823. EPMO Open Source Coordination Office Redaction File Detail Report

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823.1 Files compared

#	Location	File	Last Modified
1	C:\working_scrub\Unredacted\VAP Code Base\VAP_Bld2_Source_Code_CIF_2017-02-14\nvap-web\src\main\resources\gov\va\nvap\mock\report\sampleExportSQA\20170112\DEPARTMENT OF VETERANS AFFAIRS	374213_CCDACCD_20161201.xml	Thu Jan 12 19:48:06 2017 UTC
2	eHX-CIF.zip\eHX-CIF\VAP Code Base\VAP_Bld2_Source_Code_CIF_2017-02-14\nvap-web\src\main\resources\gov\va\nvap\mock\report\sampleExportSQA\20170112\DEPARTMENT OF VETERANS AFFAIRS	374213_CCDACCD_20161201.xml	Mon Apr 3 14:14:37 2017 UTC

823.2 Comparison summary

Description	Between Files 1 and 2
Description	Text Blocks	Lines
Unchanged	2	10700
Changed	1	2
Inserted	0	0
Removed	0	0

823.3 Comparison options

Whitespace
Character case	Differences in character case are significant
Line endings	Differences in line endings (`CR` and `LF` characters) are ignored
CR/LF characters	Not shown in the comparison detail

823.4 Active regular expressions

No regular expressions were active.

823.5 Comparison detail

	1	<?xml
	2	version="1 .0"
	3	encoding=" UTF-8"
	4	standalone ="no"
	5	?>
	6	<?xml-styl esheet
	7	type="text /xsl"
	8	href="cda. xsl"
	9	?>
	10	<ClinicalD ocument
	11	xmlns="urn :hl7-org:v 3"
	12	xmlns:sdtc ="urn:hl7- org:sdtc"
	13	xmlns:xsi= "http://ww w.w3.org/2 001/XMLSch ema-instan ce"
	14	xsi:schema Location=" urn:hl7-or g:v3 CDA.x sd"
	15	>
	16
	17	<!-- *** ****** ****** ****** ****** ******** * C-CDA CC D
	18	R1.1 HEADER ****** ****** ****** ****** ****** ** -->
	19
	20	<realmCode
	21	code="US"
	22	/>
	23
	24	<typeId
	25	extension= "POCD_HD00 0040"
	26	root="2.16 .840.1.113 883.1.3"
	27	/>
	28
	29	<templateI d
	30	root="2.16 .840.1.113 883.10.20. 22.1.1"
	31	/>
	32
	33	<templateI d
	34	root="2.16 .840.1.113 883.10.20. 22.1.2"
	35	/>
	36
	37	<!-- CCD D ocument Id entifer, i d=VA OID, extension= system-gen erated -->
	38
	39	<id
	40	extension= "2.25.1793 5688889648 0785453243 1321973056 29346"
	41	root="2.16 .840.1.113 883.4.349"
	42	/>
	43
	44	<!-- CCD D ocument Co de -->
	45
	46	<code
	47	code="3413 3-9"
	48	codeSystem ="2.16.840 .1.113883. 6.1"
	49	codeSystem Name="LOIN C"
	50	displayNam e="Summari zation of Episode No te"
	51	/>
	52
	53	<!-- CCD D ocument Ti tle -->
	54
	55	<title>
	56	Department of Vetera ns Affairs Health Su mmary
	57	</title>
	58
	59	<!-- 1.01 DOCUMENT T IMESTAMP, REQUIRED - ->
	60
	61	<effective Time
	62	value="201 6120107561 4-0600"
	63	/>
	64
	65	<!-- CCD C onfidentia lity Code, REQUIRED -->
	66
	67	<confident ialityCode
	68	code="N"
	69	codeSystem ="2.16.840 .1.113883. 5.25"
	70	codeSystem Name="Conf identialit yCode"
	71	/>
	72
	73	<!-- CCD D OCUMENT LA NGUAGE, RE QUIRED -->
	74
	75	<languageC ode
	76	code="en-U S"
	77	/>
	78
	79	<recordTar get>
	80
	81	<patientRo le>
	82
	83	<!-- 1.02 PERSON ID, REQUIRED, id=VA OID , extensio n=GUID -->
	84
	85	<id
	86	extension= "101263892 5V204624"
	87	root="2.16 .840.1.113 883.4.349"
	88	/>
	89
	90	<!-- 1.03 PERSON ADD RESS-HOME PERMANENT, REQUIRED -->
	91
	92	<addr
	93	use="HP"
	94	>
	95
	96	<streetAdd ressLine>
	97	1200 TEST STREET
	98	</streetAd dressLine>
	99
	100	<city>
	101	HELENA
	102	</city>
	103
	104	<state>
	105	AL
	106	</state>
	107
	108	<postalCod e>
	109	35080
	110	</postalCo de>
	111
	112	</addr>
	113
	114	<!-- 1.04 PERSON PHO NE/EMAIL/U RL, REQUIR ED -->
	115
	116	<telecom
	117	use="HP"
	118	value="tel :+1-205-11 1-2222"
	119	/>
	120
	121	<patient>
	122
	123	<!-- 1.05 PERSON NAM E LEGAL, R EQUIRED -- >
	124
	125	<name
	126	use="L"
	127	>
	128
	129
	130	<given>
	131	NWHINTWO
	132	</given>
	133
	134	<family>
	135	NWHINZZZTE STPATIENT
	136	</family>
	137
	138
	139	</name>
	140
	141	<!-- 1.05 PERSON NAM E Alias Na me, Option al -->
	142
	143	<name
	144	use="P"
	145	>
	146
	147
	148	<given
	149	nullFlavor ="UNK"
	150	/>
	151
	152	<family
	153	nullFlavor ="UNK"
	154	/>
	155
	156
	157	</name>
	158
	159	<!-- 1.06 GENDER, RE QUIRED, HL 7 Administ rative Gen der -->
	160
	161	<administr ativeGende rCode
	162	code="M"
	163	codeSystem ="2.16.840 .1.113883. 5.1"
	164	codeSystem Name="Admi nistrative GenderCode "
	165	displayNam e="Male"
	166	>
	167
	168	<originalT ext>
	169	MALE
	170	</original Text>
	171
	172	</administ rativeGend erCode>
	173
	174	<!-- 1.07 PERSON DAT E OF BIRTH , REQUIRED -->
	175
	176	<birthTime
	177	value="198 20102"
	178	/>
	179
	180	<maritalSt atusCode
	181	code="M"
	182	codeSystem ="2.16.840 .1.113883. 5.2"
	183	codeSystem Name="Mari talStatusC ode"
	184	displayNam e="Married "
	185	>
	186
	187	<originalT ext>
	188	MARRIED
	189	</original Text>
	190
	191	<!-- 1.08 MARITAL ST ATUS, Opti onal-R2 -- >
	192
	193	</maritalS tatusCode>
	194
	195	<!-- 1.09 RELIGIOUS AFFILIATIO N, Optiona l, Removed b/c data not yet av ailable
	196	via VA VIs tA RPCs -- >
	197
	198	<!-- 1.10 RACE, Opti onal -->
	199
	200	<raceCode
	201	code="2054 -5"
	202	codeSystem ="2.16.840 .1.113883. 6.238"
	203	codeSystem Name="Race & Eth nicity - C DC"
	204	displayNam e="Black o r African American"
	205	>
	206
	207	<originalT ext>
	208	BLACK OR A FRICAN AME RICAN
	209	</original Text>
	210
	211	</raceCode >
	212
	213	<sdtc:race Code
	214	code="2054 -5"
	215	codeSystem ="2.16.840 .1.113883. 6.238"
	216	codeSystem Name="Race & Eth nicity - C DC"
	217	displayNam e="BLACK O R AFRICAN AMERICAN"
	218	>
	219
	220	<originalT ext>
	221	BLACK OR A FRICAN AME RICAN
	222	</original Text>
	223
	224	</sdtc:rac eCode>
	225
	226	<!-- 1.11 ETHNICITY, Optional -->
	227
	228	<ethnicGro upCode
	229	code="2135 -2"
	230	codeSystem ="2.16.840 .1.113883. 6.238"
	231	codeSystem Name="Race & Eth nicity - C DC"
	232	displayNam e="Hispani c or Latin o"
	233	>
	234
	235	<originalT ext>
	236	HISPANIC O R LATINO
	237	</original Text>
	238
	239	</ethnicGr oupCode>
	240
	241	<!-- *** ****** ****** ****** ****** ****** * LANGUA GE
	242	SPOKEN CON TENT MODUL E, R2 ** ****** ****** ****** ****** ****** ** -->
	243
	244	<languageC ommunicati on>
	245
	246	<!-- 2.01 LANGUAGE, REQUIRED, languageCo de as null Flavor b/c data not
	247	ye t availabl e via VA V istA RPCs -->
	248
	249	<languageC ode
	250	nullFlavor ="UNK"
	251	/>
	252
	253	</language Communicat ion>
	254
	255	</patient>
	256
	257	</patientR ole>
	258
	259	</recordTa rget>
	260
	261	<!-- *** ****** ****** ****** ****** ****** ****** ***
	262	INFO RMATION SO URCE CONTE NT MODULE, REQUIRED ******** ****** ****** ****** ****** ****** ******** -->
	263
	264	<!-- AUTHO R SECTION (REQUIRED) OF INFORM ATION SOUR CE CONTENT MODULE -- >
	265
	266	<author>
	267
	268	<!-- 10.01 AUTHOR TI ME (=Docum ent Creati on Date), REQUIRED - ->
	269
	270	<time
	271	value="201 6120107561 4-0600"
	272	/>
	273
	274	<assignedA uthor>
	275
	276	<!-- 10.02 AUTHOR ID (VA OID) (authorOID ), REQUIIR ED -->
	277
	278	<id
	279	root="2.16 .840.1.113 883.4.349"
	280	/>
	281
	282	<!-- Assig ned Author Address R equired, b ut VA Vist A data not yet avail able -->
	283
	284	<addr
	285	nullFlavor ="NA"
	286	/>
	287
	288	<!-- Assig ned Author Telecom R equired, b ut VA Vist A data not yet avail able -->
	289
	290	<telecom
	291	nullFlavor ="NA"
	292	/>
	293
	294	<!-- 10.02 AUTHOR NA ME REQUIRE D -->
	295
	296	<!-- assig nedPerson/ Author Nam e REQUIRED but provi ded as rep resentedOr ganization -->
	297
	298	<assignedP erson>
	299
	300	<name>
	301	Department of Vetera ns Affairs
	302	</name>
	303
	304	</assigned Person>
	305
	306	<!-- 10.02 AUTHOR NA ME REQUIRE D as repre sentedOrga nization - ->
	307
	308	<represent edOrganiza tion>
	309
	310	<!-- 10.02 AUTHORING DEVICE OR GANIZATION OID (VA O ID) (devic eOrgOID),
	311	REQUIIRED -->
	312
	313	<id
	314	root="2.16 .840.1.113 883.4.349"
	315	/>
	316
	317	<!-- 10.02 AUTHORING DEVICE OR GANIZATION NAME (dev iceOrgName ), REQUIIR ED -->
	318
	319	<name>
	320	Department of Vetera ns Affairs
	321	</name>
	322
	323	<!-- Assig ned Author Telecom R equired, b ut VA Vist A data not yet avail able -->
	324
	325	<telecom
	326	nullFlavor ="NA"
	327	/>
	328
	329	<!-- Assig ned Author Address R equired, b ut VA Vist A data not yet avail able -->
	330
	331	<addr
	332	nullFlavor ="NA"
	333	/>
	334
	335	</represen tedOrganiz ation>
	336
	337	</assigned Author>
	338
	339	</author>
	340
	341	<!-- *** ****** ****** ****** ****** ****** ****** ****** ****** ****
	342	INFO RMANT SECT ION (AS AN ORGANIZAT ION), Opti onal *** ****** ****** ****** ****** ****** ****** ****** ****** **** -->
	343
	344	<informant >
	345
	346	<assignedE ntity>
	347
	348	<id
	349	nullFlavor ="NI"
	350	/>
	351
	352	<addr
	353	nullFlavor ="NA"
	354	/>
	355
	356	<telecom
	357	nullFlavor ="NA"
	358	/>
	359
	360	<assignedP erson>
	361
	362	<!-- Name Required f or informa nt/assigne dEntity/as signedPers on -->
	363
	364	<name>
	365	Department of Vetera ns Affairs
	366	</name>
	367
	368	</assigned Person>
	369
	370	<represent edOrganiza tion>
	371
	372	<!-- 10.06 INFORMATI ON SOURCE ORGANIZATI ON OID (VA OID) (sou rceOrgOID) ,
	373	REQUIRED - ->
	374
	375	<id
	376	root="2.16 .840.1.113 883.4.349"
	377	/>
	378
	379	<!-- 10.06 INFORMATI ON SOURCE ORGANIZATI ON NAME (s ourceOrgNa me), REQUI RED -->
	380
	381	<name>
	382	Department of Vetera ns Affairs
	383	</name>
	384
	385	<telecom
	386	nullFlavor ="NA"
	387	/>
	388
	389	<addr
	390	nullFlavor ="NA"
	391	/>
	392
	393	</represen tedOrganiz ation>
	394
	395	</assigned Entity>
	396
	397	</informan t>
	398
	399	<!-- *** ****** ****** ****** ****** ****** ****** ****** ****
	400	CUST ODIAN AS A N ORGANIZA TION, REQU IRED *** ****** ****** ****** ****** ****** ****** ****** ***** -- >
	401
	402	<custodian >
	403
	404	<assignedC ustodian>
	405
	406	<represent edCustodia nOrganizat ion>
	407
	408	<!-- CUSTO DIAN OID ( VA OID) -- >
	409
	410	<id
	411	root="2.16 .840.1.113 883.4.349"
	412	/>
	413
	414	<!-- CUSTO DIAN NAME -->
	415
	416	<name>
	417	Department of Vetera ns Affairs
	418	</name>
	419
	420	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	421	not yet av ailable -- >
	422
	423	<telecom
	424	nullFlavor ="NA"
	425	/>
	426
	427	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	428	not yet av ailable -- >
	429
	430	<addr>
	431
	432	<streetAdd ressLine>
	433	810 Vermon t Avenue N W
	434	</streetAd dressLine>
	435
	436	<city>
	437	Washington
	438	</city>
	439
	440	<state>
	441	DC
	442	</state>
	443
	444	<postalCod e>
	445	20420
	446	</postalCo de>
	447
	448	</addr>
	449
	450	</represen tedCustodi anOrganiza tion>
	451
	452	</assigned Custodian>
	453
	454	</custodia n>
	455
	456	<!-- *** ****** ****** ****** ****** ****** ****** ********
	457	LEGA L AUTHENTI CATOR (AS AN ORGANIZ ATION), Op tional * ****** ****** ****** ****** ****** ****** ****** -->
	458
	459	<legalAuth enticator>
	460
	461	<!-- TIME OF AUTHENT ICATION -- >
	462
	463	<time
	464	value="201 6120107561 4-0600"
	465	/>
	466
	467	<signature Code
	468	code="S"
	469	/>
	470
	471	<assignedE ntity>
	472
	473	<id
	474	nullFlavor ="NA"
	475	/>
	476
	477	<addr
	478	nullFlavor ="NA"
	479	/>
	480
	481	<telecom
	482	nullFlavor ="NA"
	483	/>
	484
	485	<assignedP erson>
	486
	487	<name>
	488	Department of Vetera ns Affairs
	489	</name>
	490
	491	</assigned Person>
	492
	493	<represent edOrganiza tion>
	494
	495	<!-- LEGAL AUTHENTIC ATOR OID ( VA) -->
	496
	497	<id
	498	root="2.16 .840.1.113 883.4.349"
	499	/>
	500
	501	<name>
	502	Department of Vetera ns Affairs
	503	</name>
	504
	505	<telecom
	506	nullFlavor ="NA"
	507	/>
	508
	509	<addr>
	510	810 Vermon t Avenue N W Washingt on, DC 204 20
	511	</addr>
	512
	513	</represen tedOrganiz ation>
	514
	515	</assigned Entity>
	516
	517	</legalAut henticator >
	518
	519	<!-- *** ****** ****** ****** ****** ****** ****** *
	520	SUPP ORT INFORM ATION CONT ENT MODULE , Optional ******* ****** ****** ****** ****** ****** ******* -->
	521
	522	<participa nt
	523	typeCode=" IND"
	524	>
	525
	526	<!-- 3.01 DATE, REQU IRED -->
	527
	528	<!-- 3.01 DATE date as nullFla vor b/c da ta not yet available via VA Vi stA
	529	RPCs - ->
	530
	531	<time
	532	nullFlavor ="UNK"
	533	/>
	534
	535	<!-- 3.02 CONTACT TY PE, REQUIR ED, classC ode value determined by VistA value
	536	in con tactType - ->
	537
	538	<associate dEntity
	539	classCode= "ECON"
	540	>
	541
	542	<code
	543	code="UNK"
	544	codeSystem ="2.16.840 .1.113883. 5.111"
	545	codeSystem Name="Role Code"
	546	nullFlavor ="UNK"
	547	>
	548
	549	<originalT ext>
	550	relationsh ipType
	551	</original Text>
	552
	553	</code>
	554
	555	<!-- 3.04 CONTACT Ad dresss, Ho me Permane nt, Option al-R2 -->
	556
	557	<addr
	558	use="HP"
	559	>
	560
	561
	562	<city>
	563	homeCity
	564	</city>
	565
	566	<state>
	567	homeState
	568	</state>
	569
	570	<postalCod e>
	571	homePostal
	572	</postalCo de>
	573
	574	</addr>
	575
	576	<!-- 3.05 CONTACT PH ONE/EMAIL/ URL, Optio nal-R2, Re moved b/c data not y et
	577	availabl e via VA V istA RPCs -->
	578
	579	<telecom
	580	nullFlavor ="UNK"
	581	/>
	582
	583	<associate dPerson>
	584
	585	<!-- 3.06 CONTACT NA ME, REQUIR ED -->
	586
	587	<name>
	588
	589
	590	<given>
	591	NWHINTWO
	592	</given>
	593
	594	<family>
	595	NWHINZZZTE STPATIENT
	596	</family>
	597
	598
	599	</name>
	600
	601	</associat edPerson>
	602
	603	</associat edEntity>
	604
	605	</particip ant>
	606
	607	<!-- *** ****** ****** ****** ****** ****** ****** ****** **
	608	DOCU MENTATION OF MODULE - QUERY ME TA DATA, O ptional ****** ****** ****** ****** ****** ****** ****** ***** -- >
	609
	610	<documenta tionOf>
	611
	612	<serviceEv ent
	613	classCode= "PCPR"
	614	>
	615
	616	<effective Time>
	617
	618	<low
	619	value="198 20102"
	620	/>
	621
	622	<high
	623	value="201 6120107561 4-0600"
	624	/>
	625
	626	</effectiv eTime>
	627
	628
	629
	630
	631	<performer
	632	typeCode=" PRF"
	633	>
	634
	635	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	636
	637
	638	<assignedE ntity>
	639
	640	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	641
	642	<id
	643	extension= "provider1 001"
	644	root="2.16 .840.1.113 883.4.349"
	645	/>
	646
	647
	648	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	649	av ailable -- >
	650
	651	<addr
	652	nullFlavor ="UNK"
	653	/>
	654
	655	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	656	av ailable -- >
	657
	658	<telecom
	659	nullFlavor ="UNK"
	660	/>
	661
	662	<assignedP erson>
	663
	664	<name>
	665	TREEHORN,J ACKIE
	666	</name>
	667
	668	</assigned Person>
	669
	670	<represent edOrganiza tion>
	671
	672	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	673	FACI LITY NBR - ->
	674
	675	<id
	676	extension= "983"
	677	nullFlavor ="UNK"
	678	root="2.16 .840.1.113 883.4.349"
	679	/>
	680
	681	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	682
	683	<name>
	684	CHYSHR TES T LAB
	685	</name>
	686
	687	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	688	not yet availa ble -->
	689
	690	<telecom
	691	nullFlavor ="UNK"
	692	/>
	693
	694	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	695	not yet availa ble -->
	696
	697	<addr
	698	nullFlavor ="UNK"
	699	/>
	700
	701	</represen tedOrganiz ation>
	702
	703	</assigned Entity>
	704
	705	</performe r>
	706	<performer
	707	typeCode=" PRF"
	708	>
	709
	710	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	711
	712
	713	<assignedE ntity>
	714
	715	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	716
	717	<id
	718	extension= "provider1 002"
	719	root="2.16 .840.1.113 883.4.349"
	720	/>
	721
	722
	723	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	724	av ailable -- >
	725
	726	<addr
	727	nullFlavor ="UNK"
	728	/>
	729
	730	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	731	av ailable -- >
	732
	733	<telecom
	734	nullFlavor ="UNK"
	735	/>
	736
	737	<assignedP erson>
	738
	739	<name>
	740	TREEHORN,J ACKIE
	741	</name>
	742
	743	</assigned Person>
	744
	745	<represent edOrganiza tion>
	746
	747	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	748	FACI LITY NBR - ->
	749
	750	<id
	751	extension= "983"
	752	nullFlavor ="UNK"
	753	root="2.16 .840.1.113 883.4.349"
	754	/>
	755
	756	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	757
	758	<name>
	759	CHYSHR TES T LAB
	760	</name>
	761
	762	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	763	not yet availa ble -->
	764
	765	<telecom
	766	nullFlavor ="UNK"
	767	/>
	768
	769	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	770	not yet availa ble -->
	771
	772	<addr
	773	nullFlavor ="UNK"
	774	/>
	775
	776	</represen tedOrganiz ation>
	777
	778	</assigned Entity>
	779
	780	</performe r>
	781	<performer
	782	typeCode=" PRF"
	783	>
	784
	785	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	786
	787
	788	<assignedE ntity>
	789
	790	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	791
	792	<id
	793	extension= "provider1 003"
	794	root="2.16 .840.1.113 883.4.349"
	795	/>
	796
	797
	798	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	799	av ailable -- >
	800
	801	<addr
	802	nullFlavor ="UNK"
	803	/>
	804
	805	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	806	av ailable -- >
	807
	808	<telecom
	809	nullFlavor ="UNK"
	810	/>
	811
	812	<assignedP erson>
	813
	814	<name>
	815	TREEHORN,J ACKIE
	816	</name>
	817
	818	</assigned Person>
	819
	820	<represent edOrganiza tion>
	821
	822	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	823	FACI LITY NBR - ->
	824
	825	<id
	826	extension= "983"
	827	nullFlavor ="UNK"
	828	root="2.16 .840.1.113 883.4.349"
	829	/>
	830
	831	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	832
	833	<name>
	834	CHYSHR TES T LAB
	835	</name>
	836
	837	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	838	not yet availa ble -->
	839
	840	<telecom
	841	nullFlavor ="UNK"
	842	/>
	843
	844	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	845	not yet availa ble -->
	846
	847	<addr
	848	nullFlavor ="UNK"
	849	/>
	850
	851	</represen tedOrganiz ation>
	852
	853	</assigned Entity>
	854
	855	</performe r>
	856
	857
	858
	859	</serviceE vent>
	860
	861	</document ationOf>
	862
	863	<component Of>
	864
	865	<encompass ingEncount er>
	866
	867	<id
	868	root="2.16 .840.1.113 883.4.349"
	869	/>
	870
	871	<effective Time
	872	nullFlavor ="UNK"
	873	/>
	874
	875	</encompas singEncoun ter>
	876
	877	</componen tOf>
	878
	879	<!-- *** ****** ****** ****** ****** ******** * CDA BODY ******* ****** ****** ****** ****** ***** -- >
	880
	881	<component >
	882
	883	<structure dBody>
	884
	885	<component >
	886
	887	<!-- *** ****** ****** ****** ****** ****** **** ALL ERGY/DRUG
	888	SECTION SE CTION, REQ UIRED ** ****** ****** ****** ****** ****** ***** -- >
	889
	890	<section>
	891
	892	<!-- ALLER GY/DRUG Se ction Temp late Entri es REQUIRE D -->
	893
	894	<templateI d
	895	root="2.16 .840.1.113 883.10.20. 22.2.6.1"
	896	/>
	897
	898	<templateI d
	899	root="2.16 .840.1.113 883.10.20. 22.2.6"
	900	/>
	901
	902	<code
	903	code="4876 5-2"
	904	codeSystem ="2.16.840 .1.113883. 6.1"
	905	codeSystem Name="LOIN C"
	906	displayNam e="Allergi es, advers e reaction s, alerts"
	907	/>
	908
	909	<title>
	910	Allergies Section
	911	</title>
	912
	913	<!-- ALLER GIES NARRA TIVE BLOCK -->
	914
	915	<text>
	916
	917	<!-- VA Al lergies/Dr ug Busines s Rules fo r Medical Content -- >
	918
	919	<paragraph >
	920	This secti on contain s Allergie s on recor d with VA for the
	921	pati ent. The d ata comes from all V A treatmen t faciliti es. It doe s
	922	not list aller gies that were remov ed or ente red in err or. Some
	923	alle rgies may be reporte d in the I mmunizatio n section.
	924	</paragrap h>
	925
	926	<table
	927	ID="allerg yNarrative "
	928	border="1"
	929	width="100 %"
	930	>
	931
	932	<thead>
	933
	934	<tr>
	935
	936	<th>
	937	Allergen
	938	</th>
	939
	940	<th>
	941	Event Date
	942	</th>
	943
	944	<th>
	945	Event Type
	946	</th>
	947
	948	<th>
	949	Reaction(s )
	950	</th>
	951
	952	<th>
	953	Severity
	954	</th>
	955
	956	<th>
	957	Source
	958	</th>
	959
	960	</tr>
	961
	962	</thead>
	963
	964	<tbody>
	965
	966	<tr>
	967
	968
	969
	970
	971
	972	<td
	973	colspan="7 "
	974	>
	975	Assessment Not Done
	976	</td>
	977
	978
	979
	980	</tr>
	981	<tr>
	982
	983
	984
	985
	986
	987	<td
	988	colspan="7 "
	989	>
	990	No Known A llergies
	991	</td>
	992
	993
	994
	995	</tr>
	996
	997	</tbody>
	998
	999	</table>
	1000
	1001	</text>
	1002
	1003	<!-- ALLER GIES STRUC TURED DATA -->
	1004
	1005	<entry
	1006	typeCode=" DRIV"
	1007	>
	1008
	1009	<act
	1010	classCode= "ACT"
	1011	moodCode=" EVN"
	1012	>
	1013
	1014	<templateI d
	1015	root="2.16 .840.1.113 883.10.20. 22.4.30"
	1016	/>
	1017
	1018	<!-- CCD A llergy Act ID as nul lflavor -- >
	1019
	1020	<id
	1021	nullFlavor ="NA"
	1022	/>
	1023
	1024	<code
	1025	code="4876 5-2"
	1026	codeSystem ="2.16.840 .1.113883. 6.1"
	1027	codeSystem Name="LOIN C"
	1028	displayNam e="Allergi es, advers e reaction s, alerts"
	1029	/>
	1030
	1031	<statusCod e
	1032	code="acti ve"
	1033	/>
	1034
	1035	<effective Time
	1036	nullFlavor ="NA"
	1037	>
	1038
	1039	<low
	1040	nullFlavor ="NA"
	1041	/>
	1042
	1043	</effectiv eTime>
	1044
	1045	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	1046
	1047	<author>
	1048
	1049	<time
	1050	nullFlavor ="NA"
	1051	/>
	1052
	1053	<assignedA uthor>
	1054
	1055	<id
	1056	nullFlavor ="NA"
	1057	/>
	1058
	1059	<represent edOrganiza tion>
	1060
	1061	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	1062	FA CILITY NBR -->
	1063
	1064	<id
	1065	extension= "984"
	1066	root="2.16 .840.1.113 883.4.349"
	1067	/>
	1068
	1069	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	1070
	1071	<name>
	1072	DAYTSHR TE ST LAB
	1073	</name>
	1074
	1075	<telecom
	1076	nullFlavor ="NA"
	1077	/>
	1078
	1079	<addr
	1080	nullFlavor ="NA"
	1081	/>
	1082
	1083	</represen tedOrganiz ation>
	1084
	1085	</assigned Author>
	1086
	1087	</author>
	1088
	1089	<entryRela tionship
	1090	inversionI nd="true"
	1091	typeCode=" SUBJ"
	1092	>
	1093
	1094	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	1095
	1096	<observati on
	1097	classCode= "OBS"
	1098	moodCode=" EVN"
	1099	negationIn d="false"
	1100	nullFlavor ="NASK"
	1101	>
	1102
	1103	<templateI d
	1104	root="2.16 .840.1.113 883.10.20. 22.4.7"
	1105	/>
	1106
	1107	<id
	1108	nullFlavor ="NA"
	1109	/>
	1110
	1111	<code
	1112	code="ASSE RTION"
	1113	codeSystem ="2.16.840 .1.113883. 5.4"
	1114	codeSystem Name="HL7A ctCode"
	1115	/>
	1116
	1117	<statusCod e
	1118	code="comp leted"
	1119	/>
	1120
	1121	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	1122
	1123	<effective Time>
	1124
	1125	<low/>
	1126
	1127	</effectiv eTime>
	1128
	1129	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	1130
	1131	<value
	1132	code="4191 99007"
	1133	codeSystem ="2.16.840 .1.113883. 6.96"
	1134	codeSystem Name="SNOM ED CT"
	1135	displayNam e="Allergy to substa nce (disor der)"
	1136	xsi:type=" CD"
	1137	>
	1138
	1139
	1140	</value>
	1141
	1142
	1143	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	1144
	1145
	1146	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	1147
	1148
	1149	</observat ion>
	1150
	1151	</entryRel ationship>
	1152
	1153	</act>
	1154
	1155	</entry>
	1156	<entry
	1157	typeCode=" DRIV"
	1158	>
	1159
	1160	<act
	1161	classCode= "ACT"
	1162	moodCode=" EVN"
	1163	>
	1164
	1165	<templateI d
	1166	root="2.16 .840.1.113 883.10.20. 22.4.30"
	1167	/>
	1168
	1169	<!-- CCD A llergy Act ID as nul lflavor -- >
	1170
	1171	<id
	1172	nullFlavor ="NA"
	1173	/>
	1174
	1175	<code
	1176	code="4876 5-2"
	1177	codeSystem ="2.16.840 .1.113883. 6.1"
	1178	codeSystem Name="LOIN C"
	1179	displayNam e="Allergi es, advers e reaction s, alerts"
	1180	/>
	1181
	1182	<statusCod e
	1183	code="acti ve"
	1184	/>
	1185
	1186	<effective Time
	1187	nullFlavor ="NA"
	1188	>
	1189
	1190	<low
	1191	nullFlavor ="NA"
	1192	/>
	1193
	1194	</effectiv eTime>
	1195
	1196	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	1197
	1198	<author>
	1199
	1200	<time
	1201	nullFlavor ="NA"
	1202	/>
	1203
	1204	<assignedA uthor>
	1205
	1206	<id
	1207	nullFlavor ="NA"
	1208	/>
	1209
	1210	<represent edOrganiza tion>
	1211
	1212	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	1213	FA CILITY NBR -->
	1214
	1215	<id
	1216	extension= "983"
	1217	root="2.16 .840.1.113 883.4.349"
	1218	/>
	1219
	1220	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	1221
	1222	<name>
	1223	CHYSHR TES T LAB
	1224	</name>
	1225
	1226	<telecom
	1227	nullFlavor ="NA"
	1228	/>
	1229
	1230	<addr
	1231	nullFlavor ="NA"
	1232	/>
	1233
	1234	</represen tedOrganiz ation>
	1235
	1236	</assigned Author>
	1237
	1238	</author>
	1239
	1240	<entryRela tionship
	1241	inversionI nd="true"
	1242	typeCode=" SUBJ"
	1243	>
	1244
	1245	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	1246
	1247	<observati on
	1248	classCode= "OBS"
	1249	moodCode=" EVN"
	1250	negationIn d="true"
	1251	>
	1252
	1253	<templateI d
	1254	root="2.16 .840.1.113 883.10.20. 22.4.7"
	1255	/>
	1256
	1257	<id
	1258	nullFlavor ="NA"
	1259	/>
	1260
	1261	<code
	1262	code="ASSE RTION"
	1263	codeSystem ="2.16.840 .1.113883. 5.4"
	1264	codeSystem Name="HL7A ctCode"
	1265	/>
	1266
	1267	<statusCod e
	1268	code="comp leted"
	1269	/>
	1270
	1271	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	1272
	1273	<effective Time>
	1274
	1275	<low/>
	1276
	1277	</effectiv eTime>
	1278
	1279	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	1280
	1281	<value
	1282	code="4191 99007"
	1283	codeSystem ="2.16.840 .1.113883. 6.96"
	1284	codeSystem Name="SNOM ED CT"
	1285	displayNam e="Allergy to substa nce (disor der)"
	1286	xsi:type=" CD"
	1287	>
	1288
	1289
	1290	</value>
	1291
	1292
	1293	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	1294
	1295
	1296	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	1297
	1298
	1299	</observat ion>
	1300
	1301	</entryRel ationship>
	1302
	1303	</act>
	1304
	1305	</entry>
	1306
	1307	</section>
	1308
	1309	</componen t>
	1310
	1311	<component >
	1312
	1313	<!-- *** ****** ****** ****** ****** ******** * VITAL SI GNS
	1314	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	1315
	1316	<section
	1317	nullFlavor ="NI"
	1318	>
	1319
	1320	<!-- C-CDA CCD VITAL SIGNS Sec tion Templ ate Entrie s REQUIRED -->
	1321
	1322	<templateI d
	1323	root="2.16 .840.1.113 883.10.20. 22.2.4.1"
	1324	/>
	1325
	1326	<templateI d
	1327	root="2.16 .840.1.113 883.10.20. 22.2.4"
	1328	/>
	1329
	1330	<code
	1331	code="8716 -3"
	1332	codeSystem ="2.16.840 .1.113883. 6.1"
	1333	codeSystem Name="LOIN C"
	1334	displayNam e="Vital S igns"
	1335	/>
	1336
	1337	<title>
	1338	Vital Sign s Section
	1339	</title>
	1340
	1341	<!-- VITAL SIGNS NAR RATIVE BLO CK, REQUIR ED -->
	1342
	1343	<text>
	1344	No Data Pr ovided for This Sect ion
	1345	</text>
	1346
	1347	<!-- VITAL SIGNS STR UCTURED DA TA -->
	1348
	1349
	1350	</section>
	1351
	1352	</componen t>
	1353
	1354	<component >
	1355
	1356	<!-- *** ****** ****** ****** ****** ******** * PROBLEM/ CONDITION
	1357	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	1358
	1359	<section>
	1360
	1361	<!-- C-CDA Problem S ection Tem plate. Ent ries REQUI RED -->
	1362
	1363	<templateI d
	1364	root="2.16 .840.1.113 883.10.20. 22.2.5.1"
	1365	/>
	1366
	1367	<templateI d
	1368	root="2.16 .840.1.113 883.10.20. 22.2.5"
	1369	/>
	1370
	1371	<code
	1372	code="1145 0-4"
	1373	codeSystem ="2.16.840 .1.113883. 6.1"
	1374	codeSystem Name="LOIN C"
	1375	displayNam e="Problem List"
	1376	/>
	1377
	1378	<title>
	1379	Problem Li st
	1380	</title>
	1381
	1382	<!-- PROBL EMS NARRAT IVE BLOCK -->
	1383
	1384	<text>
	1385
	1386	<!-- VA Pr oblem/Cond ition Busi ness Rules for Medic al Content -->
	1387
	1388	<paragraph >
	1389	This secti on contain s a list o f Problems /Condition s known to VA
	1390	for the patien t. It incl udes both active and inactive
	1391	prob lems/condi tions. The data come s from all VA treatm ent
	1392	faci lities.
	1393	</paragrap h>
	1394
	1395	<table
	1396	ID="proble mNarrative "
	1397	border="1"
	1398	width="100 %"
	1399	>
	1400
	1401	<thead>
	1402
	1403	<tr>
	1404
	1405	<th>
	1406	Problem
	1407	</th>
	1408
	1409	<th>
	1410	Status
	1411	</th>
	1412
	1413	<th>
	1414	Problem Co de
	1415	</th>
	1416
	1417	<th>
	1418	Date of On set
	1419	</th>
	1420
	1421	<th>
	1422	Date of Re solution
	1423	</th>
	1424
	1425	<th>
	1426	Comment(s)
	1427	</th>
	1428
	1429	<th>
	1430	Provider
	1431	</th>
	1432
	1433	<th>
	1434	Source
	1435	</th>
	1436
	1437	</tr>
	1438
	1439	</thead>
	1440
	1441	<tbody>
	1442
	1443	<tr>
	1444
	1445	<td>
	1446
	1447	<content
	1448	ID="pndPro blem1001"
	1449	>
	1450	Contusion of shoulde r region ( ICD-9-CM 9 23.00)
	1451	</content>
	1452
	1453	</td>
	1454
	1455	<td>
	1456
	1457	<content
	1458	ID="pndSta tus1001"
	1459	>
	1460	Active
	1461	</content>
	1462
	1463	</td>
	1464
	1465	<td>
	1466
	1467	<content
	1468	ID="pndPro blemCode10 01"
	1469	>
	1470	40257000
	1471	</content>
	1472
	1473	</td>
	1474
	1475	<td>
	1476
	1477	<content
	1478	ID="pndDat eOfOnset10 01"
	1479	>
	1480	Nov 11, 20 11
	1481	</content>
	1482
	1483	</td>
	1484
	1485	<td>
	1486
	1487	<content
	1488	ID="pndDat eOfResolut ion1001"
	1489	/>
	1490
	1491	</td>
	1492
	1493	<td>
	1494
	1495	<list>
	1496
	1497	<item>
	1498
	1499	<content
	1500	ID="pndCom ment1001_1 001"
	1501	>
	1502	Nov 22, 20 11
	1503	Entered By : TREEHORN ,JACKIE
	1504	Comment: T his is fro m a fall.
	1505	</content>
	1506
	1507	</item>
	1508
	1509	</list>
	1510
	1511	</td>
	1512
	1513	<td>
	1514
	1515	<content
	1516	ID="pndPro vider1001"
	1517	>
	1518	TREEHORN,J ACKIE
	1519	</content>
	1520
	1521	</td>
	1522
	1523	<td>
	1524
	1525	<content
	1526	ID="pndSou rce1001"
	1527	>
	1528	CHYSHR TES T LAB
	1529	</content>
	1530
	1531	</td>
	1532
	1533	</tr>
	1534	<tr>
	1535
	1536	<td>
	1537
	1538	<content
	1539	ID="pndPro blem1002"
	1540	>
	1541	Asthma (IC D-9-CM 493 .90)
	1542	</content>
	1543
	1544	</td>
	1545
	1546	<td>
	1547
	1548	<content
	1549	ID="pndSta tus1002"
	1550	>
	1551	Active
	1552	</content>
	1553
	1554	</td>
	1555
	1556	<td>
	1557
	1558	<content
	1559	ID="pndPro blemCode10 02"
	1560	>
	1561	55570000
	1562	</content>
	1563
	1564	</td>
	1565
	1566	<td>
	1567
	1568	<content
	1569	ID="pndDat eOfOnset10 02"
	1570	>
	1571	Jan 02, 19 82
	1572	</content>
	1573
	1574	</td>
	1575
	1576	<td>
	1577
	1578	<content
	1579	ID="pndDat eOfResolut ion1002"
	1580	/>
	1581
	1582	</td>
	1583
	1584	<td>
	1585
	1586	<list>
	1587
	1588	<item>
	1589
	1590	<content
	1591	ID="pndCom ment1002_1 002"
	1592	>
	1593	Nov 22, 20 11
	1594	Entered By : TREEHORN ,JACKIE
	1595	Comment: T his condit ion is fro m birth.
	1596	</content>
	1597
	1598	</item>
	1599
	1600	</list>
	1601
	1602	</td>
	1603
	1604	<td>
	1605
	1606	<content
	1607	ID="pndPro vider1002"
	1608	>
	1609	TREEHORN,J ACKIE
	1610	</content>
	1611
	1612	</td>
	1613
	1614	<td>
	1615
	1616	<content
	1617	ID="pndSou rce1002"
	1618	>
	1619	CHYSHR TES T LAB
	1620	</content>
	1621
	1622	</td>
	1623
	1624	</tr>
	1625	<tr>
	1626
	1627	<td>
	1628
	1629	<content
	1630	ID="pndPro blem1003"
	1631	>
	1632	Hemangioma , any site (ICD-9-CM 228.09)
	1633	</content>
	1634
	1635	</td>
	1636
	1637	<td>
	1638
	1639	<content
	1640	ID="pndSta tus1003"
	1641	>
	1642	Active
	1643	</content>
	1644
	1645	</td>
	1646
	1647	<td>
	1648
	1649	<content
	1650	ID="pndPro blemCode10 03"
	1651	>
	1652	228.09
	1653	</content>
	1654
	1655	</td>
	1656
	1657	<td>
	1658
	1659	<content
	1660	ID="pndDat eOfOnset10 03"
	1661	>
	1662	Feb 02, 19 84
	1663	</content>
	1664
	1665	</td>
	1666
	1667	<td>
	1668
	1669	<content
	1670	ID="pndDat eOfResolut ion1003"
	1671	/>
	1672
	1673	</td>
	1674
	1675	<td>
	1676
	1677	<list>
	1678
	1679	<item>
	1680
	1681	<content
	1682	ID="pndCom ment1003_1 003"
	1683	>
	1684	Nov 22, 20 11
	1685	Entered By : TREEHORN ,JACKIE
	1686	Comment: S tarted at birth.
	1687	</content>
	1688
	1689	</item>
	1690
	1691	</list>
	1692
	1693	</td>
	1694
	1695	<td>
	1696
	1697	<content
	1698	ID="pndPro vider1003"
	1699	>
	1700	TREEHORN,J ACKIE
	1701	</content>
	1702
	1703	</td>
	1704
	1705	<td>
	1706
	1707	<content
	1708	ID="pndSou rce1003"
	1709	>
	1710	CHYSHR TES T LAB
	1711	</content>
	1712
	1713	</td>
	1714
	1715	</tr>
	1716
	1717	</tbody>
	1718
	1719	</table>
	1720
	1721	</text>
	1722
	1723	<!-- PROBL EMS STRUCT URED DATA -->
	1724
	1725	<!-- Probl em Concern Activty E ntry -->
	1726
	1727	<entry>
	1728
	1729	<act
	1730	classCode= "ACT"
	1731	moodCode=" EVN"
	1732	>
	1733
	1734	<templateI d
	1735	root="2.16 .840.1.113 883.10.20. 22.4.3"
	1736	/>
	1737
	1738	<id
	1739	nullFlavor ="NA"
	1740	/>
	1741
	1742	<code
	1743	code="CONC "
	1744	codeSystem ="2.16.840 .1.113883. 5.6"
	1745	codeSystem Name="HL7A ctClass"
	1746	displayNam e="Concern "
	1747	/>
	1748
	1749	<statusCod e
	1750	code="acti ve"
	1751	/>
	1752
	1753	<!-- 7.01 PROBLEM DA TE, R2 -->
	1754
	1755	<effective Time>
	1756
	1757	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	1758
	1759	<low
	1760	value="201 11111"
	1761	/>
	1762
	1763	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	1764
	1765	<high
	1766	nullFlavor ="UNK"
	1767	/>
	1768
	1769	</effectiv eTime>
	1770
	1771	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	1772
	1773	<performer >
	1774
	1775	<assignedE ntity>
	1776
	1777	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	1778	HealthCare Provider Section -- >
	1779
	1780	<id
	1781	extension= "provider1 001"
	1782	root="2.16 .840.1.113 883.4.349"
	1783	/>
	1784
	1785	<assignedP erson>
	1786
	1787	<name/>
	1788
	1789	</assigned Person>
	1790
	1791	</assigned Entity>
	1792
	1793	</performe r>
	1794
	1795	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	1796
	1797	<author>
	1798
	1799	<time
	1800	nullFlavor ="NA"
	1801	/>
	1802
	1803	<assignedA uthor>
	1804
	1805	<id
	1806	nullFlavor ="NA"
	1807	/>
	1808
	1809	<represent edOrganiza tion>
	1810
	1811	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	1812	FA CILITY NBR -->
	1813
	1814	<id
	1815	extension= "983"
	1816	root="2.16 .840.1.113 883.4.349"
	1817	/>
	1818
	1819	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	1820
	1821	<name>
	1822	CHYSHR TES T LAB
	1823	</name>
	1824
	1825	<telecom
	1826	nullFlavor ="NA"
	1827	/>
	1828
	1829	<addr
	1830	nullFlavor ="NA"
	1831	/>
	1832
	1833	</represen tedOrganiz ation>
	1834
	1835	</assigned Author>
	1836
	1837	</author>
	1838
	1839	<entryRela tionship
	1840	typeCode=" SUBJ"
	1841	>
	1842
	1843	<!-- CCD P roblem Obs ervation - ->
	1844
	1845	<observati on
	1846	classCode= "OBS"
	1847	moodCode=" EVN"
	1848	>
	1849
	1850	<templateI d
	1851	root="2.16 .840.1.113 883.10.20. 22.4.4"
	1852	/>
	1853
	1854	<id
	1855	nullFlavor ="NA"
	1856	/>
	1857
	1858	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	1859	b/c data n ot yet ava ilable via VA VistA RPCs -->
	1860
	1861	<code
	1862	codeSystem ="2.16.840 .1.113883. 6.96"
	1863	codeSystem Name="SNOM ED CT"
	1864	nullFlavor ="UNK"
	1865	>
	1866
	1867	<originalT ext>
	1868	Problem Ty pe Not Ava ilable
	1869	</original Text>
	1870
	1871	</code>
	1872
	1873	<!-- 7.03 PROBLEM NA ME, R2 -->
	1874
	1875	<text>
	1876
	1877	<reference
	1878	value="#pn dProblem10 01"
	1879	/>
	1880
	1881	</text>
	1882
	1883	<statusCod e
	1884	code="comp leted"
	1885	/>
	1886
	1887	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	1888	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	1889
	1890	<value
	1891	code="4025 7000"
	1892	codeSystem ="2.16.840 .1.113883. 6.96"
	1893	codeSystem Name="SNOM ED CT"
	1894	displayNam e="Contusi on of shou lder regio n (disorde r)"
	1895	xsi:type=" CD"
	1896	>
	1897
	1898	<originalT ext>
	1899
	1900	<reference
	1901	value="#pn dProblem10 01"
	1902	/>
	1903
	1904	</original Text>
	1905
	1906	<translati on
	1907	code="923. 00"
	1908	codeSystem ="2.16.840 .1.113883. 6.103"
	1909	codeSystem Name="ICD- 9-CM"
	1910	/>
	1911
	1912	</value>
	1913
	1914	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	1915
	1916	<entryRela tionship
	1917	typeCode=" SUBJ"
	1918	>
	1919
	1920	<observati on
	1921	classCode= "OBS"
	1922	moodCode=" EVN"
	1923	>
	1924
	1925	<templateI d
	1926	root="2.16 .840.1.113 883.10.20. 22.4.6"
	1927	/>
	1928
	1929	<code
	1930	code="3399 9-4"
	1931	codeSystem ="2.16.840 .1.113883. 6.1"
	1932	codeSystem Name="LOIN C"
	1933	displayNam e="Status"
	1934	/>
	1935
	1936	<statusCod e
	1937	code="comp leted"
	1938	/>
	1939
	1940	<value
	1941	code="5556 1003"
	1942	codeSystem ="2.16.840 .1.113883. 6.96"
	1943	codeSystem Name="SNOM ED CT"
	1944	displayNam e="Active"
	1945	xsi:type=" CD"
	1946	>
	1947
	1948	<originalT ext>
	1949	ACTIVE
	1950	</original Text>
	1951
	1952	<translati on/>
	1953
	1954	</value>
	1955
	1956	</observat ion>
	1957
	1958	</entryRel ationship>
	1959
	1960	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	1961
	1962	<entryRela tionship
	1963	inversionI nd="true"
	1964	typeCode=" MFST"
	1965	>
	1966
	1967	<act
	1968	classCode= "ACT"
	1969	moodCode=" EVN"
	1970	>
	1971
	1972	<templateI d
	1973	root="2.16 .840.1.113 883.10.20. 22.4.64"
	1974	/>
	1975
	1976	<code
	1977	code="4876 7-8"
	1978	codeSystem ="2.16.840 .1.113883. 6.1"
	1979	codeSystem Name="LOIN C"
	1980	displayNam e="Annotat ion commen t"
	1981	/>
	1982
	1983	<text>
	1984
	1985	<reference
	1986	value="#pn dComment10 01_1001"
	1987	/>
	1988
	1989	</text>
	1990
	1991	</act>
	1992
	1993	</entryRel ationship>
	1994
	1995	</observat ion>
	1996
	1997	</entryRel ationship>
	1998
	1999	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	2000	via VA VistA RPC s -->
	2001
	2002	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	2003	availa ble via VA VistA RPC s -->
	2004
	2005	</act>
	2006
	2007	</entry>
	2008	<entry>
	2009
	2010	<act
	2011	classCode= "ACT"
	2012	moodCode=" EVN"
	2013	>
	2014
	2015	<templateI d
	2016	root="2.16 .840.1.113 883.10.20. 22.4.3"
	2017	/>
	2018
	2019	<id
	2020	nullFlavor ="NA"
	2021	/>
	2022
	2023	<code
	2024	code="CONC "
	2025	codeSystem ="2.16.840 .1.113883. 5.6"
	2026	codeSystem Name="HL7A ctClass"
	2027	displayNam e="Concern "
	2028	/>
	2029
	2030	<statusCod e
	2031	code="acti ve"
	2032	/>
	2033
	2034	<!-- 7.01 PROBLEM DA TE, R2 -->
	2035
	2036	<effective Time>
	2037
	2038	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	2039
	2040	<low
	2041	value="198 20102"
	2042	/>
	2043
	2044	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	2045
	2046	<high
	2047	nullFlavor ="UNK"
	2048	/>
	2049
	2050	</effectiv eTime>
	2051
	2052	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	2053
	2054	<performer >
	2055
	2056	<assignedE ntity>
	2057
	2058	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	2059	HealthCare Provider Section -- >
	2060
	2061	<id
	2062	extension= "provider1 002"
	2063	root="2.16 .840.1.113 883.4.349"
	2064	/>
	2065
	2066	<assignedP erson>
	2067
	2068	<name/>
	2069
	2070	</assigned Person>
	2071
	2072	</assigned Entity>
	2073
	2074	</performe r>
	2075
	2076	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	2077
	2078	<author>
	2079
	2080	<time
	2081	nullFlavor ="NA"
	2082	/>
	2083
	2084	<assignedA uthor>
	2085
	2086	<id
	2087	nullFlavor ="NA"
	2088	/>
	2089
	2090	<represent edOrganiza tion>
	2091
	2092	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	2093	FA CILITY NBR -->
	2094
	2095	<id
	2096	extension= "983"
	2097	root="2.16 .840.1.113 883.4.349"
	2098	/>
	2099
	2100	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	2101
	2102	<name>
	2103	CHYSHR TES T LAB
	2104	</name>
	2105
	2106	<telecom
	2107	nullFlavor ="NA"
	2108	/>
	2109
	2110	<addr
	2111	nullFlavor ="NA"
	2112	/>
	2113
	2114	</represen tedOrganiz ation>
	2115
	2116	</assigned Author>
	2117
	2118	</author>
	2119
	2120	<entryRela tionship
	2121	typeCode=" SUBJ"
	2122	>
	2123
	2124	<!-- CCD P roblem Obs ervation - ->
	2125
	2126	<observati on
	2127	classCode= "OBS"
	2128	moodCode=" EVN"
	2129	>
	2130
	2131	<templateI d
	2132	root="2.16 .840.1.113 883.10.20. 22.4.4"
	2133	/>
	2134
	2135	<id
	2136	nullFlavor ="NA"
	2137	/>
	2138
	2139	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	2140	b/c data n ot yet ava ilable via VA VistA RPCs -->
	2141
	2142	<code
	2143	codeSystem ="2.16.840 .1.113883. 6.96"
	2144	codeSystem Name="SNOM ED CT"
	2145	nullFlavor ="UNK"
	2146	>
	2147
	2148	<originalT ext>
	2149	Problem Ty pe Not Ava ilable
	2150	</original Text>
	2151
	2152	</code>
	2153
	2154	<!-- 7.03 PROBLEM NA ME, R2 -->
	2155
	2156	<text>
	2157
	2158	<reference
	2159	value="#pn dProblem10 02"
	2160	/>
	2161
	2162	</text>
	2163
	2164	<statusCod e
	2165	code="comp leted"
	2166	/>
	2167
	2168	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	2169	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	2170
	2171	<value
	2172	code="5557 0000"
	2173	codeSystem ="2.16.840 .1.113883. 6.96"
	2174	codeSystem Name="SNOM ED CT"
	2175	displayNam e="Asthma without st atus asthm aticus (di sorder)"
	2176	xsi:type=" CD"
	2177	>
	2178
	2179	<originalT ext>
	2180
	2181	<reference
	2182	value="#pn dProblem10 02"
	2183	/>
	2184
	2185	</original Text>
	2186
	2187	<translati on
	2188	code="493. 90"
	2189	codeSystem ="2.16.840 .1.113883. 6.103"
	2190	codeSystem Name="ICD- 9-CM"
	2191	/>
	2192
	2193	</value>
	2194
	2195	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	2196
	2197	<entryRela tionship
	2198	typeCode=" SUBJ"
	2199	>
	2200
	2201	<observati on
	2202	classCode= "OBS"
	2203	moodCode=" EVN"
	2204	>
	2205
	2206	<templateI d
	2207	root="2.16 .840.1.113 883.10.20. 22.4.6"
	2208	/>
	2209
	2210	<code
	2211	code="3399 9-4"
	2212	codeSystem ="2.16.840 .1.113883. 6.1"
	2213	codeSystem Name="LOIN C"
	2214	displayNam e="Status"
	2215	/>
	2216
	2217	<statusCod e
	2218	code="comp leted"
	2219	/>
	2220
	2221	<value
	2222	code="5556 1003"
	2223	codeSystem ="2.16.840 .1.113883. 6.96"
	2224	codeSystem Name="SNOM ED CT"
	2225	displayNam e="Active"
	2226	xsi:type=" CD"
	2227	>
	2228
	2229	<originalT ext>
	2230	ACTIVE
	2231	</original Text>
	2232
	2233	<translati on/>
	2234
	2235	</value>
	2236
	2237	</observat ion>
	2238
	2239	</entryRel ationship>
	2240
	2241	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	2242
	2243	<entryRela tionship
	2244	inversionI nd="true"
	2245	typeCode=" MFST"
	2246	>
	2247
	2248	<act
	2249	classCode= "ACT"
	2250	moodCode=" EVN"
	2251	>
	2252
	2253	<templateI d
	2254	root="2.16 .840.1.113 883.10.20. 22.4.64"
	2255	/>
	2256
	2257	<code
	2258	code="4876 7-8"
	2259	codeSystem ="2.16.840 .1.113883. 6.1"
	2260	codeSystem Name="LOIN C"
	2261	displayNam e="Annotat ion commen t"
	2262	/>
	2263
	2264	<text>
	2265
	2266	<reference
	2267	value="#pn dComment10 02_1002"
	2268	/>
	2269
	2270	</text>
	2271
	2272	</act>
	2273
	2274	</entryRel ationship>
	2275
	2276	</observat ion>
	2277
	2278	</entryRel ationship>
	2279
	2280	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	2281	via VA VistA RPC s -->
	2282
	2283	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	2284	availa ble via VA VistA RPC s -->
	2285
	2286	</act>
	2287
	2288	</entry>
	2289	<entry>
	2290
	2291	<act
	2292	classCode= "ACT"
	2293	moodCode=" EVN"
	2294	>
	2295
	2296	<templateI d
	2297	root="2.16 .840.1.113 883.10.20. 22.4.3"
	2298	/>
	2299
	2300	<id
	2301	nullFlavor ="NA"
	2302	/>
	2303
	2304	<code
	2305	code="CONC "
	2306	codeSystem ="2.16.840 .1.113883. 5.6"
	2307	codeSystem Name="HL7A ctClass"
	2308	displayNam e="Concern "
	2309	/>
	2310
	2311	<statusCod e
	2312	code="acti ve"
	2313	/>
	2314
	2315	<!-- 7.01 PROBLEM DA TE, R2 -->
	2316
	2317	<effective Time>
	2318
	2319	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	2320
	2321	<low
	2322	value="198 40202"
	2323	/>
	2324
	2325	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	2326
	2327	<high
	2328	nullFlavor ="UNK"
	2329	/>
	2330
	2331	</effectiv eTime>
	2332
	2333	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	2334
	2335	<performer >
	2336
	2337	<assignedE ntity>
	2338
	2339	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	2340	HealthCare Provider Section -- >
	2341
	2342	<id
	2343	extension= "provider1 003"
	2344	root="2.16 .840.1.113 883.4.349"
	2345	/>
	2346
	2347	<assignedP erson>
	2348
	2349	<name/>
	2350
	2351	</assigned Person>
	2352
	2353	</assigned Entity>
	2354
	2355	</performe r>
	2356
	2357	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	2358
	2359	<author>
	2360
	2361	<time
	2362	nullFlavor ="NA"
	2363	/>
	2364
	2365	<assignedA uthor>
	2366
	2367	<id
	2368	nullFlavor ="NA"
	2369	/>
	2370
	2371	<represent edOrganiza tion>
	2372
	2373	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	2374	FA CILITY NBR -->
	2375
	2376	<id
	2377	extension= "983"
	2378	root="2.16 .840.1.113 883.4.349"
	2379	/>
	2380
	2381	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	2382
	2383	<name>
	2384	CHYSHR TES T LAB
	2385	</name>
	2386
	2387	<telecom
	2388	nullFlavor ="NA"
	2389	/>
	2390
	2391	<addr
	2392	nullFlavor ="NA"
	2393	/>
	2394
	2395	</represen tedOrganiz ation>
	2396
	2397	</assigned Author>
	2398
	2399	</author>
	2400
	2401	<entryRela tionship
	2402	typeCode=" SUBJ"
	2403	>
	2404
	2405	<!-- CCD P roblem Obs ervation - ->
	2406
	2407	<observati on
	2408	classCode= "OBS"
	2409	moodCode=" EVN"
	2410	>
	2411
	2412	<templateI d
	2413	root="2.16 .840.1.113 883.10.20. 22.4.4"
	2414	/>
	2415
	2416	<id
	2417	nullFlavor ="NA"
	2418	/>
	2419
	2420	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	2421	b/c data n ot yet ava ilable via VA VistA RPCs -->
	2422
	2423	<code
	2424	codeSystem ="2.16.840 .1.113883. 6.96"
	2425	codeSystem Name="SNOM ED CT"
	2426	nullFlavor ="UNK"
	2427	>
	2428
	2429	<originalT ext>
	2430	Problem Ty pe Not Ava ilable
	2431	</original Text>
	2432
	2433	</code>
	2434
	2435	<!-- 7.03 PROBLEM NA ME, R2 -->
	2436
	2437	<text>
	2438
	2439	<reference
	2440	value="#pn dProblem10 03"
	2441	/>
	2442
	2443	</text>
	2444
	2445	<statusCod e
	2446	code="comp leted"
	2447	/>
	2448
	2449	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	2450	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	2451
	2452	<value
	2453	codeSystem ="2.16.840 .1.113883. 6.96"
	2454	codeSystem Name="SNOM ED CT"
	2455	nullFlavor ="UNK"
	2456	xsi:type=" CD"
	2457	>
	2458
	2459	<originalT ext>
	2460
	2461	<reference
	2462	value="#pn dProblem10 03"
	2463	/>
	2464
	2465	</original Text>
	2466
	2467	<translati on
	2468	code="228. 09"
	2469	codeSystem ="2.16.840 .1.113883. 6.103"
	2470	codeSystem Name="ICD- 9-CM"
	2471	/>
	2472
	2473	</value>
	2474
	2475	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	2476
	2477	<entryRela tionship
	2478	typeCode=" SUBJ"
	2479	>
	2480
	2481	<observati on
	2482	classCode= "OBS"
	2483	moodCode=" EVN"
	2484	>
	2485
	2486	<templateI d
	2487	root="2.16 .840.1.113 883.10.20. 22.4.6"
	2488	/>
	2489
	2490	<code
	2491	code="3399 9-4"
	2492	codeSystem ="2.16.840 .1.113883. 6.1"
	2493	codeSystem Name="LOIN C"
	2494	displayNam e="Status"
	2495	/>
	2496
	2497	<statusCod e
	2498	code="comp leted"
	2499	/>
	2500
	2501	<value
	2502	code="5556 1003"
	2503	codeSystem ="2.16.840 .1.113883. 6.96"
	2504	codeSystem Name="SNOM ED CT"
	2505	displayNam e="Active"
	2506	xsi:type=" CD"
	2507	>
	2508
	2509	<originalT ext>
	2510	ACTIVE
	2511	</original Text>
	2512
	2513	<translati on/>
	2514
	2515	</value>
	2516
	2517	</observat ion>
	2518
	2519	</entryRel ationship>
	2520
	2521	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	2522
	2523	<entryRela tionship
	2524	inversionI nd="true"
	2525	typeCode=" MFST"
	2526	>
	2527
	2528	<act
	2529	classCode= "ACT"
	2530	moodCode=" EVN"
	2531	>
	2532
	2533	<templateI d
	2534	root="2.16 .840.1.113 883.10.20. 22.4.64"
	2535	/>
	2536
	2537	<code
	2538	code="4876 7-8"
	2539	codeSystem ="2.16.840 .1.113883. 6.1"
	2540	codeSystem Name="LOIN C"
	2541	displayNam e="Annotat ion commen t"
	2542	/>
	2543
	2544	<text>
	2545
	2546	<reference
	2547	value="#pn dComment10 03_1003"
	2548	/>
	2549
	2550	</text>
	2551
	2552	</act>
	2553
	2554	</entryRel ationship>
	2555
	2556	</observat ion>
	2557
	2558	</entryRel ationship>
	2559
	2560	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	2561	via VA VistA RPC s -->
	2562
	2563	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	2564	availa ble via VA VistA RPC s -->
	2565
	2566	</act>
	2567
	2568	</entry>
	2569
	2570	</section>
	2571
	2572	</componen t>
	2573
	2574
	2575
	2576	<component >
	2577
	2578	<!-- *** ****** ****** ****** ****** ****** *******
	2579	MEDICATION S (RX & No n-RX) SECT ION, REQUI RED **** ****** ****** ****** ****** ****** ****** - ->
	2580
	2581	<section
	2582	nullFlavor ="NI"
	2583	>
	2584
	2585	<!-- C-CDA Medicatio ns Section Template Entries RE QUIRED -->
	2586
	2587	<templateI d
	2588	root="2.16 .840.1.113 883.10.20. 22.2.1.1"
	2589	/>
	2590
	2591	<templateI d
	2592	root="2.16 .840.1.113 883.10.20. 22.2.1"
	2593	/>
	2594
	2595	<code
	2596	code="1016 0-0"
	2597	codeSystem ="2.16.840 .1.113883. 6.1"
	2598	codeSystem Name="LOIN C"
	2599	displayNam e="History of medica tion use"
	2600	/>
	2601
	2602	<title>
	2603	Medication s Section
	2604	</title>
	2605
	2606	<!-- MEDIC ATIONS NAR RATIVE BLO CK -->
	2607
	2608	<text>
	2609	No Data Pr ovided for This Sect ion
	2610	</text>
	2611
	2612	<!-- MEDIC ATIONS STR UCTURED DA TA -->
	2613
	2614	<!-- CCD M edication Activity E ntry -->
	2615
	2616
	2617	</section>
	2618
	2619	</componen t>
	2620
	2621
	2622	<component >
	2623
	2624	<!-- *** ****** ****** ****** ****** ******** * RESULTS
	2625	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	2626
	2627	<section
	2628	nullFlavor ="NI"
	2629	>
	2630
	2631	<!-- CCD R esults Sec tion Entri es REQUIRE D -->
	2632
	2633	<templateI d
	2634	root="2.16 .840.1.113 883.10.20. 22.2.3.1"
	2635	/>
	2636
	2637	<templateI d
	2638	root="2.16 .840.1.113 883.10.20. 22.2.3"
	2639	/>
	2640
	2641	<code
	2642	code="3095 4-2"
	2643	codeSystem ="2.16.840 .1.113883. 6.1"
	2644	codeSystem Name="LOIN C"
	2645	displayNam e="Relevan t diagnost ic tests a nd/or labo ratory dat a"
	2646	/>
	2647
	2648	<title>
	2649	Results Se ction
	2650	</title>
	2651
	2652	<text>
	2653	No Data Pr ovided for This
	2654	Section
	2655
	2656	</text>
	2657
	2658
	2659	</section>
	2660
	2661	</componen t>
	2662
	2663	<component >
	2664
	2665	<!-- *** ****** ****** ****** ****** ******** * IMMUNIZA TIONS
	2666	SECTION, O ptional ****** ****** ****** ****** ****** ** -->
	2667
	2668	<section>
	2669
	2670	<!-- CCD R esults Sec tion Entri es REQUIRE D -->
	2671
	2672	<templateI d
	2673	root="2.16 .840.1.113 883.10.20. 22.2.2.1"
	2674	/>
	2675
	2676	<templateI d
	2677	root="2.16 .840.1.113 883.10.20. 22.2.2"
	2678	/>
	2679
	2680	<code
	2681	code="1136 9-6"
	2682	codeSystem ="2.16.840 .1.113883. 6.1"
	2683	codeSystem Name="LOIN C"
	2684	/>
	2685
	2686	<title>
	2687	Immunizati ons Sectio n
	2688	</title>
	2689
	2690	<text>
	2691
	2692	<!-- VA Im munization Business Rules for Medical Co ntent -->
	2693
	2694	<paragraph >
	2695	This secti on contain s Immuniza tions on r ecord with VA for th e
	2696	pati ent. The d ata comes from all V A treatmen t faciliti es. A
	2697	reac tion to an immunizat ion may be reported in the all ergy
	2698	sect ion.
	2699	</paragrap h>
	2700
	2701	<table
	2702	ID="immuni zationNarr ative"
	2703	border="1"
	2704	width="100 %"
	2705	>
	2706
	2707	<thead>
	2708
	2709	<tr>
	2710
	2711	<th>
	2712	Immunizati on
	2713	</th>
	2714
	2715	<th>
	2716	Series
	2717	</th>
	2718
	2719	<th>
	2720	Date Issue d
	2721	</th>
	2722
	2723	<th>
	2724	Reaction
	2725	</th>
	2726
	2727	<th>
	2728	Comments
	2729	</th>
	2730
	2731	</tr>
	2732
	2733	</thead>
	2734
	2735	<tbody>
	2736
	2737	<tr>
	2738
	2739	<td>
	2740
	2741	<content
	2742	ID="indImm unization1 001"
	2743	>
	2744	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	2745	</content>
	2746
	2747	</td>
	2748
	2749	<td>
	2750
	2751	<content
	2752	ID="indSer ies1001"
	2753	/>
	2754
	2755	</td>
	2756
	2757	<td>
	2758	Apr 27, 20 15
	2759	</td>
	2760
	2761
	2762	<td>
	2763
	2764	<content
	2765	ID="indRea ction1001"
	2766	/>
	2767
	2768	</td>
	2769
	2770	<td>
	2771
	2772	<content
	2773	ID="indCom ments1001"
	2774	>
	2775	Partner: W algreens. Administer ed by: Wal greens Cli nician (NP I=99876543 21). Partn er Patient ID: 59910 903087 Lot #: 1122336 6 Mfr: Mer ck
	2776	</content>
	2777
	2778	</td>
	2779
	2780	</tr>
	2781	<tr>
	2782
	2783	<td>
	2784
	2785	<content
	2786	ID="indImm unization1 002"
	2787	>
	2788	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	2789	</content>
	2790
	2791	</td>
	2792
	2793	<td>
	2794
	2795	<content
	2796	ID="indSer ies1002"
	2797	/>
	2798
	2799	</td>
	2800
	2801	<td>
	2802	Apr 27, 20 15
	2803	</td>
	2804
	2805
	2806	<td>
	2807
	2808	<content
	2809	ID="indRea ction1002"
	2810	/>
	2811
	2812	</td>
	2813
	2814	<td>
	2815
	2816	<content
	2817	ID="indCom ments1002"
	2818	>
	2819	Partner: W algreens. Administer ed by: Wal greens Cli nician (NP I=99876543 21). Partn er Patient ID: 59910 903087 Lot #: 1122336 6 Mfr: Mer ck
	2820	</content>
	2821
	2822	</td>
	2823
	2824	</tr>
	2825
	2826	</tbody>
	2827
	2828	</table>
	2829
	2830	</text>
	2831
	2832	<entry
	2833	typeCode=" DRIV"
	2834	>
	2835
	2836	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	2837
	2838	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	2839
	2840	<substance Administra tion
	2841	classCode= "SBADM"
	2842	moodCode=" EVN"
	2843	negationIn d="false"
	2844	>
	2845
	2846	<templateI d
	2847	root="2.16 .840.1.113 883.10.20. 22.4.52"
	2848	/>
	2849
	2850	<id
	2851	nullFlavor ="NA"
	2852	/>
	2853
	2854	<text>
	2855
	2856	<reference
	2857	value="#in dComments1 001"
	2858	/>
	2859
	2860	</text>
	2861
	2862	<statusCod e
	2863	code="comp leted"
	2864	/>
	2865
	2866	<effective Time
	2867	value="201 50427"
	2868	/>
	2869
	2870	<repeatNum ber
	2871	nullFlavor ="UNK"
	2872	/>
	2873
	2874	<consumabl e>
	2875
	2876	<manufactu redProduct
	2877	classCode= "MANU"
	2878	>
	2879
	2880	<templateI d
	2881	root="2.16 .840.1.113 883.10.20. 22.4.54"
	2882	/>
	2883
	2884	<manufactu redMateria l>
	2885
	2886	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	2887
	2888	<code
	2889	code="33"
	2890	codeSystem ="2.16.840 .1.113883. 12.292"
	2891	codeSystem Name="Vacc ine Admini stered (CV X code)"
	2892	displayNam e="PNEUMOC OCCAL VACC INE"
	2893	>
	2894
	2895	<originalT ext>
	2896
	2897	<reference
	2898	value="#in dImmunizat ion1001"
	2899	/>
	2900
	2901	</original Text>
	2902
	2903	<translati on
	2904	code="9073 2"
	2905	codeSystem ="2.16.840 .1.113883. 6.12"
	2906	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	2907	displayNam e="PNEUMOC OCCAL VACC INE"
	2908	/>
	2909
	2910	</code>
	2911
	2912	</manufact uredMateri al>
	2913
	2914	</manufact uredProduc t>
	2915
	2916	</consumab le>
	2917
	2918	<performer >
	2919
	2920	<assignedE ntity>
	2921
	2922	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	2923
	2924	<id
	2925	root="2.16 .840.1.113 883.4.349"
	2926	/>
	2927
	2928	<assignedP erson>
	2929
	2930	<!-- CCD P rovider Na me, REQUIR ED -->
	2931
	2932	<name/>
	2933
	2934	</assigned Person>
	2935
	2936	</assigned Entity>
	2937
	2938	</performe r>
	2939
	2940	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	2941
	2942	<author>
	2943
	2944	<time
	2945	nullFlavor ="NA"
	2946	/>
	2947
	2948	<assignedA uthor>
	2949
	2950	<id
	2951	nullFlavor ="NA"
	2952	/>
	2953
	2954	<represent edOrganiza tion>
	2955
	2956	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	2957	FA CILITY NBR ) -->
	2958
	2959	<id
	2960	extension= "984"
	2961	nullFlavor ="NA"
	2962	/>
	2963
	2964	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	2965
	2966	<name>
	2967	DAYTSHR TE ST LAB
	2968	</name>
	2969
	2970	</represen tedOrganiz ation>
	2971
	2972	</assigned Author>
	2973
	2974	</author>
	2975
	2976
	2977	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	2978	immuni zations on ly -->
	2979
	2980	</substanc eAdministr ation>
	2981
	2982	</entry>
	2983	<entry
	2984	typeCode=" DRIV"
	2985	>
	2986
	2987	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	2988
	2989	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	2990
	2991	<substance Administra tion
	2992	classCode= "SBADM"
	2993	moodCode=" EVN"
	2994	negationIn d="false"
	2995	>
	2996
	2997	<templateI d
	2998	root="2.16 .840.1.113 883.10.20. 22.4.52"
	2999	/>
	3000
	3001	<id
	3002	nullFlavor ="NA"
	3003	/>
	3004
	3005	<text>
	3006
	3007	<reference
	3008	value="#in dComments1 002"
	3009	/>
	3010
	3011	</text>
	3012
	3013	<statusCod e
	3014	code="comp leted"
	3015	/>
	3016
	3017	<effective Time
	3018	value="201 50427"
	3019	/>
	3020
	3021	<repeatNum ber
	3022	nullFlavor ="UNK"
	3023	/>
	3024
	3025	<consumabl e>
	3026
	3027	<manufactu redProduct
	3028	classCode= "MANU"
	3029	>
	3030
	3031	<templateI d
	3032	root="2.16 .840.1.113 883.10.20. 22.4.54"
	3033	/>
	3034
	3035	<manufactu redMateria l>
	3036
	3037	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	3038
	3039	<code
	3040	code="33"
	3041	codeSystem ="2.16.840 .1.113883. 12.292"
	3042	codeSystem Name="Vacc ine Admini stered (CV X code)"
	3043	displayNam e="PNEUMOC OCCAL VACC INE"
	3044	>
	3045
	3046	<originalT ext>
	3047
	3048	<reference
	3049	value="#in dImmunizat ion1002"
	3050	/>
	3051
	3052	</original Text>
	3053
	3054	<translati on
	3055	code="9073 2"
	3056	codeSystem ="2.16.840 .1.113883. 6.12"
	3057	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	3058	displayNam e="PNEUMOC OCCAL VACC INE"
	3059	/>
	3060
	3061	</code>
	3062
	3063	</manufact uredMateri al>
	3064
	3065	</manufact uredProduc t>
	3066
	3067	</consumab le>
	3068
	3069	<performer >
	3070
	3071	<assignedE ntity>
	3072
	3073	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	3074
	3075	<id
	3076	root="2.16 .840.1.113 883.4.349"
	3077	/>
	3078
	3079	<assignedP erson>
	3080
	3081	<!-- CCD P rovider Na me, REQUIR ED -->
	3082
	3083	<name/>
	3084
	3085	</assigned Person>
	3086
	3087	</assigned Entity>
	3088
	3089	</performe r>
	3090
	3091	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	3092
	3093	<author>
	3094
	3095	<time
	3096	nullFlavor ="NA"
	3097	/>
	3098
	3099	<assignedA uthor>
	3100
	3101	<id
	3102	nullFlavor ="NA"
	3103	/>
	3104
	3105	<represent edOrganiza tion>
	3106
	3107	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	3108	FA CILITY NBR ) -->
	3109
	3110	<id
	3111	extension= "983"
	3112	nullFlavor ="NA"
	3113	/>
	3114
	3115	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	3116
	3117	<name>
	3118	CHYSHR TES T LAB
	3119	</name>
	3120
	3121	</represen tedOrganiz ation>
	3122
	3123	</assigned Author>
	3124
	3125	</author>
	3126
	3127
	3128	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	3129	immuni zations on ly -->
	3130
	3131	</substanc eAdministr ation>
	3132
	3133	</entry>
	3134
	3135	</section>
	3136
	3137	</componen t>
	3138
	3139	<component >
	3140
	3141	<!-- *** ****** ****** ****** ****** ******** * PROCEDUR ES
	3142	SECTION ****** ****** ****** ****** ****** ** -->
	3143
	3144	<section
	3145	nullFlavor ="NI"
	3146	>
	3147
	3148	<!-- CCD P rocedures Section En tries REQU IRED -->
	3149
	3150	<templateI d
	3151	root="2.16 .840.1.113 883.10.20. 22.2.7.1"
	3152	/>
	3153
	3154	<code
	3155	code="4751 9-4"
	3156	codeSystem ="2.16.840 .1.113883. 6.1"
	3157	codeSystem Name="LOIN C"
	3158	displayNam e="History of Proced ures"
	3159	/>
	3160
	3161	<title>
	3162	History of Procedure s
	3163	</title>
	3164
	3165	<!-- PROCE DURE NARRA TIVE BLOCK -->
	3166
	3167	<text>
	3168	No Data Pr ovided for This Sect ion
	3169	</text>
	3170
	3171	<!-- PROCE DURE STRUC TURED -->
	3172
	3173
	3174	</section>
	3175
	3176	</componen t>
	3177
	3178	<component >
	3179
	3180	<!-- *** ****** ****** ****** ****** ******** * SOCIAL
	3181	HISTORY SE CTION, Opt ional ** ****** ****** ****** ****** ****** -->
	3182
	3183	<section
	3184	nullFlavor ="NI"
	3185	>
	3186
	3187	<!-- CCD S ocial Hist ory Sectio n Entries -->
	3188
	3189	<templateI d
	3190	root="2.16 .840.1.113 883.10.20. 22.2.17"
	3191	/>
	3192
	3193	<code
	3194	code="2976 2-2"
	3195	codeSystem ="2.16.840 .1.113883. 6.1"
	3196	codeSystem Name="LOIN C"
	3197	displayNam e="Social history"
	3198	/>
	3199
	3200	<title>
	3201	Social His tory Secti on
	3202	</title>
	3203
	3204	<text>
	3205	No Data Pr ovided for This Sect ion
	3206	</text>
	3207
	3208
	3209	</section>
	3210
	3211	</componen t>
	3212
	3213	<component >
	3214
	3215	<!-- *** ****** ****** ****** ****** ******** * PLAN OF
	3216	CARE SECTI ON, Option al ***** ****** ****** ****** ****** ******* -->
	3217
	3218	<section
	3219	nullFlavor ="NI"
	3220	>
	3221
	3222	<!-- CCD P lan of Car e Section Entries -- >
	3223
	3224	<templateI d
	3225	root="2.16 .840.1.113 883.10.20. 22.2.10"
	3226	/>
	3227
	3228	<code
	3229	code="1877 6-5"
	3230	codeSystem ="2.16.840 .1.113883. 6.1"
	3231	codeSystem Name="LOIN C"
	3232	displayNam e="Treatme nt plan"
	3233	/>
	3234
	3235	<title>
	3236	Treatment Plan
	3237	</title>
	3238
	3239	<text>
	3240	No Data Pr ovided for This Sect ion
	3241	</text>
	3242
	3243	<!-- PLAN OF CARE (P OC) STRUCT URED DATA -->
	3244
	3245	<!-- CCD P lan of Car e (POC) Ac tivity Enc ounter (Fu ture VA Ap pointments ,
	3246	Fu ture Sched uled Tests , Wellness Reminders ), Optiona l -->
	3247
	3248
	3249	</section>
	3250
	3251	</componen t>
	3252
	3253
	3254	<!-- ***** FUNCTIONA L STATUS, Optional * ********** * -->
	3255
	3256	<component >
	3257
	3258	<section
	3259	nullFlavor ="NI"
	3260	>
	3261
	3262	<templateI d
	3263	root="2.16 .840.1.113 883.10.20. 22.2.14"
	3264	/>
	3265
	3266	<code
	3267	code="4742 0-5"
	3268	codeSystem ="2.16.840 .1.113883. 6.1"
	3269	codeSystem Name="LOIN C"
	3270	displayNam e="Functio nal status assessmen t note"
	3271	/>
	3272
	3273	<title>
	3274	Functional Status
	3275	</title>
	3276
	3277	<text>
	3278	No Data Pr ovided for This Sect ion
	3279	</text>
	3280
	3281	<!-- FUNC TIONAL STA TUS STRUCT URED ENTRI ES -->
	3282
	3283	<entry
	3284	typeCode=" DRIV"
	3285	>
	3286
	3287	<organizer
	3288	classCode= "CLUSTER"
	3289	moodCode=" EVN"
	3290	>
	3291
	3292	<!-- ** Functional Status Re sult Organ izer templ ate ** - ->
	3293
	3294	<templateI d
	3295	root="2.16 .840.1.113 883.10.20. 22.4.66"
	3296	/>
	3297
	3298	<id
	3299	nullFlavor ="UNK"
	3300	root="2.16 .840.1.113 883.4.349"
	3301	/>
	3302
	3303	<!-- Funct ional Stat us Result Organizer Code, ICF or SNOMED CT, FIM A ssessment Type -->
	3304
	3305	<code
	3306	nullFlavor ="UNK"
	3307	>
	3308
	3309	<originalT ext>
	3310
	3311	<reference
	3312	value="#fi mAssessmen t"
	3313	/>
	3314
	3315	</original Text>
	3316
	3317	</code>
	3318
	3319	<statusCod e
	3320	code="comp leted"
	3321	/>
	3322
	3323	<!-- Func tional Sta tus Result Organizer Date/Time , FIM Asse ssment Dat e -->
	3324
	3325	<effective Time>
	3326
	3327	<low
	3328	value="ass essTime"
	3329	/>
	3330
	3331	</effectiv eTime>
	3332
	3333	<!-- * Inf ormation S ource for Functional Status, V A Facility -->
	3334
	3335	<author>
	3336
	3337	<time
	3338	nullFlavor ="NA"
	3339	/>
	3340
	3341	<assignedA uthor>
	3342
	3343	<id
	3344	nullFlavor ="NA"
	3345	/>
	3346
	3347	<represent edOrganiza tion>
	3348
	3349	<id
	3350	extension= "442"
	3351	root="2.16 .840.1.113 883.3.1275 "
	3352	/>
	3353
	3354	<name>
	3355	DNS ENNE VAMC
	3356	</name>
	3357
	3358	</represen tedOrganiz ation>
	3359
	3360	</assigned Author>
	3361
	3362	</author>
	3363
	3364	<component >
	3365
	3366	<!-- Funct ional Stat us Result Observatio n -->
	3367
	3368	<observati on
	3369	classCode= "OBS"
	3370	moodCode=" EVN"
	3371	>
	3372
	3373	<templateI d
	3374	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3375	/>
	3376
	3377	<!-- Funct ional Stat us Result Observatio n ID -->
	3378
	3379	<id
	3380	nullFlavor ="UNK"
	3381	root="2.16 .840.1.113 883.4.349"
	3382	/>
	3383
	3384	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3385
	3386	<code
	3387	nullFlavor ="UNK"
	3388	/>
	3389
	3390	<text>
	3391
	3392	<reference
	3393	value="#fi mEatName"
	3394	/>
	3395
	3396	</text>
	3397
	3398	<statusCod e
	3399	code="comp leted"
	3400	/>
	3401
	3402	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3403
	3404	<effective Time>
	3405
	3406	<low
	3407	value="ski llTime"
	3408	/>
	3409
	3410	</effectiv eTime>
	3411
	3412	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3413
	3414	<value
	3415	nullFlavor ="NA"
	3416	xsi:type=" CD"
	3417	>
	3418
	3419	<originalT ext>
	3420
	3421	<reference
	3422	value="#fi mEat"
	3423	/>
	3424
	3425	</original Text>
	3426
	3427	</value>
	3428
	3429	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3430
	3431	<entryRela tionship
	3432	inversionI nd="true"
	3433	typeCode=" SUBJ"
	3434	>
	3435
	3436	<act
	3437	classCode= "ACT"
	3438	moodCode=" EVN"
	3439	>
	3440
	3441	<templateI d
	3442	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3443	/>
	3444
	3445	<code
	3446	code="4876 7-8"
	3447	codeSystem ="2.16.840 .1.113883. 6.1"
	3448	codeSystem Name="LOIN C"
	3449	displayNam e="Annotat ion commen t"
	3450	/>
	3451
	3452	<text>
	3453
	3454	<reference
	3455	value="#fi mEatDetail "
	3456	/>
	3457
	3458	</text>
	3459
	3460	</act>
	3461
	3462	</entryRel ationship>
	3463
	3464	</observat ion>
	3465
	3466	</componen t>
	3467
	3468	<component >
	3469
	3470	<!-- Funct ional Stat us Result Observatio n -->
	3471
	3472	<observati on
	3473	classCode= "OBS"
	3474	moodCode=" EVN"
	3475	>
	3476
	3477	<templateI d
	3478	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3479	/>
	3480
	3481	<!-- Funct ional Stat us Result Observatio n ID -->
	3482
	3483	<id
	3484	nullFlavor ="UNK"
	3485	root="2.16 .840.1.113 883.4.349"
	3486	/>
	3487
	3488	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3489
	3490	<code
	3491	nullFlavor ="UNK"
	3492	/>
	3493
	3494	<text>
	3495
	3496	<reference
	3497	value="#fi mGroomName "
	3498	/>
	3499
	3500	</text>
	3501
	3502	<statusCod e
	3503	code="comp leted"
	3504	/>
	3505
	3506	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3507
	3508	<effective Time>
	3509
	3510	<low
	3511	value="ski llTime"
	3512	/>
	3513
	3514	</effectiv eTime>
	3515
	3516	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3517
	3518	<value
	3519	nullFlavor ="NA"
	3520	xsi:type=" CD"
	3521	>
	3522
	3523	<originalT ext>
	3524
	3525	<reference
	3526	value="#fi mGroom"
	3527	/>
	3528
	3529	</original Text>
	3530
	3531	</value>
	3532
	3533	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3534
	3535	<entryRela tionship
	3536	inversionI nd="true"
	3537	typeCode=" SUBJ"
	3538	>
	3539
	3540	<act
	3541	classCode= "ACT"
	3542	moodCode=" EVN"
	3543	>
	3544
	3545	<templateI d
	3546	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3547	/>
	3548
	3549	<code
	3550	code="4876 7-8"
	3551	codeSystem ="2.16.840 .1.113883. 6.1"
	3552	codeSystem Name="LOIN C"
	3553	displayNam e="Annotat ion commen t"
	3554	/>
	3555
	3556	<text>
	3557
	3558	<reference
	3559	value="#fi mGroomDeta il"
	3560	/>
	3561
	3562	</text>
	3563
	3564	</act>
	3565
	3566	</entryRel ationship>
	3567
	3568	</observat ion>
	3569
	3570	</componen t>
	3571
	3572	<component >
	3573
	3574	<!-- Funct ional Stat us Result Observatio n -->
	3575
	3576	<observati on
	3577	classCode= "OBS"
	3578	moodCode=" EVN"
	3579	>
	3580
	3581	<templateI d
	3582	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3583	/>
	3584
	3585	<!-- Funct ional Stat us Result Observatio n ID -->
	3586
	3587	<id
	3588	nullFlavor ="UNK"
	3589	root="2.16 .840.1.113 883.4.349"
	3590	/>
	3591
	3592	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3593
	3594	<code
	3595	nullFlavor ="UNK"
	3596	/>
	3597
	3598	<text>
	3599
	3600	<reference
	3601	value="#fi mBathName"
	3602	/>
	3603
	3604	</text>
	3605
	3606	<statusCod e
	3607	code="comp leted"
	3608	/>
	3609
	3610	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3611
	3612	<effective Time>
	3613
	3614	<low
	3615	value="ski llTime"
	3616	/>
	3617
	3618	</effectiv eTime>
	3619
	3620	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3621
	3622	<value
	3623	nullFlavor ="NA"
	3624	xsi:type=" CD"
	3625	>
	3626
	3627	<originalT ext>
	3628
	3629	<reference
	3630	value="#fi mBath"
	3631	/>
	3632
	3633	</original Text>
	3634
	3635	</value>
	3636
	3637	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3638
	3639	<entryRela tionship
	3640	inversionI nd="true"
	3641	typeCode=" SUBJ"
	3642	>
	3643
	3644	<act
	3645	classCode= "ACT"
	3646	moodCode=" EVN"
	3647	>
	3648
	3649	<templateI d
	3650	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3651	/>
	3652
	3653	<code
	3654	code="4876 7-8"
	3655	codeSystem ="2.16.840 .1.113883. 6.1"
	3656	codeSystem Name="LOIN C"
	3657	displayNam e="Annotat ion commen t"
	3658	/>
	3659
	3660	<text>
	3661
	3662	<reference
	3663	value="#fi mBathDetai l"
	3664	/>
	3665
	3666	</text>
	3667
	3668	</act>
	3669
	3670	</entryRel ationship>
	3671
	3672	</observat ion>
	3673
	3674	</componen t>
	3675
	3676	<component >
	3677
	3678	<!-- Funct ional Stat us Result Observatio n -->
	3679
	3680	<observati on
	3681	classCode= "OBS"
	3682	moodCode=" EVN"
	3683	>
	3684
	3685	<templateI d
	3686	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3687	/>
	3688
	3689	<!-- Funct ional Stat us Result Observatio n ID -->
	3690
	3691	<id
	3692	nullFlavor ="UNK"
	3693	root="2.16 .840.1.113 883.4.349"
	3694	/>
	3695
	3696	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3697
	3698	<code
	3699	nullFlavor ="UNK"
	3700	/>
	3701
	3702	<text>
	3703
	3704	<reference
	3705	value="#fi mDressUpNa me"
	3706	/>
	3707
	3708	</text>
	3709
	3710	<statusCod e
	3711	code="comp leted"
	3712	/>
	3713
	3714	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3715
	3716	<effective Time>
	3717
	3718	<low
	3719	value="ski llTime"
	3720	/>
	3721
	3722	</effectiv eTime>
	3723
	3724	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3725
	3726	<value
	3727	nullFlavor ="NA"
	3728	xsi:type=" CD"
	3729	>
	3730
	3731	<originalT ext>
	3732
	3733	<reference
	3734	value="#fi mDressUp"
	3735	/>
	3736
	3737	</original Text>
	3738
	3739	</value>
	3740
	3741	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3742
	3743	<entryRela tionship
	3744	inversionI nd="true"
	3745	typeCode=" SUBJ"
	3746	>
	3747
	3748	<act
	3749	classCode= "ACT"
	3750	moodCode=" EVN"
	3751	>
	3752
	3753	<templateI d
	3754	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3755	/>
	3756
	3757	<code
	3758	code="4876 7-8"
	3759	codeSystem ="2.16.840 .1.113883. 6.1"
	3760	codeSystem Name="LOIN C"
	3761	displayNam e="Annotat ion commen t"
	3762	/>
	3763
	3764	<text>
	3765
	3766	<reference
	3767	value="#fi mDressUpDe tail"
	3768	/>
	3769
	3770	</text>
	3771
	3772	</act>
	3773
	3774	</entryRel ationship>
	3775
	3776	</observat ion>
	3777
	3778	</componen t>
	3779
	3780	<component >
	3781
	3782	<!-- Funct ional Stat us Result Observatio n -->
	3783
	3784	<observati on
	3785	classCode= "OBS"
	3786	moodCode=" EVN"
	3787	>
	3788
	3789	<templateI d
	3790	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3791	/>
	3792
	3793	<!-- Funct ional Stat us Result Observatio n ID -->
	3794
	3795	<id
	3796	nullFlavor ="UNK"
	3797	root="2.16 .840.1.113 883.4.349"
	3798	/>
	3799
	3800	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3801
	3802	<code
	3803	nullFlavor ="UNK"
	3804	/>
	3805
	3806	<text>
	3807
	3808	<reference
	3809	value="#fi mDressLoNa me"
	3810	/>
	3811
	3812	</text>
	3813
	3814	<statusCod e
	3815	code="comp leted"
	3816	/>
	3817
	3818	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3819
	3820	<effective Time>
	3821
	3822	<low
	3823	value="ski llTime"
	3824	/>
	3825
	3826	</effectiv eTime>
	3827
	3828	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3829
	3830	<value
	3831	nullFlavor ="NA"
	3832	xsi:type=" CD"
	3833	>
	3834
	3835	<originalT ext>
	3836
	3837	<reference
	3838	value="#fi mDressLo"
	3839	/>
	3840
	3841	</original Text>
	3842
	3843	</value>
	3844
	3845	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3846
	3847	<entryRela tionship
	3848	inversionI nd="true"
	3849	typeCode=" SUBJ"
	3850	>
	3851
	3852	<act
	3853	classCode= "ACT"
	3854	moodCode=" EVN"
	3855	>
	3856
	3857	<templateI d
	3858	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3859	/>
	3860
	3861	<code
	3862	code="4876 7-8"
	3863	codeSystem ="2.16.840 .1.113883. 6.1"
	3864	codeSystem Name="LOIN C"
	3865	displayNam e="Annotat ion commen t"
	3866	/>
	3867
	3868	<text>
	3869
	3870	<reference
	3871	value="#fi mDressLoDe tail"
	3872	/>
	3873
	3874	</text>
	3875
	3876	</act>
	3877
	3878	</entryRel ationship>
	3879
	3880	</observat ion>
	3881
	3882	</componen t>
	3883
	3884	<component >
	3885
	3886	<!-- Funct ional Stat us Result Observatio n -->
	3887
	3888	<observati on
	3889	classCode= "OBS"
	3890	moodCode=" EVN"
	3891	>
	3892
	3893	<templateI d
	3894	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3895	/>
	3896
	3897	<!-- Funct ional Stat us Result Observatio n ID -->
	3898
	3899	<id
	3900	nullFlavor ="UNK"
	3901	root="2.16 .840.1.113 883.4.349"
	3902	/>
	3903
	3904	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	3905
	3906	<code
	3907	nullFlavor ="UNK"
	3908	/>
	3909
	3910	<text>
	3911
	3912	<reference
	3913	value="#fi mToiletNam e"
	3914	/>
	3915
	3916	</text>
	3917
	3918	<statusCod e
	3919	code="comp leted"
	3920	/>
	3921
	3922	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	3923
	3924	<effective Time>
	3925
	3926	<low
	3927	value="ski llTime"
	3928	/>
	3929
	3930	</effectiv eTime>
	3931
	3932	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	3933
	3934	<value
	3935	nullFlavor ="NA"
	3936	xsi:type=" CD"
	3937	>
	3938
	3939	<originalT ext>
	3940
	3941	<reference
	3942	value="#fi mToilet"
	3943	/>
	3944
	3945	</original Text>
	3946
	3947	</value>
	3948
	3949	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	3950
	3951	<entryRela tionship
	3952	inversionI nd="true"
	3953	typeCode=" SUBJ"
	3954	>
	3955
	3956	<act
	3957	classCode= "ACT"
	3958	moodCode=" EVN"
	3959	>
	3960
	3961	<templateI d
	3962	root="2.16 .840.1.113 883.10.20. 22.4.64"
	3963	/>
	3964
	3965	<code
	3966	code="4876 7-8"
	3967	codeSystem ="2.16.840 .1.113883. 6.1"
	3968	codeSystem Name="LOIN C"
	3969	displayNam e="Annotat ion commen t"
	3970	/>
	3971
	3972	<text>
	3973
	3974	<reference
	3975	value="#fi mToiletDet ail"
	3976	/>
	3977
	3978	</text>
	3979
	3980	</act>
	3981
	3982	</entryRel ationship>
	3983
	3984	</observat ion>
	3985
	3986	</componen t>
	3987
	3988	<component >
	3989
	3990	<!-- Funct ional Stat us Result Observatio n -->
	3991
	3992	<observati on
	3993	classCode= "OBS"
	3994	moodCode=" EVN"
	3995	>
	3996
	3997	<templateI d
	3998	root="2.16 .840.1.113 883.10.20. 22.4.67"
	3999	/>
	4000
	4001	<!-- Funct ional Stat us Result Observatio n ID -->
	4002
	4003	<id
	4004	nullFlavor ="UNK"
	4005	root="2.16 .840.1.113 883.4.349"
	4006	/>
	4007
	4008	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4009
	4010	<code
	4011	nullFlavor ="UNK"
	4012	/>
	4013
	4014	<text>
	4015
	4016	<reference
	4017	value="#fi mBladderNa me"
	4018	/>
	4019
	4020	</text>
	4021
	4022	<statusCod e
	4023	code="comp leted"
	4024	/>
	4025
	4026	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4027
	4028	<effective Time>
	4029
	4030	<low
	4031	value="ski llTime"
	4032	/>
	4033
	4034	</effectiv eTime>
	4035
	4036	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4037
	4038	<value
	4039	nullFlavor ="NA"
	4040	xsi:type=" CD"
	4041	>
	4042
	4043	<originalT ext>
	4044
	4045	<reference
	4046	value="#fi mBladder"
	4047	/>
	4048
	4049	</original Text>
	4050
	4051	</value>
	4052
	4053	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4054
	4055	<entryRela tionship
	4056	inversionI nd="true"
	4057	typeCode=" SUBJ"
	4058	>
	4059
	4060	<act
	4061	classCode= "ACT"
	4062	moodCode=" EVN"
	4063	>
	4064
	4065	<templateI d
	4066	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4067	/>
	4068
	4069	<code
	4070	code="4876 7-8"
	4071	codeSystem ="2.16.840 .1.113883. 6.1"
	4072	codeSystem Name="LOIN C"
	4073	displayNam e="Annotat ion commen t"
	4074	/>
	4075
	4076	<text>
	4077
	4078	<reference
	4079	value="#fi mBladderDe tail"
	4080	/>
	4081
	4082	</text>
	4083
	4084	</act>
	4085
	4086	</entryRel ationship>
	4087
	4088	</observat ion>
	4089
	4090	</componen t>
	4091
	4092	<component >
	4093
	4094	<!-- Funct ional Stat us Result Observatio n -->
	4095
	4096	<observati on
	4097	classCode= "OBS"
	4098	moodCode=" EVN"
	4099	>
	4100
	4101	<templateI d
	4102	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4103	/>
	4104
	4105	<!-- Funct ional Stat us Result Observatio n ID -->
	4106
	4107	<id
	4108	nullFlavor ="UNK"
	4109	root="2.16 .840.1.113 883.4.349"
	4110	/>
	4111
	4112	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4113
	4114	<code
	4115	nullFlavor ="UNK"
	4116	/>
	4117
	4118	<text>
	4119
	4120	<reference
	4121	value="#fi mBowelName "
	4122	/>
	4123
	4124	</text>
	4125
	4126	<statusCod e
	4127	code="comp leted"
	4128	/>
	4129
	4130	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4131
	4132	<effective Time>
	4133
	4134	<low
	4135	value="ski llTime"
	4136	/>
	4137
	4138	</effectiv eTime>
	4139
	4140	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4141
	4142	<value
	4143	nullFlavor ="NA"
	4144	xsi:type=" CD"
	4145	>
	4146
	4147	<originalT ext>
	4148
	4149	<reference
	4150	value="#fi mBowel"
	4151	/>
	4152
	4153	</original Text>
	4154
	4155	</value>
	4156
	4157	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4158
	4159	<entryRela tionship
	4160	inversionI nd="true"
	4161	typeCode=" SUBJ"
	4162	>
	4163
	4164	<act
	4165	classCode= "ACT"
	4166	moodCode=" EVN"
	4167	>
	4168
	4169	<templateI d
	4170	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4171	/>
	4172
	4173	<code
	4174	code="4876 7-8"
	4175	codeSystem ="2.16.840 .1.113883. 6.1"
	4176	codeSystem Name="LOIN C"
	4177	displayNam e="Annotat ion commen t"
	4178	/>
	4179
	4180	<text>
	4181
	4182	<reference
	4183	value="#fi mBowelDeta il"
	4184	/>
	4185
	4186	</text>
	4187
	4188	</act>
	4189
	4190	</entryRel ationship>
	4191
	4192	</observat ion>
	4193
	4194	</componen t>
	4195
	4196	<component >
	4197
	4198	<!-- Funct ional Stat us Result Observatio n -->
	4199
	4200	<observati on
	4201	classCode= "OBS"
	4202	moodCode=" EVN"
	4203	>
	4204
	4205	<templateI d
	4206	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4207	/>
	4208
	4209	<!-- Funct ional Stat us Result Observatio n ID -->
	4210
	4211	<id
	4212	nullFlavor ="UNK"
	4213	root="2.16 .840.1.113 883.4.349"
	4214	/>
	4215
	4216	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4217
	4218	<code
	4219	nullFlavor ="UNK"
	4220	/>
	4221
	4222	<text>
	4223
	4224	<reference
	4225	value="#fi mTransChai rName"
	4226	/>
	4227
	4228	</text>
	4229
	4230	<statusCod e
	4231	code="comp leted"
	4232	/>
	4233
	4234	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4235
	4236	<effective Time>
	4237
	4238	<low
	4239	value="ski llTime"
	4240	/>
	4241
	4242	</effectiv eTime>
	4243
	4244	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4245
	4246	<value
	4247	nullFlavor ="NA"
	4248	xsi:type=" CD"
	4249	>
	4250
	4251	<originalT ext>
	4252
	4253	<reference
	4254	value="#fi mTransChai r"
	4255	/>
	4256
	4257	</original Text>
	4258
	4259	</value>
	4260
	4261	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4262
	4263	<entryRela tionship
	4264	inversionI nd="true"
	4265	typeCode=" SUBJ"
	4266	>
	4267
	4268	<act
	4269	classCode= "ACT"
	4270	moodCode=" EVN"
	4271	>
	4272
	4273	<templateI d
	4274	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4275	/>
	4276
	4277	<code
	4278	code="4876 7-8"
	4279	codeSystem ="2.16.840 .1.113883. 6.1"
	4280	codeSystem Name="LOIN C"
	4281	displayNam e="Annotat ion commen t"
	4282	/>
	4283
	4284	<text>
	4285
	4286	<reference
	4287	value="#fi mTransChai rDetail"
	4288	/>
	4289
	4290	</text>
	4291
	4292	</act>
	4293
	4294	</entryRel ationship>
	4295
	4296	</observat ion>
	4297
	4298	</componen t>
	4299
	4300	<component >
	4301
	4302	<!-- Funct ional Stat us Result Observatio n -->
	4303
	4304	<observati on
	4305	classCode= "OBS"
	4306	moodCode=" EVN"
	4307	>
	4308
	4309	<templateI d
	4310	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4311	/>
	4312
	4313	<!-- Funct ional Stat us Result Observatio n ID -->
	4314
	4315	<id
	4316	nullFlavor ="UNK"
	4317	root="2.16 .840.1.113 883.4.349"
	4318	/>
	4319
	4320	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4321
	4322	<code
	4323	nullFlavor ="UNK"
	4324	/>
	4325
	4326	<text>
	4327
	4328	<reference
	4329	value="#fi mTransToil etName"
	4330	/>
	4331
	4332	</text>
	4333
	4334	<statusCod e
	4335	code="comp leted"
	4336	/>
	4337
	4338	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4339
	4340	<effective Time>
	4341
	4342	<low
	4343	value="ski llTime"
	4344	/>
	4345
	4346	</effectiv eTime>
	4347
	4348	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4349
	4350	<value
	4351	nullFlavor ="NA"
	4352	xsi:type=" CD"
	4353	>
	4354
	4355	<originalT ext>
	4356
	4357	<reference
	4358	value="#fi mTransToil et"
	4359	/>
	4360
	4361	</original Text>
	4362
	4363	</value>
	4364
	4365	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4366
	4367	<entryRela tionship
	4368	inversionI nd="true"
	4369	typeCode=" SUBJ"
	4370	>
	4371
	4372	<act
	4373	classCode= "ACT"
	4374	moodCode=" EVN"
	4375	>
	4376
	4377	<templateI d
	4378	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4379	/>
	4380
	4381	<code
	4382	code="4876 7-8"
	4383	codeSystem ="2.16.840 .1.113883. 6.1"
	4384	codeSystem Name="LOIN C"
	4385	displayNam e="Annotat ion commen t"
	4386	/>
	4387
	4388	<text>
	4389
	4390	<reference
	4391	value="#fi mTransToil etDetail"
	4392	/>
	4393
	4394	</text>
	4395
	4396	</act>
	4397
	4398	</entryRel ationship>
	4399
	4400	</observat ion>
	4401
	4402	</componen t>
	4403
	4404	<component >
	4405
	4406	<!-- Funct ional Stat us Result Observatio n -->
	4407
	4408	<observati on
	4409	classCode= "OBS"
	4410	moodCode=" EVN"
	4411	>
	4412
	4413	<templateI d
	4414	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4415	/>
	4416
	4417	<!-- Funct ional Stat us Result Observatio n ID -->
	4418
	4419	<id
	4420	nullFlavor ="UNK"
	4421	root="2.16 .840.1.113 883.4.349"
	4422	/>
	4423
	4424	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4425
	4426	<code
	4427	nullFlavor ="UNK"
	4428	/>
	4429
	4430	<text>
	4431
	4432	<reference
	4433	value="#fi mTransTubN ame"
	4434	/>
	4435
	4436	</text>
	4437
	4438	<statusCod e
	4439	code="comp leted"
	4440	/>
	4441
	4442	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4443
	4444	<effective Time>
	4445
	4446	<low
	4447	value="ski llTime"
	4448	/>
	4449
	4450	</effectiv eTime>
	4451
	4452	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4453
	4454	<value
	4455	nullFlavor ="NA"
	4456	xsi:type=" CD"
	4457	>
	4458
	4459	<originalT ext>
	4460
	4461	<reference
	4462	value="#fi mTransTub"
	4463	/>
	4464
	4465	</original Text>
	4466
	4467	</value>
	4468
	4469	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4470
	4471	<entryRela tionship
	4472	inversionI nd="true"
	4473	typeCode=" SUBJ"
	4474	>
	4475
	4476	<act
	4477	classCode= "ACT"
	4478	moodCode=" EVN"
	4479	>
	4480
	4481	<templateI d
	4482	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4483	/>
	4484
	4485	<code
	4486	code="4876 7-8"
	4487	codeSystem ="2.16.840 .1.113883. 6.1"
	4488	codeSystem Name="LOIN C"
	4489	displayNam e="Annotat ion commen t"
	4490	/>
	4491
	4492	<text>
	4493
	4494	<reference
	4495	value="#fi mTransTubD etail"
	4496	/>
	4497
	4498	</text>
	4499
	4500	</act>
	4501
	4502	</entryRel ationship>
	4503
	4504	</observat ion>
	4505
	4506	</componen t>
	4507
	4508	<component >
	4509
	4510	<!-- Funct ional Stat us Result Observatio n -->
	4511
	4512	<observati on
	4513	classCode= "OBS"
	4514	moodCode=" EVN"
	4515	>
	4516
	4517	<templateI d
	4518	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4519	/>
	4520
	4521	<!-- Funct ional Stat us Result Observatio n ID -->
	4522
	4523	<id
	4524	nullFlavor ="UNK"
	4525	root="2.16 .840.1.113 883.4.349"
	4526	/>
	4527
	4528	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4529
	4530	<code
	4531	nullFlavor ="UNK"
	4532	/>
	4533
	4534	<text>
	4535
	4536	<reference
	4537	value="#fi mLocomWalk Name"
	4538	/>
	4539
	4540	</text>
	4541
	4542	<statusCod e
	4543	code="comp leted"
	4544	/>
	4545
	4546	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4547
	4548	<effective Time>
	4549
	4550	<low
	4551	value="ski llTime"
	4552	/>
	4553
	4554	</effectiv eTime>
	4555
	4556	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4557
	4558	<value
	4559	nullFlavor ="NA"
	4560	xsi:type=" CD"
	4561	>
	4562
	4563	<originalT ext>
	4564
	4565	<reference
	4566	value="#fi mLocomWalk "
	4567	/>
	4568
	4569	</original Text>
	4570
	4571	</value>
	4572
	4573	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4574
	4575	<entryRela tionship
	4576	inversionI nd="true"
	4577	typeCode=" SUBJ"
	4578	>
	4579
	4580	<act
	4581	classCode= "ACT"
	4582	moodCode=" EVN"
	4583	>
	4584
	4585	<templateI d
	4586	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4587	/>
	4588
	4589	<code
	4590	code="4876 7-8"
	4591	codeSystem ="2.16.840 .1.113883. 6.1"
	4592	codeSystem Name="LOIN C"
	4593	displayNam e="Annotat ion commen t"
	4594	/>
	4595
	4596	<text>
	4597
	4598	<reference
	4599	value="#fi mLocomWalk Detail"
	4600	/>
	4601
	4602	</text>
	4603
	4604	</act>
	4605
	4606	</entryRel ationship>
	4607
	4608	</observat ion>
	4609
	4610	</componen t>
	4611
	4612	<component >
	4613
	4614	<!-- Funct ional Stat us Result Observatio n -->
	4615
	4616	<observati on
	4617	classCode= "OBS"
	4618	moodCode=" EVN"
	4619	>
	4620
	4621	<templateI d
	4622	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4623	/>
	4624
	4625	<!-- Funct ional Stat us Result Observatio n ID -->
	4626
	4627	<id
	4628	nullFlavor ="UNK"
	4629	root="2.16 .840.1.113 883.4.349"
	4630	/>
	4631
	4632	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4633
	4634	<code
	4635	nullFlavor ="UNK"
	4636	/>
	4637
	4638	<text>
	4639
	4640	<reference
	4641	value="#fi mLocomStai rName"
	4642	/>
	4643
	4644	</text>
	4645
	4646	<statusCod e
	4647	code="comp leted"
	4648	/>
	4649
	4650	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4651
	4652	<effective Time>
	4653
	4654	<low
	4655	value="ski llTime"
	4656	/>
	4657
	4658	</effectiv eTime>
	4659
	4660	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4661
	4662	<value
	4663	nullFlavor ="NA"
	4664	xsi:type=" CD"
	4665	>
	4666
	4667	<originalT ext>
	4668
	4669	<reference
	4670	value="#fi mLocomStai r"
	4671	/>
	4672
	4673	</original Text>
	4674
	4675	</value>
	4676
	4677	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4678
	4679	<entryRela tionship
	4680	inversionI nd="true"
	4681	typeCode=" SUBJ"
	4682	>
	4683
	4684	<act
	4685	classCode= "ACT"
	4686	moodCode=" EVN"
	4687	>
	4688
	4689	<templateI d
	4690	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4691	/>
	4692
	4693	<code
	4694	code="4876 7-8"
	4695	codeSystem ="2.16.840 .1.113883. 6.1"
	4696	codeSystem Name="LOIN C"
	4697	displayNam e="Annotat ion commen t"
	4698	/>
	4699
	4700	<text>
	4701
	4702	<reference
	4703	value="#fi mLocomStai rDetail"
	4704	/>
	4705
	4706	</text>
	4707
	4708	</act>
	4709
	4710	</entryRel ationship>
	4711
	4712	</observat ion>
	4713
	4714	</componen t>
	4715
	4716	<component >
	4717
	4718	<!-- Funct ional Stat us Result Observatio n -->
	4719
	4720	<observati on
	4721	classCode= "OBS"
	4722	moodCode=" EVN"
	4723	>
	4724
	4725	<templateI d
	4726	root="2.16 .840.1.113 883.10.20. 22.4.67"
	4727	/>
	4728
	4729	<!-- Funct ional Stat us Result Observatio n ID -->
	4730
	4731	<id
	4732	nullFlavor ="UNK"
	4733	root="2.16 .840.1.113 883.4.349"
	4734	/>
	4735
	4736	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	4737
	4738	<code
	4739	nullFlavor ="UNK"
	4740	/>
	4741
	4742	<text>
	4743
	4744	<reference
	4745	value="#fi mComprehen dName"
	4746	/>
	4747
	4748	</text>
	4749
	4750	<statusCod e
	4751	code="comp leted"
	4752	/>
	4753
	4754	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	4755
	4756	<effective Time>
	4757
	4758	<low
	4759	value="ski llTime"
	4760	/>
	4761
	4762	</effectiv eTime>
	4763
	4764	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	4765
	4766	<value
	4767	nullFlavor ="NA"
	4768	xsi:type=" CD"
	4769	>
	4770
	4771	<originalT ext>
	4772
	4773	<reference
	4774	value="#fi mComprehen d"
	4775	/>
	4776
	4777	</original Text>
	4778
	4779	</value>
	4780
	4781	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	4782
	4783	<entryRela tionship
	4784	inversionI nd="true"
	4785	typeCode=" SUBJ"
	4786	>
	4787
	4788	<act
	4789	classCode= "ACT"
	4790	moodCode=" EVN"
	4791	>
	4792
	4793	<templateI d
	4794	root="2.16 .840.1.113 883.10.20. 22.4.64"
	4795	/>
	4796
	4797	<code
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