Patient</family>
					<suffix>Jr</suffix>
					<title>MD</title>
				</name>
			</patient>
			<surveyPatient>
				<icn>String</icn>
				<ssn>000000000</ssn>
				<name>
					<family>String</family>
					<middle>String</middle>
					<given>String</given>
				</name>
				<birthdate>1967-08-13</birthdate>
			</surveyPatient>
			<enrollmentDate>1967-08-13</enrollmentDate>
			<disenrollmentDate>1967-08-13</disenrollmentDate>
			<activationDate>1967-08-13</activationDate>
			<inactivationDate>1967-08-13</inactivationDate>
			<facilityNumber>540</facilityNumber>
			<vendorNumber>200T5</vendorNumber>
			<vendorName>Viterion</vendorName>
			<vendorMRN>String</vendorMRN>
			<careCoordinator>
				<id>String</id>
				<name>
					<family>String</family>
					<middle>String</middle>
					<given>String</given>
				</name>
			</careCoordinator>
			<scheduledDate>1967-08-13</scheduledDate>
			<completedDate>2001-12-17T09:30:47Z</completedDate>
			<currentDialogueName>String</currentDialogueName>
			<programName>String</programName>
			<deviceName>String</deviceName>
			<surveyAcceptedStatus>ACCEPTED</surveyAcceptedStatus>
			<recordSource>
				<namespaceId>200T5</namespaceId>
				<universalId>LOCALHOST</universalId>
				<universalIdType>DNS</universalIdType>
			</recordSource>
			<recordUpdateTime>
				<literal>20040621104503 05 00</literal>
			</recordUpdateTime>
			<surveyTitle>Patient Satisfaction</surveyTitle>
			<surveyVersion>1.0</surveyVersion>
			<psSurveyQuestionsAndAnswers>
				<psSurveyQuestionAndAnswer>
					<questionNumber>1</questionNumber>
					<answer>1</answer>
				</psSurveyQuestionAndAnswer>
				<psSurveyQuestionAndAnswer>
					<questionNumber>2</questionNumber>
					<answer>1</answer>
				</psSurveyQuestionAndAnswer>
			</psSurveyQuestionsAndAnswers>
		</psSurveyResponse>
	</patient>
</ClinicalData>
