825. EPMO Open Source Coordination Office Redaction File Detail Report

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825.1 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	374215_CCDACCD_20161205.xml	Thu Jan 12 19:48:40 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	374215_CCDACCD_20161205.xml	Wed Apr 5 15:42:12 2017 UTC

825.2 Comparison summary

Description	Between Files 1 and 2
Description	Text Blocks	Lines
Unchanged	4	68508
Changed	3	6
Inserted	0	0
Removed	0	0

825.3 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

825.4 Active regular expressions

No regular expressions were active.

825.5 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= "2.25.3196 2658429703 9729348854 4926584641 56992"
	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 6120509262 2-0600"
	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 4V546709"
	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	1100 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 1-1111"
	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	NWHINONE
	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	STEVIE
	150	</given>
	151
	152	<family>
	153	VAUGHAN
	154	</family>
	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 10101"
	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="2186 -5"
	230	codeSystem ="2.16.840 .1.113883. 6.238"
	231	codeSystem Name="Race & Eth nicity - C DC"
	232	displayNam e="Not His panic or L atino"
	233	>
	234
	235	<originalT ext>
	236	NOT HISPAN IC OR LATI NO
	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 6120509262 2-0600"
	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 6120509262 2-0600"
	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	Uncle
	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	<streetAdd ressLine>
	562	1100 Test Street
	563	</streetAd dressLine>
	564
	565	<city>
	566	HELENA
	567	</city>
	568
	569	<state>
	570	ALABAMA
	571	</state>
	572
	573	<postalCod e>
	574	35080
	575	</postalCo de>
	576
	577	</addr>
	578
	579	<!-- 3.05 CONTACT PH ONE/EMAIL/ URL, Optio nal-R2, Re moved b/c data not y et
	580	availabl e via VA V istA RPCs -->
	581
	582	<telecom
	583	use="HP"
	584	value="tel :+1-201-11 1-1111"
	585	/>
	586
	587	<associate dPerson>
	588
	589	<!-- 3.06 CONTACT NA ME, REQUIR ED -->
	590
	591	<name>
	592
	593
	594	<given>
	595	TEST
	596	</given>
	597
	598	<family>
	599	TEST
	600	</family>
	601
	602
	603	</name>
	604
	605	</associat edPerson>
	606
	607	</associat edEntity>
	608
	609	</particip ant>
	610	<participa nt
	611	typeCode=" IND"
	612	>
	613
	614	<!-- 3.01 DATE, REQU IRED -->
	615
	616	<!-- 3.01 DATE date as nullFla vor b/c da ta not yet available via VA Vi stA
	617	RPCs - ->
	618
	619	<time
	620	nullFlavor ="UNK"
	621	/>
	622
	623	<!-- 3.02 CONTACT TY PE, REQUIR ED, classC ode value determined by VistA value
	624	in con tactType - ->
	625
	626	<associate dEntity
	627	classCode= "NOK"
	628	>
	629
	630	<code
	631	code="UNK"
	632	codeSystem ="2.16.840 .1.113883. 5.111"
	633	codeSystem Name="Role Code"
	634	nullFlavor ="UNK"
	635	>
	636
	637	<originalT ext>
	638	Uncle
	639	</original Text>
	640
	641	</code>
	642
	643	<!-- 3.04 CONTACT Ad dresss, Ho me Permane nt, Option al-R2 -->
	644
	645	<addr
	646	use="HP"
	647	>
	648
	649	<streetAdd ressLine>
	650	1100 Test Street
	651	</streetAd dressLine>
	652
	653	<city>
	654	HELENA
	655	</city>
	656
	657	<state>
	658	ALABAMA
	659	</state>
	660
	661	<postalCod e>
	662	35080
	663	</postalCo de>
	664
	665	</addr>
	666
	667	<!-- 3.05 CONTACT PH ONE/EMAIL/ URL, Optio nal-R2, Re moved b/c data not y et
	668	availabl e via VA V istA RPCs -->
	669
	670	<telecom
	671	use="HP"
	672	value="tel :+1-201-11 1-1111"
	673	/>
	674
	675	<associate dPerson>
	676
	677	<!-- 3.06 CONTACT NA ME, REQUIR ED -->
	678
	679	<name>
	680
	681
	682	<given>
	683	TEST
	684	</given>
	685
	686	<family>
	687	TEST
	688	</family>
	689
	690
	691	</name>
	692
	693	</associat edPerson>
	694
	695	</associat edEntity>
	696
	697	</particip ant>
	698
	699	<!-- *** ****** ****** ****** ****** ****** ****** ****** **
	700	DOCU MENTATION OF MODULE - QUERY ME TA DATA, O ptional ****** ****** ****** ****** ****** ****** ****** ***** -- >
	701
	702	<documenta tionOf>
	703
	704	<serviceEv ent
	705	classCode= "PCPR"
	706	>
	707
	708	<effective Time>
	709
	710	<low
	711	value="198 10101"
	712	/>
	713
	714	<high
	715	value="201 6120509262 2-0600"
	716	/>
	717
	718	</effectiv eTime>
	719
	720
	721
	722
	723	<performer
	724	typeCode=" PRF"
	725	>
	726
	727	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	728
	729
	730	<assignedE ntity>
	731
	732	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	733
	734	<id
	735	extension= "provider1 001"
	736	root="2.16 .840.1.113 883.4.349"
	737	/>
	738
	739
	740	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	741	av ailable -- >
	742
	743	<addr
	744	nullFlavor ="UNK"
	745	/>
	746
	747	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	748	av ailable -- >
	749
	750	<telecom
	751	nullFlavor ="UNK"
	752	/>
	753
	754	<assignedP erson>
	755
	756	<name>
	757	SEITZ,DAVI D
	758	</name>
	759
	760	</assigned Person>
	761
	762	<represent edOrganiza tion>
	763
	764	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	765	FACI LITY NBR - ->
	766
	767	<id
	768	extension= "552"
	769	nullFlavor ="UNK"
	770	root="2.16 .840.1.113 883.4.349"
	771	/>
	772
	773	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	774
	775	<name>
	776	DAYTON
	777	</name>
	778
	779	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	780	not yet availa ble -->
	781
	782	<telecom
	783	nullFlavor ="UNK"
	784	/>
	785
	786	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	787	not yet availa ble -->
	788
	789	<addr
	790	nullFlavor ="UNK"
	791	/>
	792
	793	</represen tedOrganiz ation>
	794
	795	</assigned Entity>
	796
	797	</performe r>
	798	<performer
	799	typeCode=" PRF"
	800	>
	801
	802	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	803
	804
	805	<assignedE ntity>
	806
	807	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	808
	809	<id
	810	extension= "provider1 002"
	811	root="2.16 .840.1.113 883.4.349"
	812	/>
	813
	814
	815	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	816	av ailable -- >
	817
	818	<addr
	819	nullFlavor ="UNK"
	820	/>
	821
	822	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	823	av ailable -- >
	824
	825	<telecom
	826	nullFlavor ="UNK"
	827	/>
	828
	829	<assignedP erson>
	830
	831	<name>
	832	SINGLETON, CHRISTINE
	833	</name>
	834
	835	</assigned Person>
	836
	837	<represent edOrganiza tion>
	838
	839	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	840	FACI LITY NBR - ->
	841
	842	<id
	843	extension= "552"
	844	nullFlavor ="UNK"
	845	root="2.16 .840.1.113 883.4.349"
	846	/>
	847
	848	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	849
	850	<name>
	851	DAYTON
	852	</name>
	853
	854	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	855	not yet availa ble -->
	856
	857	<telecom
	858	nullFlavor ="UNK"
	859	/>
	860
	861	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	862	not yet availa ble -->
	863
	864	<addr
	865	nullFlavor ="UNK"
	866	/>
	867
	868	</represen tedOrganiz ation>
	869
	870	</assigned Entity>
	871
	872	</performe r>
	873	<performer
	874	typeCode=" PRF"
	875	>
	876
	877	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	878
	879
	880	<assignedE ntity>
	881
	882	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	883
	884	<id
	885	extension= "provider1 003"
	886	root="2.16 .840.1.113 883.4.349"
	887	/>
	888
	889
	890	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	891	av ailable -- >
	892
	893	<addr
	894	nullFlavor ="UNK"
	895	/>
	896
	897	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	898	av ailable -- >
	899
	900	<telecom
	901	nullFlavor ="UNK"
	902	/>
	903
	904	<assignedP erson>
	905
	906	<name>
	907	ADAM,DAVID R
	908	</name>
	909
	910	</assigned Person>
	911
	912	<represent edOrganiza tion>
	913
	914	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	915	FACI LITY NBR - ->
	916
	917	<id
	918	extension= "552"
	919	nullFlavor ="UNK"
	920	root="2.16 .840.1.113 883.4.349"
	921	/>
	922
	923	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	924
	925	<name>
	926	DAYTON
	927	</name>
	928
	929	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	930	not yet availa ble -->
	931
	932	<telecom
	933	nullFlavor ="UNK"
	934	/>
	935
	936	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	937	not yet availa ble -->
	938
	939	<addr
	940	nullFlavor ="UNK"
	941	/>
	942
	943	</represen tedOrganiz ation>
	944
	945	</assigned Entity>
	946
	947	</performe r>
	948	<performer
	949	typeCode=" PRF"
	950	>
	951
	952	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	953
	954
	955	<assignedE ntity>
	956
	957	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	958
	959	<id
	960	extension= "provider1 004"
	961	root="2.16 .840.1.113 883.4.349"
	962	/>
	963
	964
	965	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	966	av ailable -- >
	967
	968	<addr
	969	nullFlavor ="UNK"
	970	/>
	971
	972	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	973	av ailable -- >
	974
	975	<telecom
	976	nullFlavor ="UNK"
	977	/>
	978
	979	<assignedP erson>
	980
	981	<name>
	982	GOURALNIK, YELENA
	983	</name>
	984
	985	</assigned Person>
	986
	987	<represent edOrganiza tion>
	988
	989	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	990	FACI LITY NBR - ->
	991
	992	<id
	993	extension= "552"
	994	nullFlavor ="UNK"
	995	root="2.16 .840.1.113 883.4.349"
	996	/>
	997
	998	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	999
	1000	<name>
	1001	DAYTON
	1002	</name>
	1003
	1004	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1005	not yet availa ble -->
	1006
	1007	<telecom
	1008	nullFlavor ="UNK"
	1009	/>
	1010
	1011	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1012	not yet availa ble -->
	1013
	1014	<addr
	1015	nullFlavor ="UNK"
	1016	/>
	1017
	1018	</represen tedOrganiz ation>
	1019
	1020	</assigned Entity>
	1021
	1022	</performe r>
	1023	<performer
	1024	typeCode=" PRF"
	1025	>
	1026
	1027	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1028
	1029
	1030	<assignedE ntity>
	1031
	1032	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1033
	1034	<id
	1035	extension= "provider1 005"
	1036	root="2.16 .840.1.113 883.4.349"
	1037	/>
	1038
	1039
	1040	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1041	av ailable -- >
	1042
	1043	<addr
	1044	nullFlavor ="UNK"
	1045	/>
	1046
	1047	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1048	av ailable -- >
	1049
	1050	<telecom
	1051	nullFlavor ="UNK"
	1052	/>
	1053
	1054	<assignedP erson>
	1055
	1056	<name>
	1057	GARTZ,DONN A
	1058	</name>
	1059
	1060	</assigned Person>
	1061
	1062	<represent edOrganiza tion>
	1063
	1064	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1065	FACI LITY NBR - ->
	1066
	1067	<id
	1068	extension= "552"
	1069	nullFlavor ="UNK"
	1070	root="2.16 .840.1.113 883.4.349"
	1071	/>
	1072
	1073	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1074
	1075	<name>
	1076	DAYTON
	1077	</name>
	1078
	1079	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1080	not yet availa ble -->
	1081
	1082	<telecom
	1083	nullFlavor ="UNK"
	1084	/>
	1085
	1086	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1087	not yet availa ble -->
	1088
	1089	<addr
	1090	nullFlavor ="UNK"
	1091	/>
	1092
	1093	</represen tedOrganiz ation>
	1094
	1095	</assigned Entity>
	1096
	1097	</performe r>
	1098	<performer
	1099	typeCode=" PRF"
	1100	>
	1101
	1102	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1103
	1104
	1105	<assignedE ntity>
	1106
	1107	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1108
	1109	<id
	1110	extension= "provider1 006"
	1111	root="2.16 .840.1.113 883.4.349"
	1112	/>
	1113
	1114
	1115	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1116	av ailable -- >
	1117
	1118	<addr
	1119	nullFlavor ="UNK"
	1120	/>
	1121
	1122	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1123	av ailable -- >
	1124
	1125	<telecom
	1126	nullFlavor ="UNK"
	1127	/>
	1128
	1129	<assignedP erson>
	1130
	1131	<name>
	1132	ABSHIRE,BE VERLY C
	1133	</name>
	1134
	1135	</assigned Person>
	1136
	1137	<represent edOrganiza tion>
	1138
	1139	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1140	FACI LITY NBR - ->
	1141
	1142	<id
	1143	extension= "552"
	1144	nullFlavor ="UNK"
	1145	root="2.16 .840.1.113 883.4.349"
	1146	/>
	1147
	1148	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1149
	1150	<name>
	1151	DAYTON
	1152	</name>
	1153
	1154	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1155	not yet availa ble -->
	1156
	1157	<telecom
	1158	nullFlavor ="UNK"
	1159	/>
	1160
	1161	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1162	not yet availa ble -->
	1163
	1164	<addr
	1165	nullFlavor ="UNK"
	1166	/>
	1167
	1168	</represen tedOrganiz ation>
	1169
	1170	</assigned Entity>
	1171
	1172	</performe r>
	1173	<performer
	1174	typeCode=" PRF"
	1175	>
	1176
	1177	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1178
	1179
	1180	<assignedE ntity>
	1181
	1182	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1183
	1184	<id
	1185	extension= "provider1 007"
	1186	root="2.16 .840.1.113 883.4.349"
	1187	/>
	1188
	1189
	1190	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1191	av ailable -- >
	1192
	1193	<addr
	1194	nullFlavor ="UNK"
	1195	/>
	1196
	1197	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1198	av ailable -- >
	1199
	1200	<telecom
	1201	nullFlavor ="UNK"
	1202	/>
	1203
	1204	<assignedP erson>
	1205
	1206	<name>
	1207	MANGUS,CHR ISTOPHER
	1208	</name>
	1209
	1210	</assigned Person>
	1211
	1212	<represent edOrganiza tion>
	1213
	1214	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1215	FACI LITY NBR - ->
	1216
	1217	<id
	1218	extension= "983"
	1219	nullFlavor ="UNK"
	1220	root="2.16 .840.1.113 883.4.349"
	1221	/>
	1222
	1223	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1224
	1225	<name>
	1226	CHYSHR TES T LAB
	1227	</name>
	1228
	1229	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1230	not yet availa ble -->
	1231
	1232	<telecom
	1233	nullFlavor ="UNK"
	1234	/>
	1235
	1236	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1237	not yet availa ble -->
	1238
	1239	<addr
	1240	nullFlavor ="UNK"
	1241	/>
	1242
	1243	</represen tedOrganiz ation>
	1244
	1245	</assigned Entity>
	1246
	1247	</performe r>
	1248	<performer
	1249	typeCode=" PRF"
	1250	>
	1251
	1252	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1253
	1254
	1255	<assignedE ntity>
	1256
	1257	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1258
	1259	<id
	1260	extension= "provider1 008"
	1261	root="2.16 .840.1.113 883.4.349"
	1262	/>
	1263
	1264
	1265	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1266	av ailable -- >
	1267
	1268	<addr
	1269	nullFlavor ="UNK"
	1270	/>
	1271
	1272	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1273	av ailable -- >
	1274
	1275	<telecom
	1276	nullFlavor ="UNK"
	1277	/>
	1278
	1279	<assignedP erson>
	1280
	1281	<name>
	1282	MANGUS,CHR ISTOPHER
	1283	</name>
	1284
	1285	</assigned Person>
	1286
	1287	<represent edOrganiza tion>
	1288
	1289	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1290	FACI LITY NBR - ->
	1291
	1292	<id
	1293	extension= "983"
	1294	nullFlavor ="UNK"
	1295	root="2.16 .840.1.113 883.4.349"
	1296	/>
	1297
	1298	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1299
	1300	<name>
	1301	CHYSHR TES T LAB
	1302	</name>
	1303
	1304	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1305	not yet availa ble -->
	1306
	1307	<telecom
	1308	nullFlavor ="UNK"
	1309	/>
	1310
	1311	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1312	not yet availa ble -->
	1313
	1314	<addr
	1315	nullFlavor ="UNK"
	1316	/>
	1317
	1318	</represen tedOrganiz ation>
	1319
	1320	</assigned Entity>
	1321
	1322	</performe r>
	1323	<performer
	1324	typeCode=" PRF"
	1325	>
	1326
	1327	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1328
	1329
	1330	<assignedE ntity>
	1331
	1332	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1333
	1334	<id
	1335	extension= "provider1 009"
	1336	root="2.16 .840.1.113 883.4.349"
	1337	/>
	1338
	1339
	1340	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1341	av ailable -- >
	1342
	1343	<addr
	1344	nullFlavor ="UNK"
	1345	/>
	1346
	1347	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1348	av ailable -- >
	1349
	1350	<telecom
	1351	nullFlavor ="UNK"
	1352	/>
	1353
	1354	<assignedP erson>
	1355
	1356	<name>
	1357	BOUHADDOU, OMAR
	1358	</name>
	1359
	1360	</assigned Person>
	1361
	1362	<represent edOrganiza tion>
	1363
	1364	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1365	FACI LITY NBR - ->
	1366
	1367	<id
	1368	extension= "983"
	1369	nullFlavor ="UNK"
	1370	root="2.16 .840.1.113 883.4.349"
	1371	/>
	1372
	1373	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1374
	1375	<name>
	1376	CHYSHR TES T LAB
	1377	</name>
	1378
	1379	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1380	not yet availa ble -->
	1381
	1382	<telecom
	1383	nullFlavor ="UNK"
	1384	/>
	1385
	1386	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1387	not yet availa ble -->
	1388
	1389	<addr
	1390	nullFlavor ="UNK"
	1391	/>
	1392
	1393	</represen tedOrganiz ation>
	1394
	1395	</assigned Entity>
	1396
	1397	</performe r>
	1398	<performer
	1399	typeCode=" PRF"
	1400	>
	1401
	1402	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1403
	1404
	1405	<assignedE ntity>
	1406
	1407	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1408
	1409	<id
	1410	extension= "provider1 010"
	1411	root="2.16 .840.1.113 883.4.349"
	1412	/>
	1413
	1414
	1415	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1416	av ailable -- >
	1417
	1418	<addr
	1419	nullFlavor ="UNK"
	1420	/>
	1421
	1422	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1423	av ailable -- >
	1424
	1425	<telecom
	1426	nullFlavor ="UNK"
	1427	/>
	1428
	1429	<assignedP erson>
	1430
	1431	<name>
	1432	SWALL,MARI E
	1433	</name>
	1434
	1435	</assigned Person>
	1436
	1437	<represent edOrganiza tion>
	1438
	1439	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1440	FACI LITY NBR - ->
	1441
	1442	<id
	1443	extension= "983"
	1444	nullFlavor ="UNK"
	1445	root="2.16 .840.1.113 883.4.349"
	1446	/>
	1447
	1448	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1449
	1450	<name>
	1451	CHYSHR TES T LAB
	1452	</name>
	1453
	1454	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1455	not yet availa ble -->
	1456
	1457	<telecom
	1458	nullFlavor ="UNK"
	1459	/>
	1460
	1461	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1462	not yet availa ble -->
	1463
	1464	<addr
	1465	nullFlavor ="UNK"
	1466	/>
	1467
	1468	</represen tedOrganiz ation>
	1469
	1470	</assigned Entity>
	1471
	1472	</performe r>
	1473	<performer
	1474	typeCode=" PRF"
	1475	>
	1476
	1477	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1478
	1479
	1480	<assignedE ntity>
	1481
	1482	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1483
	1484	<id
	1485	extension= "provider1 011"
	1486	root="2.16 .840.1.113 883.4.349"
	1487	/>
	1488
	1489
	1490	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1491	av ailable -- >
	1492
	1493	<addr
	1494	nullFlavor ="UNK"
	1495	/>
	1496
	1497	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1498	av ailable -- >
	1499
	1500	<telecom
	1501	nullFlavor ="UNK"
	1502	/>
	1503
	1504	<assignedP erson>
	1505
	1506	<name>
	1507	POND,NEAL
	1508	</name>
	1509
	1510	</assigned Person>
	1511
	1512	<represent edOrganiza tion>
	1513
	1514	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1515	FACI LITY NBR - ->
	1516
	1517	<id
	1518	extension= "983"
	1519	nullFlavor ="UNK"
	1520	root="2.16 .840.1.113 883.4.349"
	1521	/>
	1522
	1523	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1524
	1525	<name>
	1526	CHYSHR TES T LAB
	1527	</name>
	1528
	1529	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1530	not yet availa ble -->
	1531
	1532	<telecom
	1533	nullFlavor ="UNK"
	1534	/>
	1535
	1536	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1537	not yet availa ble -->
	1538
	1539	<addr
	1540	nullFlavor ="UNK"
	1541	/>
	1542
	1543	</represen tedOrganiz ation>
	1544
	1545	</assigned Entity>
	1546
	1547	</performe r>
	1548	<performer
	1549	typeCode=" PRF"
	1550	>
	1551
	1552	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1553
	1554
	1555	<assignedE ntity>
	1556
	1557	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1558
	1559	<id
	1560	extension= "provider1 012"
	1561	root="2.16 .840.1.113 883.4.349"
	1562	/>
	1563
	1564
	1565	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1566	av ailable -- >
	1567
	1568	<addr
	1569	nullFlavor ="UNK"
	1570	/>
	1571
	1572	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1573	av ailable -- >
	1574
	1575	<telecom
	1576	nullFlavor ="UNK"
	1577	/>
	1578
	1579	<assignedP erson>
	1580
	1581	<name>
	1582	POND,NEAL
	1583	</name>
	1584
	1585	</assigned Person>
	1586
	1587	<represent edOrganiza tion>
	1588
	1589	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1590	FACI LITY NBR - ->
	1591
	1592	<id
	1593	extension= "983"
	1594	nullFlavor ="UNK"
	1595	root="2.16 .840.1.113 883.4.349"
	1596	/>
	1597
	1598	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1599
	1600	<name>
	1601	CHYSHR TES T LAB
	1602	</name>
	1603
	1604	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1605	not yet availa ble -->
	1606
	1607	<telecom
	1608	nullFlavor ="UNK"
	1609	/>
	1610
	1611	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1612	not yet availa ble -->
	1613
	1614	<addr
	1615	nullFlavor ="UNK"
	1616	/>
	1617
	1618	</represen tedOrganiz ation>
	1619
	1620	</assigned Entity>
	1621
	1622	</performe r>
	1623	<performer
	1624	typeCode=" PRF"
	1625	>
	1626
	1627	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1628
	1629
	1630	<assignedE ntity>
	1631
	1632	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1633
	1634	<id
	1635	extension= "provider1 013"
	1636	root="2.16 .840.1.113 883.4.349"
	1637	/>
	1638
	1639
	1640	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1641	av ailable -- >
	1642
	1643	<addr
	1644	nullFlavor ="UNK"
	1645	/>
	1646
	1647	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1648	av ailable -- >
	1649
	1650	<telecom
	1651	nullFlavor ="UNK"
	1652	/>
	1653
	1654	<assignedP erson>
	1655
	1656	<name>
	1657	MANGUS,CHR ISTOPHER
	1658	</name>
	1659
	1660	</assigned Person>
	1661
	1662	<represent edOrganiza tion>
	1663
	1664	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1665	FACI LITY NBR - ->
	1666
	1667	<id
	1668	extension= "983"
	1669	nullFlavor ="UNK"
	1670	root="2.16 .840.1.113 883.4.349"
	1671	/>
	1672
	1673	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1674
	1675	<name>
	1676	CHYSHR TES T LAB
	1677	</name>
	1678
	1679	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1680	not yet availa ble -->
	1681
	1682	<telecom
	1683	nullFlavor ="UNK"
	1684	/>
	1685
	1686	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1687	not yet availa ble -->
	1688
	1689	<addr
	1690	nullFlavor ="UNK"
	1691	/>
	1692
	1693	</represen tedOrganiz ation>
	1694
	1695	</assigned Entity>
	1696
	1697	</performe r>
	1698	<performer
	1699	typeCode=" PRF"
	1700	>
	1701
	1702	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1703
	1704
	1705	<assignedE ntity>
	1706
	1707	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1708
	1709	<id
	1710	extension= "provider1 014"
	1711	root="2.16 .840.1.113 883.4.349"
	1712	/>
	1713
	1714
	1715	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1716	av ailable -- >
	1717
	1718	<addr
	1719	nullFlavor ="UNK"
	1720	/>
	1721
	1722	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1723	av ailable -- >
	1724
	1725	<telecom
	1726	nullFlavor ="UNK"
	1727	/>
	1728
	1729	<assignedP erson>
	1730
	1731	<name>
	1732	MANGUS,CHR ISTOPHER
	1733	</name>
	1734
	1735	</assigned Person>
	1736
	1737	<represent edOrganiza tion>
	1738
	1739	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1740	FACI LITY NBR - ->
	1741
	1742	<id
	1743	extension= "983"
	1744	nullFlavor ="UNK"
	1745	root="2.16 .840.1.113 883.4.349"
	1746	/>
	1747
	1748	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1749
	1750	<name>
	1751	CHYSHR TES T LAB
	1752	</name>
	1753
	1754	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1755	not yet availa ble -->
	1756
	1757	<telecom
	1758	nullFlavor ="UNK"
	1759	/>
	1760
	1761	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1762	not yet availa ble -->
	1763
	1764	<addr
	1765	nullFlavor ="UNK"
	1766	/>
	1767
	1768	</represen tedOrganiz ation>
	1769
	1770	</assigned Entity>
	1771
	1772	</performe r>
	1773	<performer
	1774	typeCode=" PRF"
	1775	>
	1776
	1777	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1778
	1779
	1780	<assignedE ntity>
	1781
	1782	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1783
	1784	<id
	1785	extension= "provider1 015"
	1786	root="2.16 .840.1.113 883.4.349"
	1787	/>
	1788
	1789
	1790	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1791	av ailable -- >
	1792
	1793	<addr
	1794	nullFlavor ="UNK"
	1795	/>
	1796
	1797	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1798	av ailable -- >
	1799
	1800	<telecom
	1801	nullFlavor ="UNK"
	1802	/>
	1803
	1804	<assignedP erson>
	1805
	1806	<name>
	1807	MANGUS,CHR ISTOPHER
	1808	</name>
	1809
	1810	</assigned Person>
	1811
	1812	<represent edOrganiza tion>
	1813
	1814	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1815	FACI LITY NBR - ->
	1816
	1817	<id
	1818	extension= "983"
	1819	nullFlavor ="UNK"
	1820	root="2.16 .840.1.113 883.4.349"
	1821	/>
	1822
	1823	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1824
	1825	<name>
	1826	CHYSHR TES T LAB
	1827	</name>
	1828
	1829	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1830	not yet availa ble -->
	1831
	1832	<telecom
	1833	nullFlavor ="UNK"
	1834	/>
	1835
	1836	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1837	not yet availa ble -->
	1838
	1839	<addr
	1840	nullFlavor ="UNK"
	1841	/>
	1842
	1843	</represen tedOrganiz ation>
	1844
	1845	</assigned Entity>
	1846
	1847	</performe r>
	1848	<performer
	1849	typeCode=" PRF"
	1850	>
	1851
	1852	<!-- ***** * HEALTHCA RE PROVIDE R MODULE, Optional * ******** - ->
	1853
	1854
	1855	<assignedE ntity>
	1856
	1857	<!-- Provi der ID fro m Problems Module (7 .05Treatin g Provider ID) -->
	1858
	1859	<id
	1860	extension= "provider1 016"
	1861	root="2.16 .840.1.113 883.4.349"
	1862	/>
	1863
	1864
	1865	<!-- Addre ss Require d for assi gnedEntity , but VA V istA data not yet
	1866	av ailable -- >
	1867
	1868	<addr
	1869	nullFlavor ="UNK"
	1870	/>
	1871
	1872	<!-- Telec om Require d for iass ignedEntit y, but VA VistA data not yet
	1873	av ailable -- >
	1874
	1875	<telecom
	1876	nullFlavor ="UNK"
	1877	/>
	1878
	1879	<assignedP erson>
	1880
	1881	<name>
	1882	POND,NEAL
	1883	</name>
	1884
	1885	</assigned Person>
	1886
	1887	<represent edOrganiza tion>
	1888
	1889	<!-- INFOR MATION SOU RCE FOR FA CILITY ID= VA OID, EX T= VAMC TR EATING
	1890	FACI LITY NBR - ->
	1891
	1892	<id
	1893	extension= "983"
	1894	nullFlavor ="UNK"
	1895	root="2.16 .840.1.113 883.4.349"
	1896	/>
	1897
	1898	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	1899
	1900	<name>
	1901	CHYSHR TES T LAB
	1902	</name>
	1903
	1904	<!-- Telec om Require d for repr esentedOrg anization, but VA Vi stA data
	1905	not yet availa ble -->
	1906
	1907	<telecom
	1908	nullFlavor ="UNK"
	1909	/>
	1910
	1911	<!-- Addre ss Require d for repr esentedOrg anization, but VA Vi stA data
	1912	not yet availa ble -->
	1913
	1914	<addr
	1915	nullFlavor ="UNK"
	1916	/>
	1917
	1918	</represen tedOrganiz ation>
	1919
	1920	</assigned Entity>
	1921
	1922	</performe r>
	1923
	1924
	1925
	1926	</serviceE vent>
	1927
	1928	</document ationOf>
	1929
	1930	<component Of>
	1931
	1932	<encompass ingEncount er>
	1933
	1934	<id
	1935	root="2.16 .840.1.113 883.4.349"
	1936	/>
	1937
	1938	<effective Time
	1939	nullFlavor ="UNK"
	1940	/>
	1941
	1942	</encompas singEncoun ter>
	1943
	1944	</componen tOf>
	1945
	1946	<!-- *** ****** ****** ****** ****** ******** * CDA BODY ******* ****** ****** ****** ****** ***** -- >
	1947
	1948	<component >
	1949
	1950	<structure dBody>
	1951
	1952	<component >
	1953
	1954	<!-- *** ****** ****** ****** ****** ****** **** ALL ERGY/DRUG
	1955	SECTION SE CTION, REQ UIRED ** ****** ****** ****** ****** ****** ***** -- >
	1956
	1957	<section>
	1958
	1959	<!-- ALLER GY/DRUG Se ction Temp late Entri es REQUIRE D -->
	1960
	1961	<templateI d
	1962	root="2.16 .840.1.113 883.10.20. 22.2.6.1"
	1963	/>
	1964
	1965	<templateI d
	1966	root="2.16 .840.1.113 883.10.20. 22.2.6"
	1967	/>
	1968
	1969	<code
	1970	code="4876 5-2"
	1971	codeSystem ="2.16.840 .1.113883. 6.1"
	1972	codeSystem Name="LOIN C"
	1973	displayNam e="Allergi es, advers e reaction s, alerts"
	1974	/>
	1975
	1976	<title>
	1977	Allergies Section
	1978	</title>
	1979
	1980	<!-- ALLER GIES NARRA TIVE BLOCK -->
	1981
	1982	<text>
	1983
	1984	<!-- VA Al lergies/Dr ug Busines s Rules fo r Medical Content -- >
	1985
	1986	<paragraph >
	1987	This secti on contain s Allergie s on recor d with VA for the
	1988	pati ent. The d ata comes from all V A treatmen t faciliti es. It doe s
	1989	not list aller gies that were remov ed or ente red in err or. Some
	1990	alle rgies may be reporte d in the I mmunizatio n section.
	1991	</paragrap h>
	1992
	1993	<table
	1994	ID="allerg yNarrative "
	1995	border="1"
	1996	width="100 %"
	1997	>
	1998
	1999	<thead>
	2000
	2001	<tr>
	2002
	2003	<th>
	2004	Allergen
	2005	</th>
	2006
	2007	<th>
	2008	Event Date
	2009	</th>
	2010
	2011	<th>
	2012	Event Type
	2013	</th>
	2014
	2015	<th>
	2016	Reaction(s )
	2017	</th>
	2018
	2019	<th>
	2020	Severity
	2021	</th>
	2022
	2023	<th>
	2024	Source
	2025	</th>
	2026
	2027	</tr>
	2028
	2029	</thead>
	2030
	2031	<tbody>
	2032
	2033	<tr>
	2034
	2035	<td>
	2036
	2037	<content
	2038	ID="andAll ergy1001"
	2039	>
	2040	MOLD
	2041	</content>
	2042
	2043	</td>
	2044
	2045	<td>
	2046	Dec 12, 20 11
	2047	</td>
	2048
	2049
	2050	<td>
	2051
	2052	<content
	2053	ID="andEve ntType1001 "
	2054	>
	2055	Propensity to advers e reaction s
	2056	</content>
	2057
	2058	</td>
	2059
	2060	<td>
	2061
	2062	<list>
	2063
	2064	<item>
	2065
	2066	<content
	2067	ID="andRea ction1001"
	2068	>
	2069	ASTHMA
	2070	</content>
	2071
	2072	</item>
	2073
	2074	</list>
	2075
	2076	</td>
	2077
	2078	<td>
	2079
	2080	<content
	2081	ID="andSev erity1001"
	2082	/>
	2083
	2084	</td>
	2085
	2086	<td>
	2087
	2088	<content
	2089	ID="andSou rce1001"
	2090	>
	2091	DAYTSHR TE ST LAB
	2092	</content>
	2093
	2094	</td>
	2095
	2096	</tr>
	2097	<tr>
	2098
	2099	<td>
	2100
	2101	<content
	2102	ID="andAll ergy1002"
	2103	>
	2104	PEPPERMINT
	2105	</content>
	2106
	2107	</td>
	2108
	2109	<td>
	2110	Dec 16, 20 11
	2111	</td>
	2112
	2113
	2114	<td>
	2115
	2116	<content
	2117	ID="andEve ntType1002 "
	2118	>
	2119	Propensity to advers e reaction s to subst ance
	2120	</content>
	2121
	2122	</td>
	2123
	2124	<td>
	2125
	2126	<list>
	2127
	2128	<item>
	2129
	2130	<content
	2131	ID="andRea ction1002"
	2132	>
	2133	HIVES
	2134	</content>
	2135
	2136	</item>
	2137
	2138	</list>
	2139
	2140	</td>
	2141
	2142	<td>
	2143
	2144	<content
	2145	ID="andSev erity1002"
	2146	>
	2147	MODERATE
	2148	</content>
	2149
	2150	</td>
	2151
	2152	<td>
	2153
	2154	<content
	2155	ID="andSou rce1002"
	2156	>
	2157	DAYTSHR TE ST LAB
	2158	</content>
	2159
	2160	</td>
	2161
	2162	</tr>
	2163	<tr>
	2164
	2165	<td>
	2166
	2167	<content
	2168	ID="andAll ergy1003"
	2169	>
	2170	ASPIRIN
	2171	</content>
	2172
	2173	</td>
	2174
	2175	<td>
	2176	Nov 17, 20 11
	2177	</td>
	2178
	2179
	2180	<td>
	2181
	2182	<content
	2183	ID="andEve ntType1003 "
	2184	>
	2185	Propensity to advers e reaction s to drug
	2186	</content>
	2187
	2188	</td>
	2189
	2190	<td>
	2191
	2192	<list>
	2193
	2194	<item>
	2195
	2196	<content
	2197	ID="andRea ction1003"
	2198	>
	2199	DIARRHEA
	2200	</content>
	2201
	2202	</item>
	2203	<item>
	2204
	2205	<content
	2206	ID="andRea ction1004"
	2207	>
	2208	NAUSEA AND VOMITING
	2209	</content>
	2210
	2211	</item>
	2212
	2213	</list>
	2214
	2215	</td>
	2216
	2217	<td>
	2218
	2219	<content
	2220	ID="andSev erity1003"
	2221	/>
	2222
	2223	</td>
	2224
	2225	<td>
	2226
	2227	<content
	2228	ID="andSou rce1003"
	2229	>
	2230	CHYSHR TES T LAB
	2231	</content>
	2232
	2233	</td>
	2234
	2235	</tr>
	2236	<tr>
	2237
	2238	<td>
	2239
	2240	<content
	2241	ID="andAll ergy1004"
	2242	>
	2243	LATEX
	2244	</content>
	2245
	2246	</td>
	2247
	2248	<td>
	2249	Nov 30, 20 11
	2250	</td>
	2251
	2252
	2253	<td>
	2254
	2255	<content
	2256	ID="andEve ntType1004 "
	2257	>
	2258	Propensity to advers e reaction s to drug
	2259	</content>
	2260
	2261	</td>
	2262
	2263	<td>
	2264
	2265	<list>
	2266
	2267	<item>
	2268
	2269	<content
	2270	ID="andRea ction1005"
	2271	>
	2272	ITCHING OF EYE
	2273	</content>
	2274
	2275	</item>
	2276
	2277	</list>
	2278
	2279	</td>
	2280
	2281	<td>
	2282
	2283	<content
	2284	ID="andSev erity1004"
	2285	/>
	2286
	2287	</td>
	2288
	2289	<td>
	2290
	2291	<content
	2292	ID="andSou rce1004"
	2293	>
	2294	CHYSHR TES T LAB
	2295	</content>
	2296
	2297	</td>
	2298
	2299	</tr>
	2300	<tr>
	2301
	2302	<td>
	2303
	2304	<content
	2305	ID="andAll ergy1005"
	2306	>
	2307	EAR DROPS
	2308	</content>
	2309
	2310	</td>
	2311
	2312	<td>
	2313	Dec 07, 20 11
	2314	</td>
	2315
	2316
	2317	<td>
	2318
	2319	<content
	2320	ID="andEve ntType1005 "
	2321	>
	2322	Propensity to advers e reaction s to drug
	2323	</content>
	2324
	2325	</td>
	2326
	2327	<td>
	2328
	2329	<list>
	2330
	2331	<item>
	2332
	2333	<content
	2334	ID="andRea ction1006"
	2335	>
	2336	DROWSY
	2337	</content>
	2338
	2339	</item>
	2340
	2341	</list>
	2342
	2343	</td>
	2344
	2345	<td>
	2346
	2347	<content
	2348	ID="andSev erity1005"
	2349	/>
	2350
	2351	</td>
	2352
	2353	<td>
	2354
	2355	<content
	2356	ID="andSou rce1005"
	2357	>
	2358	CHYSHR TES T LAB
	2359	</content>
	2360
	2361	</td>
	2362
	2363	</tr>
	2364	<tr>
	2365
	2366	<td>
	2367
	2368	<content
	2369	ID="andAll ergy1006"
	2370	>
	2371	NITROUS OX IDE
	2372	</content>
	2373
	2374	</td>
	2375
	2376	<td>
	2377	Dec 12, 20 11
	2378	</td>
	2379
	2380
	2381	<td>
	2382
	2383	<content
	2384	ID="andEve ntType1006 "
	2385	>
	2386	Propensity to advers e reaction s to drug
	2387	</content>
	2388
	2389	</td>
	2390
	2391	<td>
	2392
	2393	<list>
	2394
	2395	<item>
	2396
	2397	<content
	2398	ID="andRea ction1007"
	2399	>
	2400	ITCHING OF EYE
	2401	</content>
	2402
	2403	</item>
	2404
	2405	</list>
	2406
	2407	</td>
	2408
	2409	<td>
	2410
	2411	<content
	2412	ID="andSev erity1006"
	2413	/>
	2414
	2415	</td>
	2416
	2417	<td>
	2418
	2419	<content
	2420	ID="andSou rce1006"
	2421	>
	2422	CHYSHR TES T LAB
	2423	</content>
	2424
	2425	</td>
	2426
	2427	</tr>
	2428	<tr>
	2429
	2430	<td>
	2431
	2432	<content
	2433	ID="andAll ergy1007"
	2434	>
	2435	GLUTENS
	2436	</content>
	2437
	2438	</td>
	2439
	2440	<td>
	2441	Dec 12, 20 11
	2442	</td>
	2443
	2444
	2445	<td>
	2446
	2447	<content
	2448	ID="andEve ntType1007 "
	2449	>
	2450	Propensity to advers e reaction s to food
	2451	</content>
	2452
	2453	</td>
	2454
	2455	<td>
	2456
	2457	<list>
	2458
	2459	<item>
	2460
	2461	<content
	2462	ID="andRea ction1008"
	2463	>
	2464	ITCHING OF EYE
	2465	</content>
	2466
	2467	</item>
	2468
	2469	</list>
	2470
	2471	</td>
	2472
	2473	<td>
	2474
	2475	<content
	2476	ID="andSev erity1007"
	2477	/>
	2478
	2479	</td>
	2480
	2481	<td>
	2482
	2483	<content
	2484	ID="andSou rce1007"
	2485	>
	2486	CHYSHR TES T LAB
	2487	</content>
	2488
	2489	</td>
	2490
	2491	</tr>
	2492	<tr>
	2493
	2494	<td>
	2495
	2496	<content
	2497	ID="andAll ergy1008"
	2498	>
	2499	ITCHY EYE DROPS
	2500	</content>
	2501
	2502	</td>
	2503
	2504	<td>
	2505	Oct 01, 20 15
	2506	</td>
	2507
	2508
	2509	<td>
	2510
	2511	<content
	2512	ID="andEve ntType1008 "
	2513	>
	2514	Propensity to advers e reaction s to drug
	2515	</content>
	2516
	2517	</td>
	2518
	2519	<td>
	2520
	2521	<list>
	2522
	2523	<item>
	2524
	2525	<content
	2526	ID="andRea ction1009"
	2527	>
	2528	ITCHING,WA TERING EYE S
	2529	</content>
	2530
	2531	</item>
	2532
	2533	</list>
	2534
	2535	</td>
	2536
	2537	<td>
	2538
	2539	<content
	2540	ID="andSev erity1008"
	2541	>
	2542	MODERATE
	2543	</content>
	2544
	2545	</td>
	2546
	2547	<td>
	2548
	2549	<content
	2550	ID="andSou rce1008"
	2551	>
	2552	CHYSHR TES T LAB
	2553	</content>
	2554
	2555	</td>
	2556
	2557	</tr>
	2558	<tr>
	2559
	2560	<td>
	2561
	2562	<content
	2563	ID="andAll ergy1009"
	2564	>
	2565	NOSE DROPS
	2566	</content>
	2567
	2568	</td>
	2569
	2570	<td>
	2571	Oct 01, 20 15
	2572	</td>
	2573
	2574
	2575	<td>
	2576
	2577	<content
	2578	ID="andEve ntType1009 "
	2579	>
	2580	Propensity to advers e reaction s to drug
	2581	</content>
	2582
	2583	</td>
	2584
	2585	<td>
	2586
	2587	<list>
	2588
	2589	<item>
	2590
	2591	<content
	2592	ID="andRea ction1010"
	2593	>
	2594	DREAMING,I NCREASED
	2595	</content>
	2596
	2597	</item>
	2598
	2599	</list>
	2600
	2601	</td>
	2602
	2603	<td>
	2604
	2605	<content
	2606	ID="andSev erity1009"
	2607	>
	2608	SEVERE
	2609	</content>
	2610
	2611	</td>
	2612
	2613	<td>
	2614
	2615	<content
	2616	ID="andSou rce1009"
	2617	>
	2618	CHYSHR TES T LAB
	2619	</content>
	2620
	2621	</td>
	2622
	2623	</tr>
	2624	<tr>
	2625
	2626	<td>
	2627
	2628	<content
	2629	ID="andAll ergy1010"
	2630	>
	2631	ABALONE
	2632	</content>
	2633
	2634	</td>
	2635
	2636	<td>
	2637	Dec 02, 20 16
	2638	</td>
	2639
	2640
	2641	<td>
	2642
	2643	<content
	2644	ID="andEve ntType1010 "
	2645	>
	2646	Propensity to advers e reaction s to food
	2647	</content>
	2648
	2649	</td>
	2650
	2651	<td>
	2652
	2653	<list>
	2654
	2655	<item>
	2656
	2657	<content
	2658	ID="andRea ction1011"
	2659	>
	2660	RASH
	2661	</content>
	2662
	2663	</item>
	2664
	2665	</list>
	2666
	2667	</td>
	2668
	2669	<td>
	2670
	2671	<content
	2672	ID="andSev erity1010"
	2673	/>
	2674
	2675	</td>
	2676
	2677	<td>
	2678
	2679	<content
	2680	ID="andSou rce1010"
	2681	>
	2682	CHYSHR TES T LAB
	2683	</content>
	2684
	2685	</td>
	2686
	2687	</tr>
	2688	<tr>
	2689
	2690	<td>
	2691
	2692	<content
	2693	ID="andAll ergy1011"
	2694	>
	2695	ZEBETA TAB LET
	2696	</content>
	2697
	2698	</td>
	2699
	2700	<td>
	2701	Dec 02, 20 16
	2702	</td>
	2703
	2704
	2705	<td>
	2706
	2707	<content
	2708	ID="andEve ntType1011 "
	2709	>
	2710	Propensity to advers e reaction s to drug
	2711	</content>
	2712
	2713	</td>
	2714
	2715	<td>
	2716
	2717	<list>
	2718
	2719	<item>
	2720
	2721	<content
	2722	ID="andRea ction1012"
	2723	>
	2724	RASH
	2725	</content>
	2726
	2727	</item>
	2728
	2729	</list>
	2730
	2731	</td>
	2732
	2733	<td>
	2734
	2735	<content
	2736	ID="andSev erity1011"
	2737	/>
	2738
	2739	</td>
	2740
	2741	<td>
	2742
	2743	<content
	2744	ID="andSou rce1011"
	2745	>
	2746	CHYSHR TES T LAB
	2747	</content>
	2748
	2749	</td>
	2750
	2751	</tr>
	2752
	2753	</tbody>
	2754
	2755	</table>
	2756
	2757	</text>
	2758
	2759	<!-- ALLER GIES STRUC TURED DATA -->
	2760
	2761	<entry
	2762	typeCode=" DRIV"
	2763	>
	2764
	2765	<act
	2766	classCode= "ACT"
	2767	moodCode=" EVN"
	2768	>
	2769
	2770	<templateI d
	2771	root="2.16 .840.1.113 883.10.20. 22.4.30"
	2772	/>
	2773
	2774	<!-- CCD A llergy Act ID as nul lflavor -- >
	2775
	2776	<id
	2777	nullFlavor ="NA"
	2778	/>
	2779
	2780	<code
	2781	code="4876 5-2"
	2782	codeSystem ="2.16.840 .1.113883. 6.1"
	2783	codeSystem Name="LOIN C"
	2784	displayNam e="Allergi es, advers e reaction s, alerts"
	2785	/>
	2786
	2787	<statusCod e
	2788	code="acti ve"
	2789	/>
	2790
	2791	<effective Time
	2792	nullFlavor ="NA"
	2793	>
	2794
	2795	<low
	2796	nullFlavor ="NA"
	2797	/>
	2798
	2799	</effectiv eTime>
	2800
	2801	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	2802
	2803	<author>
	2804
	2805	<time
	2806	nullFlavor ="NA"
	2807	/>
	2808
	2809	<assignedA uthor>
	2810
	2811	<id
	2812	nullFlavor ="NA"
	2813	/>
	2814
	2815	<represent edOrganiza tion>
	2816
	2817	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	2818	FA CILITY NBR -->
	2819
	2820	<id
	2821	extension= "984"
	2822	root="2.16 .840.1.113 883.4.349"
	2823	/>
	2824
	2825	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	2826
	2827	<name>
	2828	DAYTSHR TE ST LAB
	2829	</name>
	2830
	2831	<telecom
	2832	nullFlavor ="NA"
	2833	/>
	2834
	2835	<addr
	2836	nullFlavor ="NA"
	2837	/>
	2838
	2839	</represen tedOrganiz ation>
	2840
	2841	</assigned Author>
	2842
	2843	</author>
	2844
	2845	<entryRela tionship
	2846	inversionI nd="true"
	2847	typeCode=" SUBJ"
	2848	>
	2849
	2850	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	2851
	2852	<observati on
	2853	classCode= "OBS"
	2854	moodCode=" EVN"
	2855	negationIn d="false"
	2856	>
	2857
	2858	<templateI d
	2859	root="2.16 .840.1.113 883.10.20. 22.4.7"
	2860	/>
	2861
	2862	<id
	2863	nullFlavor ="NA"
	2864	/>
	2865
	2866	<code
	2867	code="ASSE RTION"
	2868	codeSystem ="2.16.840 .1.113883. 5.4"
	2869	codeSystem Name="HL7A ctCode"
	2870	/>
	2871
	2872	<statusCod e
	2873	code="comp leted"
	2874	/>
	2875
	2876	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	2877
	2878	<effective Time>
	2879
	2880	<low
	2881	value="201 1121218284 7"
	2882	/>
	2883
	2884	</effectiv eTime>
	2885
	2886	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	2887
	2888	<value
	2889	code="4201 34006"
	2890	codeSystem ="2.16.840 .1.113883. 6.96"
	2891	codeSystem Name="SNOM ED CT"
	2892	displayNam e="Propens ity to adv erse react ions"
	2893	xsi:type=" CD"
	2894	>
	2895
	2896	<originalT ext>
	2897	OTHER
	2898	</original Text>
	2899
	2900	</value>
	2901
	2902	<participa nt
	2903	typeCode=" CSM"
	2904	>
	2905
	2906	<participa ntRole
	2907	classCode= "MANU"
	2908	>
	2909
	2910	<playingEn tity
	2911	classCode= "MMAT"
	2912	>
	2913
	2914	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	2915
	2916	<code
	2917	codeSystem ="2.16.840 .1.113883. 6.88"
	2918	codeSystem Name="RxNo rm"
	2919	nullFlavor ="UNK"
	2920	>
	2921
	2922	<originalT ext>
	2923
	2924	<reference
	2925	value="#an dAllergy10 01"
	2926	/>
	2927
	2928	</original Text>
	2929
	2930
	2931	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	2932
	2933	</code>
	2934
	2935	<name>
	2936	MOLD
	2937	</name>
	2938
	2939	</playingE ntity>
	2940
	2941	</particip antRole>
	2942
	2943	</particip ant>
	2944
	2945	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	2946
	2947	<entryRela tionship
	2948	inversionI nd="true"
	2949	typeCode=" MFST"
	2950	>
	2951
	2952	<observati on
	2953	classCode= "OBS"
	2954	moodCode=" EVN"
	2955	>
	2956
	2957	<templateI d
	2958	root="2.16 .840.1.113 883.10.20. 22.4.9"
	2959	/>
	2960
	2961	<id
	2962	nullFlavor ="NA"
	2963	/>
	2964
	2965	<code
	2966	nullFlavor ="NA"
	2967	/>
	2968
	2969	<statusCod e
	2970	code="comp leted"
	2971	/>
	2972
	2973
	2974	<!-- 6.06 REACTION C ODED, REQU IRED -->
	2975
	2976
	2977	<value
	2978	codeSystem ="2.16.840 .1.113883. 6.96"
	2979	codeSystem Name="SNOM ED CT"
	2980	nullFlavor ="UNK"
	2981	xsi:type=" CD"
	2982	>
	2983
	2984	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	2985
	2986	<originalT ext>
	2987
	2988	<reference
	2989	value="#an dReaction1 001"
	2990	/>
	2991
	2992	</original Text>
	2993
	2994
	2995	</value>
	2996
	2997	</observat ion>
	2998
	2999	</entryRel ationship>
	3000
	3001	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	3002
	3003
	3004	</observat ion>
	3005
	3006	</entryRel ationship>
	3007
	3008	</act>
	3009
	3010	</entry>
	3011	<entry
	3012	typeCode=" DRIV"
	3013	>
	3014
	3015	<act
	3016	classCode= "ACT"
	3017	moodCode=" EVN"
	3018	>
	3019
	3020	<templateI d
	3021	root="2.16 .840.1.113 883.10.20. 22.4.30"
	3022	/>
	3023
	3024	<!-- CCD A llergy Act ID as nul lflavor -- >
	3025
	3026	<id
	3027	nullFlavor ="NA"
	3028	/>
	3029
	3030	<code
	3031	code="4876 5-2"
	3032	codeSystem ="2.16.840 .1.113883. 6.1"
	3033	codeSystem Name="LOIN C"
	3034	displayNam e="Allergi es, advers e reaction s, alerts"
	3035	/>
	3036
	3037	<statusCod e
	3038	code="acti ve"
	3039	/>
	3040
	3041	<effective Time
	3042	nullFlavor ="NA"
	3043	>
	3044
	3045	<low
	3046	nullFlavor ="NA"
	3047	/>
	3048
	3049	</effectiv eTime>
	3050
	3051	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	3052
	3053	<author>
	3054
	3055	<time
	3056	nullFlavor ="NA"
	3057	/>
	3058
	3059	<assignedA uthor>
	3060
	3061	<id
	3062	nullFlavor ="NA"
	3063	/>
	3064
	3065	<represent edOrganiza tion>
	3066
	3067	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	3068	FA CILITY NBR -->
	3069
	3070	<id
	3071	extension= "984"
	3072	root="2.16 .840.1.113 883.4.349"
	3073	/>
	3074
	3075	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	3076
	3077	<name>
	3078	DAYTSHR TE ST LAB
	3079	</name>
	3080
	3081	<telecom
	3082	nullFlavor ="NA"
	3083	/>
	3084
	3085	<addr
	3086	nullFlavor ="NA"
	3087	/>
	3088
	3089	</represen tedOrganiz ation>
	3090
	3091	</assigned Author>
	3092
	3093	</author>
	3094
	3095	<entryRela tionship
	3096	inversionI nd="true"
	3097	typeCode=" SUBJ"
	3098	>
	3099
	3100	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	3101
	3102	<observati on
	3103	classCode= "OBS"
	3104	moodCode=" EVN"
	3105	negationIn d="false"
	3106	>
	3107
	3108	<templateI d
	3109	root="2.16 .840.1.113 883.10.20. 22.4.7"
	3110	/>
	3111
	3112	<id
	3113	nullFlavor ="NA"
	3114	/>
	3115
	3116	<code
	3117	code="ASSE RTION"
	3118	codeSystem ="2.16.840 .1.113883. 5.4"
	3119	codeSystem Name="HL7A ctCode"
	3120	/>
	3121
	3122	<statusCod e
	3123	code="comp leted"
	3124	/>
	3125
	3126	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	3127
	3128	<effective Time>
	3129
	3130	<low
	3131	value="201 1121612551 9"
	3132	/>
	3133
	3134	</effectiv eTime>
	3135
	3136	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	3137
	3138	<value
	3139	code="4180 38007"
	3140	codeSystem ="2.16.840 .1.113883. 6.96"
	3141	codeSystem Name="SNOM ED CT"
	3142	displayNam e="Propens ity to adv erse react ions to su bstance"
	3143	xsi:type=" CD"
	3144	>
	3145
	3146	<originalT ext>
	3147	DRUG, FOOD
	3148	</original Text>
	3149
	3150	</value>
	3151
	3152	<participa nt
	3153	typeCode=" CSM"
	3154	>
	3155
	3156	<participa ntRole
	3157	classCode= "MANU"
	3158	>
	3159
	3160	<playingEn tity
	3161	classCode= "MMAT"
	3162	>
	3163
	3164	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	3165
	3166	<code
	3167	codeSystem ="2.16.840 .1.113883. 6.88"
	3168	codeSystem Name="RxNo rm"
	3169	nullFlavor ="UNK"
	3170	>
	3171
	3172	<originalT ext>
	3173
	3174	<reference
	3175	value="#an dAllergy10 02"
	3176	/>
	3177
	3178	</original Text>
	3179
	3180
	3181	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	3182
	3183	</code>
	3184
	3185	<name>
	3186	PEPPERMINT
	3187	</name>
	3188
	3189	</playingE ntity>
	3190
	3191	</particip antRole>
	3192
	3193	</particip ant>
	3194
	3195	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	3196
	3197	<entryRela tionship
	3198	inversionI nd="true"
	3199	typeCode=" MFST"
	3200	>
	3201
	3202	<observati on
	3203	classCode= "OBS"
	3204	moodCode=" EVN"
	3205	>
	3206
	3207	<templateI d
	3208	root="2.16 .840.1.113 883.10.20. 22.4.9"
	3209	/>
	3210
	3211	<id
	3212	nullFlavor ="NA"
	3213	/>
	3214
	3215	<code
	3216	nullFlavor ="NA"
	3217	/>
	3218
	3219	<statusCod e
	3220	code="comp leted"
	3221	/>
	3222
	3223
	3224	<!-- 6.06 REACTION C ODED, REQU IRED -->
	3225
	3226
	3227	<value
	3228	codeSystem ="2.16.840 .1.113883. 6.96"
	3229	codeSystem Name="SNOM ED CT"
	3230	nullFlavor ="UNK"
	3231	xsi:type=" CD"
	3232	>
	3233
	3234	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	3235
	3236	<originalT ext>
	3237
	3238	<reference
	3239	value="#an dReaction1 002"
	3240	/>
	3241
	3242	</original Text>
	3243
	3244
	3245	</value>
	3246
	3247	</observat ion>
	3248
	3249	</entryRel ationship>
	3250
	3251	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	3252
	3253	<entryRela tionship
	3254	inversionI nd="true"
	3255	typeCode=" SUBJ"
	3256	>
	3257
	3258	<observati on
	3259	classCode= "OBS"
	3260	moodCode=" EVN"
	3261	>
	3262
	3263	<templateI d
	3264	root="2.16 .840.1.113 883.10.20. 22.4.8"
	3265	/>
	3266
	3267	<code
	3268	code="SEV"
	3269	codeSystem ="2.16.840 .1.113883. 5.4"
	3270	codeSystem Name="ActC ode"
	3271	displayNam e="Severit y Observat ion"
	3272	/>
	3273
	3274	<statusCod e
	3275	code="comp leted"
	3276	/>
	3277
	3278	<!-- 6.08 SEVERITY C ODED, REQU IRED, SNOM ED CT -->
	3279
	3280	<value
	3281	code="6736 007"
	3282	codeSystem ="2.16.840 .1.113883. 6.96"
	3283	codeSystem Name="SNOM ED CT"
	3284	displayNam e="Moderat e (qualife r value)"
	3285	xsi:type=" CD"
	3286	>
	3287
	3288	<!-- 6.07 SEVERITY F REE TEXT, Optional-R 2 Removed b/c remove d
	3289	in tem plate -->
	3290
	3291	<originalT ext>
	3292
	3293	<reference
	3294	value="#an dSeverity1 002"
	3295	/>
	3296
	3297	</original Text>
	3298
	3299	</value>
	3300
	3301	</observat ion>
	3302
	3303	</entryRel ationship>
	3304
	3305	</observat ion>
	3306
	3307	</entryRel ationship>
	3308
	3309	</act>
	3310
	3311	</entry>
	3312	<entry
	3313	typeCode=" DRIV"
	3314	>
	3315
	3316	<act
	3317	classCode= "ACT"
	3318	moodCode=" EVN"
	3319	>
	3320
	3321	<templateI d
	3322	root="2.16 .840.1.113 883.10.20. 22.4.30"
	3323	/>
	3324
	3325	<!-- CCD A llergy Act ID as nul lflavor -- >
	3326
	3327	<id
	3328	nullFlavor ="NA"
	3329	/>
	3330
	3331	<code
	3332	code="4876 5-2"
	3333	codeSystem ="2.16.840 .1.113883. 6.1"
	3334	codeSystem Name="LOIN C"
	3335	displayNam e="Allergi es, advers e reaction s, alerts"
	3336	/>
	3337
	3338	<statusCod e
	3339	code="acti ve"
	3340	/>
	3341
	3342	<effective Time
	3343	nullFlavor ="NA"
	3344	>
	3345
	3346	<low
	3347	nullFlavor ="NA"
	3348	/>
	3349
	3350	</effectiv eTime>
	3351
	3352	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	3353
	3354	<author>
	3355
	3356	<time
	3357	nullFlavor ="NA"
	3358	/>
	3359
	3360	<assignedA uthor>
	3361
	3362	<id
	3363	nullFlavor ="NA"
	3364	/>
	3365
	3366	<represent edOrganiza tion>
	3367
	3368	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	3369	FA CILITY NBR -->
	3370
	3371	<id
	3372	extension= "983"
	3373	root="2.16 .840.1.113 883.4.349"
	3374	/>
	3375
	3376	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	3377
	3378	<name>
	3379	CHYSHR TES T LAB
	3380	</name>
	3381
	3382	<telecom
	3383	nullFlavor ="NA"
	3384	/>
	3385
	3386	<addr
	3387	nullFlavor ="NA"
	3388	/>
	3389
	3390	</represen tedOrganiz ation>
	3391
	3392	</assigned Author>
	3393
	3394	</author>
	3395
	3396	<entryRela tionship
	3397	inversionI nd="true"
	3398	typeCode=" SUBJ"
	3399	>
	3400
	3401	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	3402
	3403	<observati on
	3404	classCode= "OBS"
	3405	moodCode=" EVN"
	3406	negationIn d="false"
	3407	>
	3408
	3409	<templateI d
	3410	root="2.16 .840.1.113 883.10.20. 22.4.7"
	3411	/>
	3412
	3413	<id
	3414	nullFlavor ="NA"
	3415	/>
	3416
	3417	<code
	3418	code="ASSE RTION"
	3419	codeSystem ="2.16.840 .1.113883. 5.4"
	3420	codeSystem Name="HL7A ctCode"
	3421	/>
	3422
	3423	<statusCod e
	3424	code="comp leted"
	3425	/>
	3426
	3427	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	3428
	3429	<effective Time>
	3430
	3431	<low/>
	3432
	3433	</effectiv eTime>
	3434
	3435	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	3436
	3437	<value
	3438	code="4195 11003"
	3439	codeSystem ="2.16.840 .1.113883. 6.96"
	3440	codeSystem Name="SNOM ED CT"
	3441	displayNam e="Propens ity to adv erse react ions to dr ug"
	3442	xsi:type=" CD"
	3443	>
	3444
	3445	<originalT ext>
	3446	DRUG
	3447	</original Text>
	3448
	3449	</value>
	3450
	3451	<participa nt
	3452	typeCode=" CSM"
	3453	>
	3454
	3455	<participa ntRole
	3456	classCode= "MANU"
	3457	>
	3458
	3459	<playingEn tity
	3460	classCode= "MMAT"
	3461	>
	3462
	3463	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	3464
	3465	<code
	3466	codeSystem ="2.16.840 .1.113883. 6.88"
	3467	codeSystem Name="RxNo rm"
	3468	nullFlavor ="UNK"
	3469	>
	3470
	3471	<originalT ext>
	3472
	3473	<reference
	3474	value="#an dAllergy10 03"
	3475	/>
	3476
	3477	</original Text>
	3478
	3479
	3480	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	3481
	3482	</code>
	3483
	3484	<name>
	3485	ASPIRIN
	3486	</name>
	3487
	3488	</playingE ntity>
	3489
	3490	</particip antRole>
	3491
	3492	</particip ant>
	3493
	3494	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	3495
	3496	<entryRela tionship
	3497	inversionI nd="true"
	3498	typeCode=" MFST"
	3499	>
	3500
	3501	<observati on
	3502	classCode= "OBS"
	3503	moodCode=" EVN"
	3504	>
	3505
	3506	<templateI d
	3507	root="2.16 .840.1.113 883.10.20. 22.4.9"
	3508	/>
	3509
	3510	<id
	3511	nullFlavor ="NA"
	3512	/>
	3513
	3514	<code
	3515	nullFlavor ="NA"
	3516	/>
	3517
	3518	<statusCod e
	3519	code="comp leted"
	3520	/>
	3521
	3522
	3523	<!-- 6.06 REACTION C ODED, REQU IRED -->
	3524
	3525
	3526	<value
	3527	code="6231 5008"
	3528	codeSystem ="2.16.840 .1.113883. 6.96"
	3529	codeSystem Name="SNOM ED CT"
	3530	displayNam e="Diarrhe a (finding )"
	3531	xsi:type=" CD"
	3532	>
	3533
	3534	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	3535
	3536	<originalT ext>
	3537
	3538	<reference
	3539	value="#an dReaction1 003"
	3540	/>
	3541
	3542	</original Text>
	3543
	3544	<translati on
	3545	code="4637 011"
	3546	codeSystem ="2.16.840 .1.113883. 6.233"
	3547	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	3548	displayNam e="DIARRHE A"
	3549	/>
	3550
	3551	</value>
	3552
	3553	</observat ion>
	3554
	3555	</entryRel ationship>
	3556	<entryRela tionship
	3557	inversionI nd="true"
	3558	typeCode=" MFST"
	3559	>
	3560
	3561	<observati on
	3562	classCode= "OBS"
	3563	moodCode=" EVN"
	3564	>
	3565
	3566	<templateI d
	3567	root="2.16 .840.1.113 883.10.20. 22.4.9"
	3568	/>
	3569
	3570	<id
	3571	nullFlavor ="NA"
	3572	/>
	3573
	3574	<code
	3575	nullFlavor ="NA"
	3576	/>
	3577
	3578	<statusCod e
	3579	code="comp leted"
	3580	/>
	3581
	3582
	3583	<!-- 6.06 REACTION C ODED, REQU IRED -->
	3584
	3585
	3586	<value
	3587	code="1693 2000"
	3588	codeSystem ="2.16.840 .1.113883. 6.96"
	3589	codeSystem Name="SNOM ED CT"
	3590	displayNam e="nausea and vomiti ng (disord er)"
	3591	xsi:type=" CD"
	3592	>
	3593
	3594	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	3595
	3596	<originalT ext>
	3597
	3598	<reference
	3599	value="#an dReaction1 004"
	3600	/>
	3601
	3602	</original Text>
	3603
	3604	<translati on
	3605	code="4691 091"
	3606	codeSystem ="2.16.840 .1.113883. 6.233"
	3607	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	3608	displayNam e="NAUSEA AND VOMITI NG"
	3609	/>
	3610
	3611	</value>
	3612
	3613	</observat ion>
	3614
	3615	</entryRel ationship>
	3616
	3617	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	3618
	3619
	3620	</observat ion>
	3621
	3622	</entryRel ationship>
	3623
	3624	</act>
	3625
	3626	</entry>
	3627	<entry
	3628	typeCode=" DRIV"
	3629	>
	3630
	3631	<act
	3632	classCode= "ACT"
	3633	moodCode=" EVN"
	3634	>
	3635
	3636	<templateI d
	3637	root="2.16 .840.1.113 883.10.20. 22.4.30"
	3638	/>
	3639
	3640	<!-- CCD A llergy Act ID as nul lflavor -- >
	3641
	3642	<id
	3643	nullFlavor ="NA"
	3644	/>
	3645
	3646	<code
	3647	code="4876 5-2"
	3648	codeSystem ="2.16.840 .1.113883. 6.1"
	3649	codeSystem Name="LOIN C"
	3650	displayNam e="Allergi es, advers e reaction s, alerts"
	3651	/>
	3652
	3653	<statusCod e
	3654	code="acti ve"
	3655	/>
	3656
	3657	<effective Time
	3658	nullFlavor ="NA"
	3659	>
	3660
	3661	<low
	3662	nullFlavor ="NA"
	3663	/>
	3664
	3665	</effectiv eTime>
	3666
	3667	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	3668
	3669	<author>
	3670
	3671	<time
	3672	nullFlavor ="NA"
	3673	/>
	3674
	3675	<assignedA uthor>
	3676
	3677	<id
	3678	nullFlavor ="NA"
	3679	/>
	3680
	3681	<represent edOrganiza tion>
	3682
	3683	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	3684	FA CILITY NBR -->
	3685
	3686	<id
	3687	extension= "983"
	3688	root="2.16 .840.1.113 883.4.349"
	3689	/>
	3690
	3691	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	3692
	3693	<name>
	3694	CHYSHR TES T LAB
	3695	</name>
	3696
	3697	<telecom
	3698	nullFlavor ="NA"
	3699	/>
	3700
	3701	<addr
	3702	nullFlavor ="NA"
	3703	/>
	3704
	3705	</represen tedOrganiz ation>
	3706
	3707	</assigned Author>
	3708
	3709	</author>
	3710
	3711	<entryRela tionship
	3712	inversionI nd="true"
	3713	typeCode=" SUBJ"
	3714	>
	3715
	3716	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	3717
	3718	<observati on
	3719	classCode= "OBS"
	3720	moodCode=" EVN"
	3721	negationIn d="false"
	3722	>
	3723
	3724	<templateI d
	3725	root="2.16 .840.1.113 883.10.20. 22.4.7"
	3726	/>
	3727
	3728	<id
	3729	nullFlavor ="NA"
	3730	/>
	3731
	3732	<code
	3733	code="ASSE RTION"
	3734	codeSystem ="2.16.840 .1.113883. 5.4"
	3735	codeSystem Name="HL7A ctCode"
	3736	/>
	3737
	3738	<statusCod e
	3739	code="comp leted"
	3740	/>
	3741
	3742	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	3743
	3744	<effective Time>
	3745
	3746	<low/>
	3747
	3748	</effectiv eTime>
	3749
	3750	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	3751
	3752	<value
	3753	code="4195 11003"
	3754	codeSystem ="2.16.840 .1.113883. 6.96"
	3755	codeSystem Name="SNOM ED CT"
	3756	displayNam e="Propens ity to adv erse react ions to dr ug"
	3757	xsi:type=" CD"
	3758	>
	3759
	3760	<originalT ext>
	3761	DRUG
	3762	</original Text>
	3763
	3764	</value>
	3765
	3766	<participa nt
	3767	typeCode=" CSM"
	3768	>
	3769
	3770	<participa ntRole
	3771	classCode= "MANU"
	3772	>
	3773
	3774	<playingEn tity
	3775	classCode= "MMAT"
	3776	>
	3777
	3778	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	3779
	3780	<code
	3781	codeSystem ="2.16.840 .1.113883. 6.88"
	3782	codeSystem Name="RxNo rm"
	3783	nullFlavor ="UNK"
	3784	>
	3785
	3786	<originalT ext>
	3787
	3788	<reference
	3789	value="#an dAllergy10 04"
	3790	/>
	3791
	3792	</original Text>
	3793
	3794
	3795	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	3796
	3797	</code>
	3798
	3799	<name>
	3800	LATEX
	3801	</name>
	3802
	3803	</playingE ntity>
	3804
	3805	</particip antRole>
	3806
	3807	</particip ant>
	3808
	3809	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	3810
	3811	<entryRela tionship
	3812	inversionI nd="true"
	3813	typeCode=" MFST"
	3814	>
	3815
	3816	<observati on
	3817	classCode= "OBS"
	3818	moodCode=" EVN"
	3819	>
	3820
	3821	<templateI d
	3822	root="2.16 .840.1.113 883.10.20. 22.4.9"
	3823	/>
	3824
	3825	<id
	3826	nullFlavor ="NA"
	3827	/>
	3828
	3829	<code
	3830	nullFlavor ="NA"
	3831	/>
	3832
	3833	<statusCod e
	3834	code="comp leted"
	3835	/>
	3836
	3837
	3838	<!-- 6.06 REACTION C ODED, REQU IRED -->
	3839
	3840
	3841	<value
	3842	code="7477 6002"
	3843	codeSystem ="2.16.840 .1.113883. 6.96"
	3844	codeSystem Name="SNOM ED CT"
	3845	displayNam e="Itching of eye (f inding)"
	3846	xsi:type=" CD"
	3847	>
	3848
	3849	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	3850
	3851	<originalT ext>
	3852
	3853	<reference
	3854	value="#an dReaction1 005"
	3855	/>
	3856
	3857	</original Text>
	3858
	3859	<translati on
	3860	code="4637 157"
	3861	codeSystem ="2.16.840 .1.113883. 6.233"
	3862	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	3863	displayNam e="ITCHING OF EYE"
	3864	/>
	3865
	3866	</value>
	3867
	3868	</observat ion>
	3869
	3870	</entryRel ationship>
	3871
	3872	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	3873
	3874
	3875	</observat ion>
	3876
	3877	</entryRel ationship>
	3878
	3879	</act>
	3880
	3881	</entry>
	3882	<entry
	3883	typeCode=" DRIV"
	3884	>
	3885
	3886	<act
	3887	classCode= "ACT"
	3888	moodCode=" EVN"
	3889	>
	3890
	3891	<templateI d
	3892	root="2.16 .840.1.113 883.10.20. 22.4.30"
	3893	/>
	3894
	3895	<!-- CCD A llergy Act ID as nul lflavor -- >
	3896
	3897	<id
	3898	nullFlavor ="NA"
	3899	/>
	3900
	3901	<code
	3902	code="4876 5-2"
	3903	codeSystem ="2.16.840 .1.113883. 6.1"
	3904	codeSystem Name="LOIN C"
	3905	displayNam e="Allergi es, advers e reaction s, alerts"
	3906	/>
	3907
	3908	<statusCod e
	3909	code="acti ve"
	3910	/>
	3911
	3912	<effective Time
	3913	nullFlavor ="NA"
	3914	>
	3915
	3916	<low
	3917	nullFlavor ="NA"
	3918	/>
	3919
	3920	</effectiv eTime>
	3921
	3922	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	3923
	3924	<author>
	3925
	3926	<time
	3927	nullFlavor ="NA"
	3928	/>
	3929
	3930	<assignedA uthor>
	3931
	3932	<id
	3933	nullFlavor ="NA"
	3934	/>
	3935
	3936	<represent edOrganiza tion>
	3937
	3938	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	3939	FA CILITY NBR -->
	3940
	3941	<id
	3942	extension= "983"
	3943	root="2.16 .840.1.113 883.4.349"
	3944	/>
	3945
	3946	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	3947
	3948	<name>
	3949	CHYSHR TES T LAB
	3950	</name>
	3951
	3952	<telecom
	3953	nullFlavor ="NA"
	3954	/>
	3955
	3956	<addr
	3957	nullFlavor ="NA"
	3958	/>
	3959
	3960	</represen tedOrganiz ation>
	3961
	3962	</assigned Author>
	3963
	3964	</author>
	3965
	3966	<entryRela tionship
	3967	inversionI nd="true"
	3968	typeCode=" SUBJ"
	3969	>
	3970
	3971	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	3972
	3973	<observati on
	3974	classCode= "OBS"
	3975	moodCode=" EVN"
	3976	negationIn d="false"
	3977	>
	3978
	3979	<templateI d
	3980	root="2.16 .840.1.113 883.10.20. 22.4.7"
	3981	/>
	3982
	3983	<id
	3984	nullFlavor ="NA"
	3985	/>
	3986
	3987	<code
	3988	code="ASSE RTION"
	3989	codeSystem ="2.16.840 .1.113883. 5.4"
	3990	codeSystem Name="HL7A ctCode"
	3991	/>
	3992
	3993	<statusCod e
	3994	code="comp leted"
	3995	/>
	3996
	3997	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	3998
	3999	<effective Time>
	4000
	4001	<low/>
	4002
	4003	</effectiv eTime>
	4004
	4005	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	4006
	4007	<value
	4008	code="4195 11003"
	4009	codeSystem ="2.16.840 .1.113883. 6.96"
	4010	codeSystem Name="SNOM ED CT"
	4011	displayNam e="Propens ity to adv erse react ions to dr ug"
	4012	xsi:type=" CD"
	4013	>
	4014
	4015	<originalT ext>
	4016	DRUG
	4017	</original Text>
	4018
	4019	</value>
	4020
	4021	<participa nt
	4022	typeCode=" CSM"
	4023	>
	4024
	4025	<participa ntRole
	4026	classCode= "MANU"
	4027	>
	4028
	4029	<playingEn tity
	4030	classCode= "MMAT"
	4031	>
	4032
	4033	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	4034
	4035	<code
	4036	code="4664 23"
	4037	codeSystem ="2.16.840 .1.113883. 6.88"
	4038	codeSystem Name="RxNo rm"
	4039	displayNam e="Antipyr ine / Benz ocaine (RX NORM)"
	4040	>
	4041
	4042	<originalT ext>
	4043
	4044	<reference
	4045	value="#an dAllergy10 05"
	4046	/>
	4047
	4048	</original Text>
	4049
	4050	<translati on
	4051	code="4022 616"
	4052	codeSystem ="2.16.840 .1.113883. 6.233"
	4053	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	4054	displayNam e="EAR DRO PS"
	4055	/>
	4056
	4057	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	4058
	4059	</code>
	4060
	4061	<name>
	4062	EAR DROPS
	4063	</name>
	4064
	4065	</playingE ntity>
	4066
	4067	</particip antRole>
	4068
	4069	</particip ant>
	4070
	4071	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	4072
	4073	<entryRela tionship
	4074	inversionI nd="true"
	4075	typeCode=" MFST"
	4076	>
	4077
	4078	<observati on
	4079	classCode= "OBS"
	4080	moodCode=" EVN"
	4081	>
	4082
	4083	<templateI d
	4084	root="2.16 .840.1.113 883.10.20. 22.4.9"
	4085	/>
	4086
	4087	<id
	4088	nullFlavor ="NA"
	4089	/>
	4090
	4091	<code
	4092	nullFlavor ="NA"
	4093	/>
	4094
	4095	<statusCod e
	4096	code="comp leted"
	4097	/>
	4098
	4099
	4100	<!-- 6.06 REACTION C ODED, REQU IRED -->
	4101
	4102
	4103	<value
	4104	code="2717 82001"
	4105	codeSystem ="2.16.840 .1.113883. 6.96"
	4106	codeSystem Name="SNOM ED CT"
	4107	displayNam e="Drowsy (finding)"
	4108	xsi:type=" CD"
	4109	>
	4110
	4111	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	4112
	4113	<originalT ext>
	4114
	4115	<reference
	4116	value="#an dReaction1 006"
	4117	/>
	4118
	4119	</original Text>
	4120
	4121	<translati on
	4122	code="4637 472"
	4123	codeSystem ="2.16.840 .1.113883. 6.233"
	4124	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	4125	displayNam e="DROWSY"
	4126	/>
	4127
	4128	</value>
	4129
	4130	</observat ion>
	4131
	4132	</entryRel ationship>
	4133
	4134	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	4135
	4136
	4137	</observat ion>
	4138
	4139	</entryRel ationship>
	4140
	4141	</act>
	4142
	4143	</entry>
	4144	<entry
	4145	typeCode=" DRIV"
	4146	>
	4147
	4148	<act
	4149	classCode= "ACT"
	4150	moodCode=" EVN"
	4151	>
	4152
	4153	<templateI d
	4154	root="2.16 .840.1.113 883.10.20. 22.4.30"
	4155	/>
	4156
	4157	<!-- CCD A llergy Act ID as nul lflavor -- >
	4158
	4159	<id
	4160	nullFlavor ="NA"
	4161	/>
	4162
	4163	<code
	4164	code="4876 5-2"
	4165	codeSystem ="2.16.840 .1.113883. 6.1"
	4166	codeSystem Name="LOIN C"
	4167	displayNam e="Allergi es, advers e reaction s, alerts"
	4168	/>
	4169
	4170	<statusCod e
	4171	code="acti ve"
	4172	/>
	4173
	4174	<effective Time
	4175	nullFlavor ="NA"
	4176	>
	4177
	4178	<low
	4179	nullFlavor ="NA"
	4180	/>
	4181
	4182	</effectiv eTime>
	4183
	4184	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	4185
	4186	<author>
	4187
	4188	<time
	4189	nullFlavor ="NA"
	4190	/>
	4191
	4192	<assignedA uthor>
	4193
	4194	<id
	4195	nullFlavor ="NA"
	4196	/>
	4197
	4198	<represent edOrganiza tion>
	4199
	4200	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	4201	FA CILITY NBR -->
	4202
	4203	<id
	4204	extension= "983"
	4205	root="2.16 .840.1.113 883.4.349"
	4206	/>
	4207
	4208	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	4209
	4210	<name>
	4211	CHYSHR TES T LAB
	4212	</name>
	4213
	4214	<telecom
	4215	nullFlavor ="NA"
	4216	/>
	4217
	4218	<addr
	4219	nullFlavor ="NA"
	4220	/>
	4221
	4222	</represen tedOrganiz ation>
	4223
	4224	</assigned Author>
	4225
	4226	</author>
	4227
	4228	<entryRela tionship
	4229	inversionI nd="true"
	4230	typeCode=" SUBJ"
	4231	>
	4232
	4233	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	4234
	4235	<observati on
	4236	classCode= "OBS"
	4237	moodCode=" EVN"
	4238	negationIn d="false"
	4239	>
	4240
	4241	<templateI d
	4242	root="2.16 .840.1.113 883.10.20. 22.4.7"
	4243	/>
	4244
	4245	<id
	4246	nullFlavor ="NA"
	4247	/>
	4248
	4249	<code
	4250	code="ASSE RTION"
	4251	codeSystem ="2.16.840 .1.113883. 5.4"
	4252	codeSystem Name="HL7A ctCode"
	4253	/>
	4254
	4255	<statusCod e
	4256	code="comp leted"
	4257	/>
	4258
	4259	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	4260
	4261	<effective Time>
	4262
	4263	<low/>
	4264
	4265	</effectiv eTime>
	4266
	4267	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	4268
	4269	<value
	4270	code="4195 11003"
	4271	codeSystem ="2.16.840 .1.113883. 6.96"
	4272	codeSystem Name="SNOM ED CT"
	4273	displayNam e="Propens ity to adv erse react ions to dr ug"
	4274	xsi:type=" CD"
	4275	>
	4276
	4277	<originalT ext>
	4278	DRUG
	4279	</original Text>
	4280
	4281	</value>
	4282
	4283	<participa nt
	4284	typeCode=" CSM"
	4285	>
	4286
	4287	<participa ntRole
	4288	classCode= "MANU"
	4289	>
	4290
	4291	<playingEn tity
	4292	classCode= "MMAT"
	4293	>
	4294
	4295	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	4296
	4297	<code
	4298	codeSystem ="2.16.840 .1.113883. 6.88"
	4299	codeSystem Name="RxNo rm"
	4300	nullFlavor ="UNK"
	4301	>
	4302
	4303	<originalT ext>
	4304
	4305	<reference
	4306	value="#an dAllergy10 06"
	4307	/>
	4308
	4309	</original Text>
	4310
	4311
	4312	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	4313
	4314	</code>
	4315
	4316	<name>
	4317	NITROUS OX IDE
	4318	</name>
	4319
	4320	</playingE ntity>
	4321
	4322	</particip antRole>
	4323
	4324	</particip ant>
	4325
	4326	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	4327
	4328	<entryRela tionship
	4329	inversionI nd="true"
	4330	typeCode=" MFST"
	4331	>
	4332
	4333	<observati on
	4334	classCode= "OBS"
	4335	moodCode=" EVN"
	4336	>
	4337
	4338	<templateI d
	4339	root="2.16 .840.1.113 883.10.20. 22.4.9"
	4340	/>
	4341
	4342	<id
	4343	nullFlavor ="NA"
	4344	/>
	4345
	4346	<code
	4347	nullFlavor ="NA"
	4348	/>
	4349
	4350	<statusCod e
	4351	code="comp leted"
	4352	/>
	4353
	4354
	4355	<!-- 6.06 REACTION C ODED, REQU IRED -->
	4356
	4357
	4358	<value
	4359	code="7477 6002"
	4360	codeSystem ="2.16.840 .1.113883. 6.96"
	4361	codeSystem Name="SNOM ED CT"
	4362	displayNam e="Itching of eye (f inding)"
	4363	xsi:type=" CD"
	4364	>
	4365
	4366	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	4367
	4368	<originalT ext>
	4369
	4370	<reference
	4371	value="#an dReaction1 007"
	4372	/>
	4373
	4374	</original Text>
	4375
	4376	<translati on
	4377	code="4637 157"
	4378	codeSystem ="2.16.840 .1.113883. 6.233"
	4379	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	4380	displayNam e="ITCHING OF EYE"
	4381	/>
	4382
	4383	</value>
	4384
	4385	</observat ion>
	4386
	4387	</entryRel ationship>
	4388
	4389	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	4390
	4391
	4392	</observat ion>
	4393
	4394	</entryRel ationship>
	4395
	4396	</act>
	4397
	4398	</entry>
	4399	<entry
	4400	typeCode=" DRIV"
	4401	>
	4402
	4403	<act
	4404	classCode= "ACT"
	4405	moodCode=" EVN"
	4406	>
	4407
	4408	<templateI d
	4409	root="2.16 .840.1.113 883.10.20. 22.4.30"
	4410	/>
	4411
	4412	<!-- CCD A llergy Act ID as nul lflavor -- >
	4413
	4414	<id
	4415	nullFlavor ="NA"
	4416	/>
	4417
	4418	<code
	4419	code="4876 5-2"
	4420	codeSystem ="2.16.840 .1.113883. 6.1"
	4421	codeSystem Name="LOIN C"
	4422	displayNam e="Allergi es, advers e reaction s, alerts"
	4423	/>
	4424
	4425	<statusCod e
	4426	code="acti ve"
	4427	/>
	4428
	4429	<effective Time
	4430	nullFlavor ="NA"
	4431	>
	4432
	4433	<low
	4434	nullFlavor ="NA"
	4435	/>
	4436
	4437	</effectiv eTime>
	4438
	4439	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	4440
	4441	<author>
	4442
	4443	<time
	4444	nullFlavor ="NA"
	4445	/>
	4446
	4447	<assignedA uthor>
	4448
	4449	<id
	4450	nullFlavor ="NA"
	4451	/>
	4452
	4453	<represent edOrganiza tion>
	4454
	4455	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	4456	FA CILITY NBR -->
	4457
	4458	<id
	4459	extension= "983"
	4460	root="2.16 .840.1.113 883.4.349"
	4461	/>
	4462
	4463	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	4464
	4465	<name>
	4466	CHYSHR TES T LAB
	4467	</name>
	4468
	4469	<telecom
	4470	nullFlavor ="NA"
	4471	/>
	4472
	4473	<addr
	4474	nullFlavor ="NA"
	4475	/>
	4476
	4477	</represen tedOrganiz ation>
	4478
	4479	</assigned Author>
	4480
	4481	</author>
	4482
	4483	<entryRela tionship
	4484	inversionI nd="true"
	4485	typeCode=" SUBJ"
	4486	>
	4487
	4488	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	4489
	4490	<observati on
	4491	classCode= "OBS"
	4492	moodCode=" EVN"
	4493	negationIn d="false"
	4494	>
	4495
	4496	<templateI d
	4497	root="2.16 .840.1.113 883.10.20. 22.4.7"
	4498	/>
	4499
	4500	<id
	4501	nullFlavor ="NA"
	4502	/>
	4503
	4504	<code
	4505	code="ASSE RTION"
	4506	codeSystem ="2.16.840 .1.113883. 5.4"
	4507	codeSystem Name="HL7A ctCode"
	4508	/>
	4509
	4510	<statusCod e
	4511	code="comp leted"
	4512	/>
	4513
	4514	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	4515
	4516	<effective Time>
	4517
	4518	<low
	4519	value="201 1121215304 0"
	4520	/>
	4521
	4522	</effectiv eTime>
	4523
	4524	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	4525
	4526	<value
	4527	code="4184 71000"
	4528	codeSystem ="2.16.840 .1.113883. 6.96"
	4529	codeSystem Name="SNOM ED CT"
	4530	displayNam e="Propens ity to adv erse react ions to fo od"
	4531	xsi:type=" CD"
	4532	>
	4533
	4534	<originalT ext>
	4535	FOOD
	4536	</original Text>
	4537
	4538	</value>
	4539
	4540	<participa nt
	4541	typeCode=" CSM"
	4542	>
	4543
	4544	<participa ntRole
	4545	classCode= "MANU"
	4546	>
	4547
	4548	<playingEn tity
	4549	classCode= "MMAT"
	4550	>
	4551
	4552	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	4553
	4554	<code
	4555	codeSystem ="2.16.840 .1.113883. 6.88"
	4556	codeSystem Name="RxNo rm"
	4557	nullFlavor ="UNK"
	4558	>
	4559
	4560	<originalT ext>
	4561
	4562	<reference
	4563	value="#an dAllergy10 07"
	4564	/>
	4565
	4566	</original Text>
	4567
	4568
	4569	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	4570
	4571	</code>
	4572
	4573	<name>
	4574	GLUTENS
	4575	</name>
	4576
	4577	</playingE ntity>
	4578
	4579	</particip antRole>
	4580
	4581	</particip ant>
	4582
	4583	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	4584
	4585	<entryRela tionship
	4586	inversionI nd="true"
	4587	typeCode=" MFST"
	4588	>
	4589
	4590	<observati on
	4591	classCode= "OBS"
	4592	moodCode=" EVN"
	4593	>
	4594
	4595	<templateI d
	4596	root="2.16 .840.1.113 883.10.20. 22.4.9"
	4597	/>
	4598
	4599	<id
	4600	nullFlavor ="NA"
	4601	/>
	4602
	4603	<code
	4604	nullFlavor ="NA"
	4605	/>
	4606
	4607	<statusCod e
	4608	code="comp leted"
	4609	/>
	4610
	4611
	4612	<!-- 6.06 REACTION C ODED, REQU IRED -->
	4613
	4614
	4615	<value
	4616	code="7477 6002"
	4617	codeSystem ="2.16.840 .1.113883. 6.96"
	4618	codeSystem Name="SNOM ED CT"
	4619	displayNam e="Itching of eye (f inding)"
	4620	xsi:type=" CD"
	4621	>
	4622
	4623	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	4624
	4625	<originalT ext>
	4626
	4627	<reference
	4628	value="#an dReaction1 008"
	4629	/>
	4630
	4631	</original Text>
	4632
	4633	<translati on
	4634	code="4637 157"
	4635	codeSystem ="2.16.840 .1.113883. 6.233"
	4636	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	4637	displayNam e="ITCHING OF EYE"
	4638	/>
	4639
	4640	</value>
	4641
	4642	</observat ion>
	4643
	4644	</entryRel ationship>
	4645
	4646	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	4647
	4648
	4649	</observat ion>
	4650
	4651	</entryRel ationship>
	4652
	4653	</act>
	4654
	4655	</entry>
	4656	<entry
	4657	typeCode=" DRIV"
	4658	>
	4659
	4660	<act
	4661	classCode= "ACT"
	4662	moodCode=" EVN"
	4663	>
	4664
	4665	<templateI d
	4666	root="2.16 .840.1.113 883.10.20. 22.4.30"
	4667	/>
	4668
	4669	<!-- CCD A llergy Act ID as nul lflavor -- >
	4670
	4671	<id
	4672	nullFlavor ="NA"
	4673	/>
	4674
	4675	<code
	4676	code="4876 5-2"
	4677	codeSystem ="2.16.840 .1.113883. 6.1"
	4678	codeSystem Name="LOIN C"
	4679	displayNam e="Allergi es, advers e reaction s, alerts"
	4680	/>
	4681
	4682	<statusCod e
	4683	code="acti ve"
	4684	/>
	4685
	4686	<effective Time
	4687	nullFlavor ="NA"
	4688	>
	4689
	4690	<low
	4691	nullFlavor ="NA"
	4692	/>
	4693
	4694	</effectiv eTime>
	4695
	4696	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	4697
	4698	<author>
	4699
	4700	<time
	4701	nullFlavor ="NA"
	4702	/>
	4703
	4704	<assignedA uthor>
	4705
	4706	<id
	4707	nullFlavor ="NA"
	4708	/>
	4709
	4710	<represent edOrganiza tion>
	4711
	4712	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	4713	FA CILITY NBR -->
	4714
	4715	<id
	4716	extension= "983"
	4717	root="2.16 .840.1.113 883.4.349"
	4718	/>
	4719
	4720	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	4721
	4722	<name>
	4723	CHYSHR TES T LAB
	4724	</name>
	4725
	4726	<telecom
	4727	nullFlavor ="NA"
	4728	/>
	4729
	4730	<addr
	4731	nullFlavor ="NA"
	4732	/>
	4733
	4734	</represen tedOrganiz ation>
	4735
	4736	</assigned Author>
	4737
	4738	</author>
	4739
	4740	<entryRela tionship
	4741	inversionI nd="true"
	4742	typeCode=" SUBJ"
	4743	>
	4744
	4745	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	4746
	4747	<observati on
	4748	classCode= "OBS"
	4749	moodCode=" EVN"
	4750	negationIn d="false"
	4751	>
	4752
	4753	<templateI d
	4754	root="2.16 .840.1.113 883.10.20. 22.4.7"
	4755	/>
	4756
	4757	<id
	4758	nullFlavor ="NA"
	4759	/>
	4760
	4761	<code
	4762	code="ASSE RTION"
	4763	codeSystem ="2.16.840 .1.113883. 5.4"
	4764	codeSystem Name="HL7A ctCode"
	4765	/>
	4766
	4767	<statusCod e
	4768	code="comp leted"
	4769	/>
	4770
	4771	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	4772
	4773	<effective Time>
	4774
	4775	<low/>
	4776
	4777	</effectiv eTime>
	4778
	4779	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	4780
	4781	<value
	4782	code="4195 11003"
	4783	codeSystem ="2.16.840 .1.113883. 6.96"
	4784	codeSystem Name="SNOM ED CT"
	4785	displayNam e="Propens ity to adv erse react ions to dr ug"
	4786	xsi:type=" CD"
	4787	>
	4788
	4789	<originalT ext>
	4790	DRUG
	4791	</original Text>
	4792
	4793	</value>
	4794
	4795	<participa nt
	4796	typeCode=" CSM"
	4797	>
	4798
	4799	<participa ntRole
	4800	classCode= "MANU"
	4801	>
	4802
	4803	<playingEn tity
	4804	classCode= "MMAT"
	4805	>
	4806
	4807	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	4808
	4809	<code
	4810	codeSystem ="2.16.840 .1.113883. 6.88"
	4811	codeSystem Name="RxNo rm"
	4812	nullFlavor ="UNK"
	4813	>
	4814
	4815	<originalT ext>
	4816
	4817	<reference
	4818	value="#an dAllergy10 08"
	4819	/>
	4820
	4821	</original Text>
	4822
	4823
	4824	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	4825
	4826	</code>
	4827
	4828	<name>
	4829	ITCHY EYE DROPS
	4830	</name>
	4831
	4832	</playingE ntity>
	4833
	4834	</particip antRole>
	4835
	4836	</particip ant>
	4837
	4838	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	4839
	4840	<entryRela tionship
	4841	inversionI nd="true"
	4842	typeCode=" MFST"
	4843	>
	4844
	4845	<observati on
	4846	classCode= "OBS"
	4847	moodCode=" EVN"
	4848	>
	4849
	4850	<templateI d
	4851	root="2.16 .840.1.113 883.10.20. 22.4.9"
	4852	/>
	4853
	4854	<id
	4855	nullFlavor ="NA"
	4856	/>
	4857
	4858	<code
	4859	nullFlavor ="NA"
	4860	/>
	4861
	4862	<statusCod e
	4863	code="comp leted"
	4864	/>
	4865
	4866
	4867	<!-- 6.06 REACTION C ODED, REQU IRED -->
	4868
	4869
	4870	<value
	4871	code="UNK"
	4872	codeSystem ="2.16.840 .1.113883. 6.96"
	4873	codeSystem Name="SNOM ED CT"
	4874	displayNam e=""
	4875	xsi:type=" CD"
	4876	>
	4877
	4878	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	4879
	4880	<originalT ext>
	4881
	4882	<reference
	4883	value="#an dReaction1 009"
	4884	/>
	4885
	4886	</original Text>
	4887
	4888	<translati on
	4889	code="4538 561"
	4890	codeSystem ="2.16.840 .1.113883. 6.233"
	4891	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	4892	displayNam e="ITCHING ,WATERING EYES"
	4893	/>
	4894
	4895	</value>
	4896
	4897	</observat ion>
	4898
	4899	</entryRel ationship>
	4900
	4901	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	4902
	4903	<entryRela tionship
	4904	inversionI nd="true"
	4905	typeCode=" SUBJ"
	4906	>
	4907
	4908	<observati on
	4909	classCode= "OBS"
	4910	moodCode=" EVN"
	4911	>
	4912
	4913	<templateI d
	4914	root="2.16 .840.1.113 883.10.20. 22.4.8"
	4915	/>
	4916
	4917	<code
	4918	code="SEV"
	4919	codeSystem ="2.16.840 .1.113883. 5.4"
	4920	codeSystem Name="ActC ode"
	4921	displayNam e="Severit y Observat ion"
	4922	/>
	4923
	4924	<statusCod e
	4925	code="comp leted"
	4926	/>
	4927
	4928	<!-- 6.08 SEVERITY C ODED, REQU IRED, SNOM ED CT -->
	4929
	4930	<value
	4931	code="6736 007"
	4932	codeSystem ="2.16.840 .1.113883. 6.96"
	4933	codeSystem Name="SNOM ED CT"
	4934	displayNam e="Moderat e (qualife r value)"
	4935	xsi:type=" CD"
	4936	>
	4937
	4938	<!-- 6.07 SEVERITY F REE TEXT, Optional-R 2 Removed b/c remove d
	4939	in tem plate -->
	4940
	4941	<originalT ext>
	4942
	4943	<reference
	4944	value="#an dSeverity1 008"
	4945	/>
	4946
	4947	</original Text>
	4948
	4949	</value>
	4950
	4951	</observat ion>
	4952
	4953	</entryRel ationship>
	4954
	4955	</observat ion>
	4956
	4957	</entryRel ationship>
	4958
	4959	</act>
	4960
	4961	</entry>
	4962	<entry
	4963	typeCode=" DRIV"
	4964	>
	4965
	4966	<act
	4967	classCode= "ACT"
	4968	moodCode=" EVN"
	4969	>
	4970
	4971	<templateI d
	4972	root="2.16 .840.1.113 883.10.20. 22.4.30"
	4973	/>
	4974
	4975	<!-- CCD A llergy Act ID as nul lflavor -- >
	4976
	4977	<id
	4978	nullFlavor ="NA"
	4979	/>
	4980
	4981	<code
	4982	code="4876 5-2"
	4983	codeSystem ="2.16.840 .1.113883. 6.1"
	4984	codeSystem Name="LOIN C"
	4985	displayNam e="Allergi es, advers e reaction s, alerts"
	4986	/>
	4987
	4988	<statusCod e
	4989	code="acti ve"
	4990	/>
	4991
	4992	<effective Time
	4993	nullFlavor ="NA"
	4994	>
	4995
	4996	<low
	4997	nullFlavor ="NA"
	4998	/>
	4999
	5000	</effectiv eTime>
	5001
	5002	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	5003
	5004	<author>
	5005
	5006	<time
	5007	nullFlavor ="NA"
	5008	/>
	5009
	5010	<assignedA uthor>
	5011
	5012	<id
	5013	nullFlavor ="NA"
	5014	/>
	5015
	5016	<represent edOrganiza tion>
	5017
	5018	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	5019	FA CILITY NBR -->
	5020
	5021	<id
	5022	extension= "983"
	5023	root="2.16 .840.1.113 883.4.349"
	5024	/>
	5025
	5026	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	5027
	5028	<name>
	5029	CHYSHR TES T LAB
	5030	</name>
	5031
	5032	<telecom
	5033	nullFlavor ="NA"
	5034	/>
	5035
	5036	<addr
	5037	nullFlavor ="NA"
	5038	/>
	5039
	5040	</represen tedOrganiz ation>
	5041
	5042	</assigned Author>
	5043
	5044	</author>
	5045
	5046	<entryRela tionship
	5047	inversionI nd="true"
	5048	typeCode=" SUBJ"
	5049	>
	5050
	5051	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	5052
	5053	<observati on
	5054	classCode= "OBS"
	5055	moodCode=" EVN"
	5056	negationIn d="false"
	5057	>
	5058
	5059	<templateI d
	5060	root="2.16 .840.1.113 883.10.20. 22.4.7"
	5061	/>
	5062
	5063	<id
	5064	nullFlavor ="NA"
	5065	/>
	5066
	5067	<code
	5068	code="ASSE RTION"
	5069	codeSystem ="2.16.840 .1.113883. 5.4"
	5070	codeSystem Name="HL7A ctCode"
	5071	/>
	5072
	5073	<statusCod e
	5074	code="comp leted"
	5075	/>
	5076
	5077	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	5078
	5079	<effective Time>
	5080
	5081	<low/>
	5082
	5083	</effectiv eTime>
	5084
	5085	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	5086
	5087	<value
	5088	code="4195 11003"
	5089	codeSystem ="2.16.840 .1.113883. 6.96"
	5090	codeSystem Name="SNOM ED CT"
	5091	displayNam e="Propens ity to adv erse react ions to dr ug"
	5092	xsi:type=" CD"
	5093	>
	5094
	5095	<originalT ext>
	5096	DRUG
	5097	</original Text>
	5098
	5099	</value>
	5100
	5101	<participa nt
	5102	typeCode=" CSM"
	5103	>
	5104
	5105	<participa ntRole
	5106	classCode= "MANU"
	5107	>
	5108
	5109	<playingEn tity
	5110	classCode= "MMAT"
	5111	>
	5112
	5113	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	5114
	5115	<code
	5116	codeSystem ="2.16.840 .1.113883. 6.88"
	5117	codeSystem Name="RxNo rm"
	5118	nullFlavor ="UNK"
	5119	>
	5120
	5121	<originalT ext>
	5122
	5123	<reference
	5124	value="#an dAllergy10 09"
	5125	/>
	5126
	5127	</original Text>
	5128
	5129
	5130	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	5131
	5132	</code>
	5133
	5134	<name>
	5135	NOSE DROPS
	5136	</name>
	5137
	5138	</playingE ntity>
	5139
	5140	</particip antRole>
	5141
	5142	</particip ant>
	5143
	5144	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	5145
	5146	<entryRela tionship
	5147	inversionI nd="true"
	5148	typeCode=" MFST"
	5149	>
	5150
	5151	<observati on
	5152	classCode= "OBS"
	5153	moodCode=" EVN"
	5154	>
	5155
	5156	<templateI d
	5157	root="2.16 .840.1.113 883.10.20. 22.4.9"
	5158	/>
	5159
	5160	<id
	5161	nullFlavor ="NA"
	5162	/>
	5163
	5164	<code
	5165	nullFlavor ="NA"
	5166	/>
	5167
	5168	<statusCod e
	5169	code="comp leted"
	5170	/>
	5171
	5172
	5173	<!-- 6.06 REACTION C ODED, REQU IRED -->
	5174
	5175
	5176	<value
	5177	code="UNK"
	5178	codeSystem ="2.16.840 .1.113883. 6.96"
	5179	codeSystem Name="SNOM ED CT"
	5180	displayNam e=""
	5181	xsi:type=" CD"
	5182	>
	5183
	5184	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	5185
	5186	<originalT ext>
	5187
	5188	<reference
	5189	value="#an dReaction1 010"
	5190	/>
	5191
	5192	</original Text>
	5193
	5194	<translati on
	5195	code="4538 595"
	5196	codeSystem ="2.16.840 .1.113883. 6.233"
	5197	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	5198	displayNam e="DREAMIN G,INCREASE D"
	5199	/>
	5200
	5201	</value>
	5202
	5203	</observat ion>
	5204
	5205	</entryRel ationship>
	5206
	5207	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	5208
	5209	<entryRela tionship
	5210	inversionI nd="true"
	5211	typeCode=" SUBJ"
	5212	>
	5213
	5214	<observati on
	5215	classCode= "OBS"
	5216	moodCode=" EVN"
	5217	>
	5218
	5219	<templateI d
	5220	root="2.16 .840.1.113 883.10.20. 22.4.8"
	5221	/>
	5222
	5223	<code
	5224	code="SEV"
	5225	codeSystem ="2.16.840 .1.113883. 5.4"
	5226	codeSystem Name="ActC ode"
	5227	displayNam e="Severit y Observat ion"
	5228	/>
	5229
	5230	<statusCod e
	5231	code="comp leted"
	5232	/>
	5233
	5234	<!-- 6.08 SEVERITY C ODED, REQU IRED, SNOM ED CT -->
	5235
	5236	<value
	5237	code="2448 4000"
	5238	codeSystem ="2.16.840 .1.113883. 6.96"
	5239	codeSystem Name="SNOM ED CT"
	5240	displayNam e="Severe (qualifer value)"
	5241	xsi:type=" CD"
	5242	>
	5243
	5244	<!-- 6.07 SEVERITY F REE TEXT, Optional-R 2 Removed b/c remove d
	5245	in tem plate -->
	5246
	5247	<originalT ext>
	5248
	5249	<reference
	5250	value="#an dSeverity1 009"
	5251	/>
	5252
	5253	</original Text>
	5254
	5255	</value>
	5256
	5257	</observat ion>
	5258
	5259	</entryRel ationship>
	5260
	5261	</observat ion>
	5262
	5263	</entryRel ationship>
	5264
	5265	</act>
	5266
	5267	</entry>
	5268	<entry
	5269	typeCode=" DRIV"
	5270	>
	5271
	5272	<act
	5273	classCode= "ACT"
	5274	moodCode=" EVN"
	5275	>
	5276
	5277	<templateI d
	5278	root="2.16 .840.1.113 883.10.20. 22.4.30"
	5279	/>
	5280
	5281	<!-- CCD A llergy Act ID as nul lflavor -- >
	5282
	5283	<id
	5284	nullFlavor ="NA"
	5285	/>
	5286
	5287	<code
	5288	code="4876 5-2"
	5289	codeSystem ="2.16.840 .1.113883. 6.1"
	5290	codeSystem Name="LOIN C"
	5291	displayNam e="Allergi es, advers e reaction s, alerts"
	5292	/>
	5293
	5294	<statusCod e
	5295	code="acti ve"
	5296	/>
	5297
	5298	<effective Time
	5299	nullFlavor ="NA"
	5300	>
	5301
	5302	<low
	5303	nullFlavor ="NA"
	5304	/>
	5305
	5306	</effectiv eTime>
	5307
	5308	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	5309
	5310	<author>
	5311
	5312	<time
	5313	nullFlavor ="NA"
	5314	/>
	5315
	5316	<assignedA uthor>
	5317
	5318	<id
	5319	nullFlavor ="NA"
	5320	/>
	5321
	5322	<represent edOrganiza tion>
	5323
	5324	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	5325	FA CILITY NBR -->
	5326
	5327	<id
	5328	extension= "983"
	5329	root="2.16 .840.1.113 883.4.349"
	5330	/>
	5331
	5332	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	5333
	5334	<name>
	5335	CHYSHR TES T LAB
	5336	</name>
	5337
	5338	<telecom
	5339	nullFlavor ="NA"
	5340	/>
	5341
	5342	<addr
	5343	nullFlavor ="NA"
	5344	/>
	5345
	5346	</represen tedOrganiz ation>
	5347
	5348	</assigned Author>
	5349
	5350	</author>
	5351
	5352	<entryRela tionship
	5353	inversionI nd="true"
	5354	typeCode=" SUBJ"
	5355	>
	5356
	5357	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	5358
	5359	<observati on
	5360	classCode= "OBS"
	5361	moodCode=" EVN"
	5362	negationIn d="false"
	5363	>
	5364
	5365	<templateI d
	5366	root="2.16 .840.1.113 883.10.20. 22.4.7"
	5367	/>
	5368
	5369	<id
	5370	nullFlavor ="NA"
	5371	/>
	5372
	5373	<code
	5374	code="ASSE RTION"
	5375	codeSystem ="2.16.840 .1.113883. 5.4"
	5376	codeSystem Name="HL7A ctCode"
	5377	/>
	5378
	5379	<statusCod e
	5380	code="comp leted"
	5381	/>
	5382
	5383	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	5384
	5385	<effective Time>
	5386
	5387	<low/>
	5388
	5389	</effectiv eTime>
	5390
	5391	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	5392
	5393	<value
	5394	code="4184 71000"
	5395	codeSystem ="2.16.840 .1.113883. 6.96"
	5396	codeSystem Name="SNOM ED CT"
	5397	displayNam e="Propens ity to adv erse react ions to fo od"
	5398	xsi:type=" CD"
	5399	>
	5400
	5401	<originalT ext>
	5402	FOOD
	5403	</original Text>
	5404
	5405	</value>
	5406
	5407	<participa nt
	5408	typeCode=" CSM"
	5409	>
	5410
	5411	<participa ntRole
	5412	classCode= "MANU"
	5413	>
	5414
	5415	<playingEn tity
	5416	classCode= "MMAT"
	5417	>
	5418
	5419	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	5420
	5421	<code
	5422	codeSystem ="2.16.840 .1.113883. 6.88"
	5423	codeSystem Name="RxNo rm"
	5424	nullFlavor ="UNK"
	5425	>
	5426
	5427	<originalT ext>
	5428
	5429	<reference
	5430	value="#an dAllergy10 10"
	5431	/>
	5432
	5433	</original Text>
	5434
	5435
	5436	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	5437
	5438	</code>
	5439
	5440	<name>
	5441	ABALONE
	5442	</name>
	5443
	5444	</playingE ntity>
	5445
	5446	</particip antRole>
	5447
	5448	</particip ant>
	5449
	5450	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	5451
	5452	<entryRela tionship
	5453	inversionI nd="true"
	5454	typeCode=" MFST"
	5455	>
	5456
	5457	<observati on
	5458	classCode= "OBS"
	5459	moodCode=" EVN"
	5460	>
	5461
	5462	<templateI d
	5463	root="2.16 .840.1.113 883.10.20. 22.4.9"
	5464	/>
	5465
	5466	<id
	5467	nullFlavor ="NA"
	5468	/>
	5469
	5470	<code
	5471	nullFlavor ="NA"
	5472	/>
	5473
	5474	<statusCod e
	5475	code="comp leted"
	5476	/>
	5477
	5478
	5479	<!-- 6.06 REACTION C ODED, REQU IRED -->
	5480
	5481
	5482	<value
	5483	code="2718 07003"
	5484	codeSystem ="2.16.840 .1.113883. 6.96"
	5485	codeSystem Name="SNOM ED CT"
	5486	displayNam e="Eruptio n of skin (disorder) "
	5487	xsi:type=" CD"
	5488	>
	5489
	5490	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	5491
	5492	<originalT ext>
	5493
	5494	<reference
	5495	value="#an dReaction1 011"
	5496	/>
	5497
	5498	</original Text>
	5499
	5500	<translati on
	5501	code="4538 635"
	5502	codeSystem ="2.16.840 .1.113883. 6.233"
	5503	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	5504	displayNam e="RASH"
	5505	/>
	5506
	5507	</value>
	5508
	5509	</observat ion>
	5510
	5511	</entryRel ationship>
	5512
	5513	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	5514
	5515
	5516	</observat ion>
	5517
	5518	</entryRel ationship>
	5519
	5520	</act>
	5521
	5522	</entry>
	5523	<entry
	5524	typeCode=" DRIV"
	5525	>
	5526
	5527	<act
	5528	classCode= "ACT"
	5529	moodCode=" EVN"
	5530	>
	5531
	5532	<templateI d
	5533	root="2.16 .840.1.113 883.10.20. 22.4.30"
	5534	/>
	5535
	5536	<!-- CCD A llergy Act ID as nul lflavor -- >
	5537
	5538	<id
	5539	nullFlavor ="NA"
	5540	/>
	5541
	5542	<code
	5543	code="4876 5-2"
	5544	codeSystem ="2.16.840 .1.113883. 6.1"
	5545	codeSystem Name="LOIN C"
	5546	displayNam e="Allergi es, advers e reaction s, alerts"
	5547	/>
	5548
	5549	<statusCod e
	5550	code="acti ve"
	5551	/>
	5552
	5553	<effective Time
	5554	nullFlavor ="NA"
	5555	>
	5556
	5557	<low
	5558	nullFlavor ="NA"
	5559	/>
	5560
	5561	</effectiv eTime>
	5562
	5563	<!-- INFOR MATION SOU RCE FOR AL LERGIES/DR UG, Option al -->
	5564
	5565	<author>
	5566
	5567	<time
	5568	nullFlavor ="NA"
	5569	/>
	5570
	5571	<assignedA uthor>
	5572
	5573	<id
	5574	nullFlavor ="NA"
	5575	/>
	5576
	5577	<represent edOrganiza tion>
	5578
	5579	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	5580	FA CILITY NBR -->
	5581
	5582	<id
	5583	extension= "983"
	5584	root="2.16 .840.1.113 883.4.349"
	5585	/>
	5586
	5587	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	5588
	5589	<name>
	5590	CHYSHR TES T LAB
	5591	</name>
	5592
	5593	<telecom
	5594	nullFlavor ="NA"
	5595	/>
	5596
	5597	<addr
	5598	nullFlavor ="NA"
	5599	/>
	5600
	5601	</represen tedOrganiz ation>
	5602
	5603	</assigned Author>
	5604
	5605	</author>
	5606
	5607	<entryRela tionship
	5608	inversionI nd="true"
	5609	typeCode=" SUBJ"
	5610	>
	5611
	5612	<!-- Aller gy Intoler ance Obser vation Ent ry -->
	5613
	5614	<observati on
	5615	classCode= "OBS"
	5616	moodCode=" EVN"
	5617	negationIn d="false"
	5618	>
	5619
	5620	<templateI d
	5621	root="2.16 .840.1.113 883.10.20. 22.4.7"
	5622	/>
	5623
	5624	<id
	5625	nullFlavor ="NA"
	5626	/>
	5627
	5628	<code
	5629	code="ASSE RTION"
	5630	codeSystem ="2.16.840 .1.113883. 5.4"
	5631	codeSystem Name="HL7A ctCode"
	5632	/>
	5633
	5634	<statusCod e
	5635	code="comp leted"
	5636	/>
	5637
	5638	<!-- 6.01 ADVERSE EV ENT DATE, REQUIRED - ->
	5639
	5640	<effective Time>
	5641
	5642	<low/>
	5643
	5644	</effectiv eTime>
	5645
	5646	<!-- 6.02 ADVERSE EV ENT TYPE, REQUIRED; SNOMED CT -->
	5647
	5648	<value
	5649	code="4195 11003"
	5650	codeSystem ="2.16.840 .1.113883. 6.96"
	5651	codeSystem Name="SNOM ED CT"
	5652	displayNam e="Propens ity to adv erse react ions to dr ug"
	5653	xsi:type=" CD"
	5654	>
	5655
	5656	<originalT ext>
	5657	DRUG
	5658	</original Text>
	5659
	5660	</value>
	5661
	5662	<participa nt
	5663	typeCode=" CSM"
	5664	>
	5665
	5666	<participa ntRole
	5667	classCode= "MANU"
	5668	>
	5669
	5670	<playingEn tity
	5671	classCode= "MMAT"
	5672	>
	5673
	5674	<!-- 6.04 PRODUCT CO DED,REQUIR ED -->
	5675
	5676	<code
	5677	codeSystem ="2.16.840 .1.113883. 6.88"
	5678	codeSystem Name="RxNo rm"
	5679	nullFlavor ="UNK"
	5680	>
	5681
	5682	<originalT ext>
	5683
	5684	<reference
	5685	value="#an dAllergy10 11"
	5686	/>
	5687
	5688	</original Text>
	5689
	5690
	5691	<!-- 6.03 PRODUCT FR EE TEXT, R 2 -->
	5692
	5693	</code>
	5694
	5695	<name>
	5696	ZEBETA TAB LET
	5697	</name>
	5698
	5699	</playingE ntity>
	5700
	5701	</particip antRole>
	5702
	5703	</particip ant>
	5704
	5705	<!-- REACT ION ENTRY RELATIONSH IP BLOCK R 2, repeata ble -->
	5706
	5707	<entryRela tionship
	5708	inversionI nd="true"
	5709	typeCode=" MFST"
	5710	>
	5711
	5712	<observati on
	5713	classCode= "OBS"
	5714	moodCode=" EVN"
	5715	>
	5716
	5717	<templateI d
	5718	root="2.16 .840.1.113 883.10.20. 22.4.9"
	5719	/>
	5720
	5721	<id
	5722	nullFlavor ="NA"
	5723	/>
	5724
	5725	<code
	5726	nullFlavor ="NA"
	5727	/>
	5728
	5729	<statusCod e
	5730	code="comp leted"
	5731	/>
	5732
	5733
	5734	<!-- 6.06 REACTION C ODED, REQU IRED -->
	5735
	5736
	5737	<value
	5738	code="2718 07003"
	5739	codeSystem ="2.16.840 .1.113883. 6.96"
	5740	codeSystem Name="SNOM ED CT"
	5741	displayNam e="Eruptio n of skin (disorder) "
	5742	xsi:type=" CD"
	5743	>
	5744
	5745	<!-- 6.05 REACTION-F REE TEXT, optional, -->
	5746
	5747	<originalT ext>
	5748
	5749	<reference
	5750	value="#an dReaction1 012"
	5751	/>
	5752
	5753	</original Text>
	5754
	5755	<translati on
	5756	code="4538 635"
	5757	codeSystem ="2.16.840 .1.113883. 6.233"
	5758	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	5759	displayNam e="RASH"
	5760	/>
	5761
	5762	</value>
	5763
	5764	</observat ion>
	5765
	5766	</entryRel ationship>
	5767
	5768	<!-- SEVER ITY ENTRY RELATIONSH IP BLOCK R 2, 0 or 1 per Allerg y -->
	5769
	5770
	5771	</observat ion>
	5772
	5773	</entryRel ationship>
	5774
	5775	</act>
	5776
	5777	</entry>
	5778
	5779	</section>
	5780
	5781	</componen t>
	5782
	5783	<component >
	5784
	5785	<!-- *** ****** ****** ****** ****** ******** * VITAL SI GNS
	5786	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	5787
	5788	<section
	5789	nullFlavor ="NI"
	5790	>
	5791
	5792	<!-- C-CDA CCD VITAL SIGNS Sec tion Templ ate Entrie s REQUIRED -->
	5793
	5794	<templateI d
	5795	root="2.16 .840.1.113 883.10.20. 22.2.4.1"
	5796	/>
	5797
	5798	<templateI d
	5799	root="2.16 .840.1.113 883.10.20. 22.2.4"
	5800	/>
	5801
	5802	<code
	5803	code="8716 -3"
	5804	codeSystem ="2.16.840 .1.113883. 6.1"
	5805	codeSystem Name="LOIN C"
	5806	displayNam e="Vital S igns"
	5807	/>
	5808
	5809	<title>
	5810	Vital Sign s Section
	5811	</title>
	5812
	5813	<!-- VITAL SIGNS NAR RATIVE BLO CK, REQUIR ED -->
	5814
	5815	<text>
	5816	No Data Pr ovided for This Sect ion
	5817	</text>
	5818
	5819	<!-- VITAL SIGNS STR UCTURED DA TA -->
	5820
	5821
	5822	</section>
	5823
	5824	</componen t>
	5825
	5826	<component >
	5827
	5828	<!-- *** ****** ****** ****** ****** ******** * PROBLEM/ CONDITION
	5829	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	5830
	5831	<section>
	5832
	5833	<!-- C-CDA Problem S ection Tem plate. Ent ries REQUI RED -->
	5834
	5835	<templateI d
	5836	root="2.16 .840.1.113 883.10.20. 22.2.5.1"
	5837	/>
	5838
	5839	<templateI d
	5840	root="2.16 .840.1.113 883.10.20. 22.2.5"
	5841	/>
	5842
	5843	<code
	5844	code="1145 0-4"
	5845	codeSystem ="2.16.840 .1.113883. 6.1"
	5846	codeSystem Name="LOIN C"
	5847	displayNam e="Problem List"
	5848	/>
	5849
	5850	<title>
	5851	Problem Li st
	5852	</title>
	5853
	5854	<!-- PROBL EMS NARRAT IVE BLOCK -->
	5855
	5856	<text>
	5857
	5858	<!-- VA Pr oblem/Cond ition Busi ness Rules for Medic al Content -->
	5859
	5860	<paragraph >
	5861	This secti on contain s a list o f Problems /Condition s known to VA
	5862	for the patien t. It incl udes both active and inactive
	5863	prob lems/condi tions. The data come s from all VA treatm ent
	5864	faci lities.
	5865	</paragrap h>
	5866
	5867	<table
	5868	ID="proble mNarrative "
	5869	border="1"
	5870	width="100 %"
	5871	>
	5872
	5873	<thead>
	5874
	5875	<tr>
	5876
	5877	<th>
	5878	Problem
	5879	</th>
	5880
	5881	<th>
	5882	Status
	5883	</th>
	5884
	5885	<th>
	5886	Problem Co de
	5887	</th>
	5888
	5889	<th>
	5890	Date of On set
	5891	</th>
	5892
	5893	<th>
	5894	Date of Re solution
	5895	</th>
	5896
	5897	<th>
	5898	Comment(s)
	5899	</th>
	5900
	5901	<th>
	5902	Provider
	5903	</th>
	5904
	5905	<th>
	5906	Source
	5907	</th>
	5908
	5909	</tr>
	5910
	5911	</thead>
	5912
	5913	<tbody>
	5914
	5915	<tr>
	5916
	5917	<td>
	5918
	5919	<content
	5920	ID="pndPro blem1001"
	5921	>
	5922	Sleep-wake schedule disorder ( ICD-9-CM 3 07.49)
	5923	</content>
	5924
	5925	</td>
	5926
	5927	<td>
	5928
	5929	<content
	5930	ID="pndSta tus1001"
	5931	>
	5932	Active
	5933	</content>
	5934
	5935	</td>
	5936
	5937	<td>
	5938
	5939	<content
	5940	ID="pndPro blemCode10 01"
	5941	>
	5942	307.49
	5943	</content>
	5944
	5945	</td>
	5946
	5947	<td>
	5948
	5949	<content
	5950	ID="pndDat eOfOnset10 01"
	5951	>
	5952	Dec 01, 20 10
	5953	</content>
	5954
	5955	</td>
	5956
	5957	<td>
	5958
	5959	<content
	5960	ID="pndDat eOfResolut ion1001"
	5961	/>
	5962
	5963	</td>
	5964
	5965	<td>
	5966
	5967	<list>
	5968
	5969	<item
	5970	ID="pndCom ment1001"
	5971	>
	5972	No comment s entered for proble m.
	5973	</item>
	5974
	5975	</list>
	5976
	5977	</td>
	5978
	5979	<td>
	5980
	5981	<content
	5982	ID="pndPro vider1001"
	5983	>
	5984	SEITZ,DAVI D
	5985	</content>
	5986
	5987	</td>
	5988
	5989	<td>
	5990
	5991	<content
	5992	ID="pndSou rce1001"
	5993	>
	5994	DAYTON
	5995	</content>
	5996
	5997	</td>
	5998
	5999	</tr>
	6000	<tr>
	6001
	6002	<td>
	6003
	6004	<content
	6005	ID="pndPro blem1002"
	6006	>
	6007	Sleep Terr or Disorde r (ICD-9-C M 307.46)
	6008	</content>
	6009
	6010	</td>
	6011
	6012	<td>
	6013
	6014	<content
	6015	ID="pndSta tus1002"
	6016	>
	6017	Active
	6018	</content>
	6019
	6020	</td>
	6021
	6022	<td>
	6023
	6024	<content
	6025	ID="pndPro blemCode10 02"
	6026	>
	6027	442176004
	6028	</content>
	6029
	6030	</td>
	6031
	6032	<td>
	6033
	6034	<content
	6035	ID="pndDat eOfOnset10 02"
	6036	/>
	6037
	6038	</td>
	6039
	6040	<td>
	6041
	6042	<content
	6043	ID="pndDat eOfResolut ion1002"
	6044	/>
	6045
	6046	</td>
	6047
	6048	<td>
	6049
	6050	<list>
	6051
	6052	<item
	6053	ID="pndCom ment1002"
	6054	>
	6055	No comment s entered for proble m.
	6056	</item>
	6057
	6058	</list>
	6059
	6060	</td>
	6061
	6062	<td>
	6063
	6064	<content
	6065	ID="pndPro vider1002"
	6066	>
	6067	SINGLETON, CHRISTINE
	6068	</content>
	6069
	6070	</td>
	6071
	6072	<td>
	6073
	6074	<content
	6075	ID="pndSou rce1002"
	6076	>
	6077	DAYTON
	6078	</content>
	6079
	6080	</td>
	6081
	6082	</tr>
	6083	<tr>
	6084
	6085	<td>
	6086
	6087	<content
	6088	ID="pndPro blem1003"
	6089	>
	6090	Nasal Poly ps (ICD-9- CM 471.9)
	6091	</content>
	6092
	6093	</td>
	6094
	6095	<td>
	6096
	6097	<content
	6098	ID="pndSta tus1003"
	6099	>
	6100	Active
	6101	</content>
	6102
	6103	</td>
	6104
	6105	<td>
	6106
	6107	<content
	6108	ID="pndPro blemCode10 03"
	6109	>
	6110	52756005
	6111	</content>
	6112
	6113	</td>
	6114
	6115	<td>
	6116
	6117	<content
	6118	ID="pndDat eOfOnset10 03"
	6119	>
	6120	Sep 30, 20 12
	6121	</content>
	6122
	6123	</td>
	6124
	6125	<td>
	6126
	6127	<content
	6128	ID="pndDat eOfResolut ion1003"
	6129	/>
	6130
	6131	</td>
	6132
	6133	<td>
	6134
	6135	<list>
	6136
	6137	<item
	6138	ID="pndCom ment1003"
	6139	>
	6140	No comment s entered for proble m.
	6141	</item>
	6142
	6143	</list>
	6144
	6145	</td>
	6146
	6147	<td>
	6148
	6149	<content
	6150	ID="pndPro vider1003"
	6151	>
	6152	ADAM,DAVID R
	6153	</content>
	6154
	6155	</td>
	6156
	6157	<td>
	6158
	6159	<content
	6160	ID="pndSou rce1003"
	6161	>
	6162	DAYTON
	6163	</content>
	6164
	6165	</td>
	6166
	6167	</tr>
	6168	<tr>
	6169
	6170	<td>
	6171
	6172	<content
	6173	ID="pndPro blem1004"
	6174	>
	6175	Cardio-vas cular Find ings: Hear t (ICD-9-C M 799.9)
	6176	</content>
	6177
	6178	</td>
	6179
	6180	<td>
	6181
	6182	<content
	6183	ID="pndSta tus1004"
	6184	>
	6185	Active
	6186	</content>
	6187
	6188	</td>
	6189
	6190	<td>
	6191
	6192	<content
	6193	ID="pndPro blemCode10 04"
	6194	>
	6195	799.9
	6196	</content>
	6197
	6198	</td>
	6199
	6200	<td>
	6201
	6202	<content
	6203	ID="pndDat eOfOnset10 04"
	6204	>
	6205	Nov 01, 20 12
	6206	</content>
	6207
	6208	</td>
	6209
	6210	<td>
	6211
	6212	<content
	6213	ID="pndDat eOfResolut ion1004"
	6214	/>
	6215
	6216	</td>
	6217
	6218	<td>
	6219
	6220	<list>
	6221
	6222	<item
	6223	ID="pndCom ment1004"
	6224	>
	6225	No comment s entered for proble m.
	6226	</item>
	6227
	6228	</list>
	6229
	6230	</td>
	6231
	6232	<td>
	6233
	6234	<content
	6235	ID="pndPro vider1004"
	6236	>
	6237	GOURALNIK, YELENA
	6238	</content>
	6239
	6240	</td>
	6241
	6242	<td>
	6243
	6244	<content
	6245	ID="pndSou rce1004"
	6246	>
	6247	DAYTON
	6248	</content>
	6249
	6250	</td>
	6251
	6252	</tr>
	6253	<tr>
	6254
	6255	<td>
	6256
	6257	<content
	6258	ID="pndPro blem1005"
	6259	>
	6260	Heart fail ure (ICD-9 -CM 428.9)
	6261	</content>
	6262
	6263	</td>
	6264
	6265	<td>
	6266
	6267	<content
	6268	ID="pndSta tus1005"
	6269	>
	6270	Active
	6271	</content>
	6272
	6273	</td>
	6274
	6275	<td>
	6276
	6277	<content
	6278	ID="pndPro blemCode10 05"
	6279	>
	6280	84114007
	6281	</content>
	6282
	6283	</td>
	6284
	6285	<td>
	6286
	6287	<content
	6288	ID="pndDat eOfOnset10 05"
	6289	/>
	6290
	6291	</td>
	6292
	6293	<td>
	6294
	6295	<content
	6296	ID="pndDat eOfResolut ion1005"
	6297	/>
	6298
	6299	</td>
	6300
	6301	<td>
	6302
	6303	<list>
	6304
	6305	<item
	6306	ID="pndCom ment1005"
	6307	>
	6308	No comment s entered for proble m.
	6309	</item>
	6310
	6311	</list>
	6312
	6313	</td>
	6314
	6315	<td>
	6316
	6317	<content
	6318	ID="pndPro vider1005"
	6319	>
	6320	GARTZ,DONN A
	6321	</content>
	6322
	6323	</td>
	6324
	6325	<td>
	6326
	6327	<content
	6328	ID="pndSou rce1005"
	6329	>
	6330	DAYTON
	6331	</content>
	6332
	6333	</td>
	6334
	6335	</tr>
	6336	<tr>
	6337
	6338	<td>
	6339
	6340	<content
	6341	ID="pndPro blem1006"
	6342	>
	6343	Posttrauma tic Stress Disorder (ICD-9-CM 309.81)
	6344	</content>
	6345
	6346	</td>
	6347
	6348	<td>
	6349
	6350	<content
	6351	ID="pndSta tus1006"
	6352	>
	6353	Active
	6354	</content>
	6355
	6356	</td>
	6357
	6358	<td>
	6359
	6360	<content
	6361	ID="pndPro blemCode10 06"
	6362	>
	6363	47505003
	6364	</content>
	6365
	6366	</td>
	6367
	6368	<td>
	6369
	6370	<content
	6371	ID="pndDat eOfOnset10 06"
	6372	/>
	6373
	6374	</td>
	6375
	6376	<td>
	6377
	6378	<content
	6379	ID="pndDat eOfResolut ion1006"
	6380	/>
	6381
	6382	</td>
	6383
	6384	<td>
	6385
	6386	<list>
	6387
	6388	<item
	6389	ID="pndCom ment1006"
	6390	>
	6391	No comment s entered for proble m.
	6392	</item>
	6393
	6394	</list>
	6395
	6396	</td>
	6397
	6398	<td>
	6399
	6400	<content
	6401	ID="pndPro vider1006"
	6402	>
	6403	ABSHIRE,BE VERLY C
	6404	</content>
	6405
	6406	</td>
	6407
	6408	<td>
	6409
	6410	<content
	6411	ID="pndSou rce1006"
	6412	>
	6413	DAYTON
	6414	</content>
	6415
	6416	</td>
	6417
	6418	</tr>
	6419	<tr>
	6420
	6421	<td>
	6422
	6423	<content
	6424	ID="pndPro blem1007"
	6425	>
	6426	Thoracic b ack sprain (SCT 2741 62005)
	6427	</content>
	6428
	6429	</td>
	6430
	6431	<td>
	6432
	6433	<content
	6434	ID="pndSta tus1007"
	6435	>
	6436	Active
	6437	</content>
	6438
	6439	</td>
	6440
	6441	<td>
	6442
	6443	<content
	6444	ID="pndPro blemCode10 07"
	6445	>
	6446	274162005
	6447	</content>
	6448
	6449	</td>
	6450
	6451	<td>
	6452
	6453	<content
	6454	ID="pndDat eOfOnset10 07"
	6455	>
	6456	Dec 02, 20 16
	6457	</content>
	6458
	6459	</td>
	6460
	6461	<td>
	6462
	6463	<content
	6464	ID="pndDat eOfResolut ion1007"
	6465	/>
	6466
	6467	</td>
	6468
	6469	<td>
	6470
	6471	<list>
	6472
	6473	<item
	6474	ID="pndCom ment1007"
	6475	>
	6476	No comment s entered for proble m.
	6477	</item>
	6478
	6479	</list>
	6480
	6481	</td>
	6482
	6483	<td>
	6484
	6485	<content
	6486	ID="pndPro vider1007"
	6487	>
	6488	MANGUS,CHR ISTOPHER
	6489	</content>
	6490
	6491	</td>
	6492
	6493	<td>
	6494
	6495	<content
	6496	ID="pndSou rce1007"
	6497	>
	6498	CHYSHR TES T LAB
	6499	</content>
	6500
	6501	</td>
	6502
	6503	</tr>
	6504	<tr>
	6505
	6506	<td>
	6507
	6508	<content
	6509	ID="pndPro blem1008"
	6510	>
	6511	Sore tummy (SCT 2716 81002)
	6512	</content>
	6513
	6514	</td>
	6515
	6516	<td>
	6517
	6518	<content
	6519	ID="pndSta tus1008"
	6520	>
	6521	Active
	6522	</content>
	6523
	6524	</td>
	6525
	6526	<td>
	6527
	6528	<content
	6529	ID="pndPro blemCode10 08"
	6530	>
	6531	271681002
	6532	</content>
	6533
	6534	</td>
	6535
	6536	<td>
	6537
	6538	<content
	6539	ID="pndDat eOfOnset10 08"
	6540	>
	6541	Dec 02, 20 16
	6542	</content>
	6543
	6544	</td>
	6545
	6546	<td>
	6547
	6548	<content
	6549	ID="pndDat eOfResolut ion1008"
	6550	/>
	6551
	6552	</td>
	6553
	6554	<td>
	6555
	6556	<list>
	6557
	6558	<item
	6559	ID="pndCom ment1008"
	6560	>
	6561	No comment s entered for proble m.
	6562	</item>
	6563
	6564	</list>
	6565
	6566	</td>
	6567
	6568	<td>
	6569
	6570	<content
	6571	ID="pndPro vider1008"
	6572	>
	6573	MANGUS,CHR ISTOPHER
	6574	</content>
	6575
	6576	</td>
	6577
	6578	<td>
	6579
	6580	<content
	6581	ID="pndSou rce1008"
	6582	>
	6583	CHYSHR TES T LAB
	6584	</content>
	6585
	6586	</td>
	6587
	6588	</tr>
	6589	<tr>
	6590
	6591	<td>
	6592
	6593	<content
	6594	ID="pndPro blem1009"
	6595	>
	6596	Back pain (SCT 16189 1005)
	6597	</content>
	6598
	6599	</td>
	6600
	6601	<td>
	6602
	6603	<content
	6604	ID="pndSta tus1009"
	6605	>
	6606	Active
	6607	</content>
	6608
	6609	</td>
	6610
	6611	<td>
	6612
	6613	<content
	6614	ID="pndPro blemCode10 09"
	6615	>
	6616	161891005
	6617	</content>
	6618
	6619	</td>
	6620
	6621	<td>
	6622
	6623	<content
	6624	ID="pndDat eOfOnset10 09"
	6625	>
	6626	Jan 01, 20 14
	6627	</content>
	6628
	6629	</td>
	6630
	6631	<td>
	6632
	6633	<content
	6634	ID="pndDat eOfResolut ion1009"
	6635	/>
	6636
	6637	</td>
	6638
	6639	<td>
	6640
	6641	<list>
	6642
	6643	<item
	6644	ID="pndCom ment1009"
	6645	>
	6646	No comment s entered for proble m.
	6647	</item>
	6648
	6649	</list>
	6650
	6651	</td>
	6652
	6653	<td>
	6654
	6655	<content
	6656	ID="pndPro vider1009"
	6657	>
	6658	BOUHADDOU, OMAR
	6659	</content>
	6660
	6661	</td>
	6662
	6663	<td>
	6664
	6665	<content
	6666	ID="pndSou rce1009"
	6667	>
	6668	CHYSHR TES T LAB
	6669	</content>
	6670
	6671	</td>
	6672
	6673	</tr>
	6674	<tr>
	6675
	6676	<td>
	6677
	6678	<content
	6679	ID="pndPro blem1010"
	6680	>
	6681	Malaria (S CT 6146200 0)
	6682	</content>
	6683
	6684	</td>
	6685
	6686	<td>
	6687
	6688	<content
	6689	ID="pndSta tus1010"
	6690	>
	6691	Active
	6692	</content>
	6693
	6694	</td>
	6695
	6696	<td>
	6697
	6698	<content
	6699	ID="pndPro blemCode10 10"
	6700	>
	6701	61462000
	6702	</content>
	6703
	6704	</td>
	6705
	6706	<td>
	6707
	6708	<content
	6709	ID="pndDat eOfOnset10 10"
	6710	/>
	6711
	6712	</td>
	6713
	6714	<td>
	6715
	6716	<content
	6717	ID="pndDat eOfResolut ion1010"
	6718	/>
	6719
	6720	</td>
	6721
	6722	<td>
	6723
	6724	<list>
	6725
	6726	<item
	6727	ID="pndCom ment1010"
	6728	>
	6729	No comment s entered for proble m.
	6730	</item>
	6731
	6732	</list>
	6733
	6734	</td>
	6735
	6736	<td>
	6737
	6738	<content
	6739	ID="pndPro vider1010"
	6740	>
	6741	SWALL,MARI E
	6742	</content>
	6743
	6744	</td>
	6745
	6746	<td>
	6747
	6748	<content
	6749	ID="pndSou rce1010"
	6750	>
	6751	CHYSHR TES T LAB
	6752	</content>
	6753
	6754	</td>
	6755
	6756	</tr>
	6757	<tr>
	6758
	6759	<td>
	6760
	6761	<content
	6762	ID="pndPro blem1011"
	6763	>
	6764	Cough (ICD -9-CM 786. 2)
	6765	</content>
	6766
	6767	</td>
	6768
	6769	<td>
	6770
	6771	<content
	6772	ID="pndSta tus1011"
	6773	>
	6774	Active
	6775	</content>
	6776
	6777	</td>
	6778
	6779	<td>
	6780
	6781	<content
	6782	ID="pndPro blemCode10 11"
	6783	>
	6784	49727002
	6785	</content>
	6786
	6787	</td>
	6788
	6789	<td>
	6790
	6791	<content
	6792	ID="pndDat eOfOnset10 11"
	6793	>
	6794	Nov 11, 20 11
	6795	</content>
	6796
	6797	</td>
	6798
	6799	<td>
	6800
	6801	<content
	6802	ID="pndDat eOfResolut ion1011"
	6803	/>
	6804
	6805	</td>
	6806
	6807	<td>
	6808
	6809	<list>
	6810
	6811	<item
	6812	ID="pndCom ment1011"
	6813	>
	6814	No comment s entered for proble m.
	6815	</item>
	6816
	6817	</list>
	6818
	6819	</td>
	6820
	6821	<td>
	6822
	6823	<content
	6824	ID="pndPro vider1011"
	6825	>
	6826	POND,NEAL
	6827	</content>
	6828
	6829	</td>
	6830
	6831	<td>
	6832
	6833	<content
	6834	ID="pndSou rce1011"
	6835	>
	6836	CHYSHR TES T LAB
	6837	</content>
	6838
	6839	</td>
	6840
	6841	</tr>
	6842	<tr>
	6843
	6844	<td>
	6845
	6846	<content
	6847	ID="pndPro blem1012"
	6848	>
	6849	Hypertensi on (ICD-9- CM 401.9)
	6850	</content>
	6851
	6852	</td>
	6853
	6854	<td>
	6855
	6856	<content
	6857	ID="pndSta tus1012"
	6858	>
	6859	Active
	6860	</content>
	6861
	6862	</td>
	6863
	6864	<td>
	6865
	6866	<content
	6867	ID="pndPro blemCode10 12"
	6868	>
	6869	59621000
	6870	</content>
	6871
	6872	</td>
	6873
	6874	<td>
	6875
	6876	<content
	6877	ID="pndDat eOfOnset10 12"
	6878	/>
	6879
	6880	</td>
	6881
	6882	<td>
	6883
	6884	<content
	6885	ID="pndDat eOfResolut ion1012"
	6886	/>
	6887
	6888	</td>
	6889
	6890	<td>
	6891
	6892	<list>
	6893
	6894	<item>
	6895
	6896	<content
	6897	ID="pndCom ment1012_1 001"
	6898	>
	6899	Nov 17, 20 11
	6900	Entered By : POND,NEA L
	6901	Comment: t est
	6902	</content>
	6903
	6904	</item>
	6905
	6906	</list>
	6907
	6908	</td>
	6909
	6910	<td>
	6911
	6912	<content
	6913	ID="pndPro vider1012"
	6914	>
	6915	POND,NEAL
	6916	</content>
	6917
	6918	</td>
	6919
	6920	<td>
	6921
	6922	<content
	6923	ID="pndSou rce1012"
	6924	>
	6925	CHYSHR TES T LAB
	6926	</content>
	6927
	6928	</td>
	6929
	6930	</tr>
	6931	<tr>
	6932
	6933	<td>
	6934
	6935	<content
	6936	ID="pndPro blem1013"
	6937	>
	6938	Back ache (SCT 16189 1005)
	6939	</content>
	6940
	6941	</td>
	6942
	6943	<td>
	6944
	6945	<content
	6946	ID="pndSta tus1013"
	6947	>
	6948	Inactive
	6949	</content>
	6950
	6951	</td>
	6952
	6953	<td>
	6954
	6955	<content
	6956	ID="pndPro blemCode10 13"
	6957	>
	6958	161891005
	6959	</content>
	6960
	6961	</td>
	6962
	6963	<td>
	6964
	6965	<content
	6966	ID="pndDat eOfOnset10 13"
	6967	>
	6968	Dec 02, 20 16
	6969	</content>
	6970
	6971	</td>
	6972
	6973	<td>
	6974
	6975	<content
	6976	ID="pndDat eOfResolut ion1013"
	6977	>
	6978	Dec 02, 20 16
	6979	</content>
	6980
	6981	</td>
	6982
	6983	<td>
	6984
	6985	<list>
	6986
	6987	<item
	6988	ID="pndCom ment1013"
	6989	>
	6990	No comment s entered for proble m.
	6991	</item>
	6992
	6993	</list>
	6994
	6995	</td>
	6996
	6997	<td>
	6998
	6999	<content
	7000	ID="pndPro vider1013"
	7001	>
	7002	MANGUS,CHR ISTOPHER
	7003	</content>
	7004
	7005	</td>
	7006
	7007	<td>
	7008
	7009	<content
	7010	ID="pndSou rce1013"
	7011	>
	7012	CHYSHR TES T LAB
	7013	</content>
	7014
	7015	</td>
	7016
	7017	</tr>
	7018	<tr>
	7019
	7020	<td>
	7021
	7022	<content
	7023	ID="pndPro blem1014"
	7024	>
	7025	Hyperexten sion defor mity of kn ee (SCT 65 621006)
	7026	</content>
	7027
	7028	</td>
	7029
	7030	<td>
	7031
	7032	<content
	7033	ID="pndSta tus1014"
	7034	>
	7035	Inactive
	7036	</content>
	7037
	7038	</td>
	7039
	7040	<td>
	7041
	7042	<content
	7043	ID="pndPro blemCode10 14"
	7044	>
	7045	65621006
	7046	</content>
	7047
	7048	</td>
	7049
	7050	<td>
	7051
	7052	<content
	7053	ID="pndDat eOfOnset10 14"
	7054	>
	7055	Dec 02, 20 16
	7056	</content>
	7057
	7058	</td>
	7059
	7060	<td>
	7061
	7062	<content
	7063	ID="pndDat eOfResolut ion1014"
	7064	>
	7065	Dec 02, 20 16
	7066	</content>
	7067
	7068	</td>
	7069
	7070	<td>
	7071
	7072	<list>
	7073
	7074	<item
	7075	ID="pndCom ment1014"
	7076	>
	7077	No comment s entered for proble m.
	7078	</item>
	7079
	7080	</list>
	7081
	7082	</td>
	7083
	7084	<td>
	7085
	7086	<content
	7087	ID="pndPro vider1014"
	7088	>
	7089	MANGUS,CHR ISTOPHER
	7090	</content>
	7091
	7092	</td>
	7093
	7094	<td>
	7095
	7096	<content
	7097	ID="pndSou rce1014"
	7098	>
	7099	CHYSHR TES T LAB
	7100	</content>
	7101
	7102	</td>
	7103
	7104	</tr>
	7105	<tr>
	7106
	7107	<td>
	7108
	7109	<content
	7110	ID="pndPro blem1015"
	7111	>
	7112	Back sprai n (SCT 281 598004)
	7113	</content>
	7114
	7115	</td>
	7116
	7117	<td>
	7118
	7119	<content
	7120	ID="pndSta tus1015"
	7121	>
	7122	Inactive
	7123	</content>
	7124
	7125	</td>
	7126
	7127	<td>
	7128
	7129	<content
	7130	ID="pndPro blemCode10 15"
	7131	>
	7132	281598004
	7133	</content>
	7134
	7135	</td>
	7136
	7137	<td>
	7138
	7139	<content
	7140	ID="pndDat eOfOnset10 15"
	7141	/>
	7142
	7143	</td>
	7144
	7145	<td>
	7146
	7147	<content
	7148	ID="pndDat eOfResolut ion1015"
	7149	>
	7150	Dec 01, 20 16
	7151	</content>
	7152
	7153	</td>
	7154
	7155	<td>
	7156
	7157	<list>
	7158
	7159	<item
	7160	ID="pndCom ment1015"
	7161	>
	7162	No comment s entered for proble m.
	7163	</item>
	7164
	7165	</list>
	7166
	7167	</td>
	7168
	7169	<td>
	7170
	7171	<content
	7172	ID="pndPro vider1015"
	7173	>
	7174	MANGUS,CHR ISTOPHER
	7175	</content>
	7176
	7177	</td>
	7178
	7179	<td>
	7180
	7181	<content
	7182	ID="pndSou rce1015"
	7183	>
	7184	CHYSHR TES T LAB
	7185	</content>
	7186
	7187	</td>
	7188
	7189	</tr>
	7190	<tr>
	7191
	7192	<td>
	7193
	7194	<content
	7195	ID="pndPro blem1016"
	7196	>
	7197	Dermatomyo sitis (ICD -9-CM 710. 3)
	7198	</content>
	7199
	7200	</td>
	7201
	7202	<td>
	7203
	7204	<content
	7205	ID="pndSta tus1016"
	7206	>
	7207	Inactive
	7208	</content>
	7209
	7210	</td>
	7211
	7212	<td>
	7213
	7214	<content
	7215	ID="pndPro blemCode10 16"
	7216	>
	7217	396230008
	7218	</content>
	7219
	7220	</td>
	7221
	7222	<td>
	7223
	7224	<content
	7225	ID="pndDat eOfOnset10 16"
	7226	/>
	7227
	7228	</td>
	7229
	7230	<td>
	7231
	7232	<content
	7233	ID="pndDat eOfResolut ion1016"
	7234	>
	7235	Dec 01, 20 16
	7236	</content>
	7237
	7238	</td>
	7239
	7240	<td>
	7241
	7242	<list>
	7243
	7244	<item>
	7245
	7246	<content
	7247	ID="pndCom ment1016_1 002"
	7248	>
	7249	Nov 17, 20 11
	7250	Entered By : POND,NEA L
	7251	Comment: t est
	7252	</content>
	7253
	7254	</item>
	7255
	7256	</list>
	7257
	7258	</td>
	7259
	7260	<td>
	7261
	7262	<content
	7263	ID="pndPro vider1016"
	7264	>
	7265	POND,NEAL
	7266	</content>
	7267
	7268	</td>
	7269
	7270	<td>
	7271
	7272	<content
	7273	ID="pndSou rce1016"
	7274	>
	7275	CHYSHR TES T LAB
	7276	</content>
	7277
	7278	</td>
	7279
	7280	</tr>
	7281
	7282	</tbody>
	7283
	7284	</table>
	7285
	7286	</text>
	7287
	7288	<!-- PROBL EMS STRUCT URED DATA -->
	7289
	7290	<!-- Probl em Concern Activty E ntry -->
	7291
	7292	<entry>
	7293
	7294	<act
	7295	classCode= "ACT"
	7296	moodCode=" EVN"
	7297	>
	7298
	7299	<templateI d
	7300	root="2.16 .840.1.113 883.10.20. 22.4.3"
	7301	/>
	7302
	7303	<id
	7304	nullFlavor ="NA"
	7305	/>
	7306
	7307	<code
	7308	code="CONC "
	7309	codeSystem ="2.16.840 .1.113883. 5.6"
	7310	codeSystem Name="HL7A ctClass"
	7311	displayNam e="Concern "
	7312	/>
	7313
	7314	<statusCod e
	7315	code="acti ve"
	7316	/>
	7317
	7318	<!-- 7.01 PROBLEM DA TE, R2 -->
	7319
	7320	<effective Time>
	7321
	7322	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	7323
	7324	<low
	7325	value="201 01201"
	7326	/>
	7327
	7328	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	7329
	7330	<high
	7331	nullFlavor ="UNK"
	7332	/>
	7333
	7334	</effectiv eTime>
	7335
	7336	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	7337
	7338	<performer >
	7339
	7340	<assignedE ntity>
	7341
	7342	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	7343	HealthCare Provider Section -- >
	7344
	7345	<id
	7346	extension= "provider1 001"
	7347	root="2.16 .840.1.113 883.4.349"
	7348	/>
	7349
	7350	<assignedP erson>
	7351
	7352	<name/>
	7353
	7354	</assigned Person>
	7355
	7356	</assigned Entity>
	7357
	7358	</performe r>
	7359
	7360	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	7361
	7362	<author>
	7363
	7364	<time
	7365	nullFlavor ="NA"
	7366	/>
	7367
	7368	<assignedA uthor>
	7369
	7370	<id
	7371	nullFlavor ="NA"
	7372	/>
	7373
	7374	<represent edOrganiza tion>
	7375
	7376	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	7377	FA CILITY NBR -->
	7378
	7379	<id
	7380	extension= "552"
	7381	root="2.16 .840.1.113 883.4.349"
	7382	/>
	7383
	7384	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	7385
	7386	<name>
	7387	DAYTON
	7388	</name>
	7389
	7390	<telecom
	7391	nullFlavor ="NA"
	7392	/>
	7393
	7394	<addr
	7395	nullFlavor ="NA"
	7396	/>
	7397
	7398	</represen tedOrganiz ation>
	7399
	7400	</assigned Author>
	7401
	7402	</author>
	7403
	7404	<entryRela tionship
	7405	typeCode=" SUBJ"
	7406	>
	7407
	7408	<!-- CCD P roblem Obs ervation - ->
	7409
	7410	<observati on
	7411	classCode= "OBS"
	7412	moodCode=" EVN"
	7413	>
	7414
	7415	<templateI d
	7416	root="2.16 .840.1.113 883.10.20. 22.4.4"
	7417	/>
	7418
	7419	<id
	7420	nullFlavor ="NA"
	7421	/>
	7422
	7423	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	7424	b/c data n ot yet ava ilable via VA VistA RPCs -->
	7425
	7426	<code
	7427	codeSystem ="2.16.840 .1.113883. 6.96"
	7428	codeSystem Name="SNOM ED CT"
	7429	nullFlavor ="UNK"
	7430	>
	7431
	7432	<originalT ext>
	7433	Problem Ty pe Not Ava ilable
	7434	</original Text>
	7435
	7436	</code>
	7437
	7438	<!-- 7.03 PROBLEM NA ME, R2 -->
	7439
	7440	<text>
	7441
	7442	<reference
	7443	value="#pn dProblem10 01"
	7444	/>
	7445
	7446	</text>
	7447
	7448	<statusCod e
	7449	code="comp leted"
	7450	/>
	7451
	7452	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	7453	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	7454
	7455	<value
	7456	codeSystem ="2.16.840 .1.113883. 6.96"
	7457	codeSystem Name="SNOM ED CT"
	7458	nullFlavor ="UNK"
	7459	xsi:type=" CD"
	7460	>
	7461
	7462	<originalT ext>
	7463
	7464	<reference
	7465	value="#pn dProblem10 01"
	7466	/>
	7467
	7468	</original Text>
	7469
	7470	<translati on
	7471	code="307. 49"
	7472	codeSystem ="2.16.840 .1.113883. 6.103"
	7473	codeSystem Name="ICD- 9-CM"
	7474	/>
	7475
	7476	</value>
	7477
	7478	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	7479
	7480	<entryRela tionship
	7481	typeCode=" SUBJ"
	7482	>
	7483
	7484	<observati on
	7485	classCode= "OBS"
	7486	moodCode=" EVN"
	7487	>
	7488
	7489	<templateI d
	7490	root="2.16 .840.1.113 883.10.20. 22.4.6"
	7491	/>
	7492
	7493	<code
	7494	code="3399 9-4"
	7495	codeSystem ="2.16.840 .1.113883. 6.1"
	7496	codeSystem Name="LOIN C"
	7497	displayNam e="Status"
	7498	/>
	7499
	7500	<statusCod e
	7501	code="comp leted"
	7502	/>
	7503
	7504	<value
	7505	code="5556 1003"
	7506	codeSystem ="2.16.840 .1.113883. 6.96"
	7507	codeSystem Name="SNOM ED CT"
	7508	displayNam e="Active"
	7509	xsi:type=" CD"
	7510	>
	7511
	7512	<originalT ext>
	7513	ACTIVE
	7514	</original Text>
	7515
	7516	<translati on/>
	7517
	7518	</value>
	7519
	7520	</observat ion>
	7521
	7522	</entryRel ationship>
	7523
	7524	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	7525
	7526	<entryRela tionship
	7527	inversionI nd="true"
	7528	typeCode=" MFST"
	7529	>
	7530
	7531	<act
	7532	classCode= "ACT"
	7533	moodCode=" EVN"
	7534	>
	7535
	7536	<templateI d
	7537	root="2.16 .840.1.113 883.10.20. 22.4.64"
	7538	/>
	7539
	7540	<code
	7541	code="4876 7-8"
	7542	codeSystem ="2.16.840 .1.113883. 6.1"
	7543	codeSystem Name="LOIN C"
	7544	displayNam e="Annotat ion commen t"
	7545	/>
	7546
	7547	<text>
	7548
	7549	<reference
	7550	value="#pn dComment10 01"
	7551	/>
	7552
	7553	</text>
	7554
	7555	</act>
	7556
	7557	</entryRel ationship>
	7558
	7559	</observat ion>
	7560
	7561	</entryRel ationship>
	7562
	7563	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	7564	via VA VistA RPC s -->
	7565
	7566	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	7567	availa ble via VA VistA RPC s -->
	7568
	7569	</act>
	7570
	7571	</entry>
	7572	<entry>
	7573
	7574	<act
	7575	classCode= "ACT"
	7576	moodCode=" EVN"
	7577	>
	7578
	7579	<templateI d
	7580	root="2.16 .840.1.113 883.10.20. 22.4.3"
	7581	/>
	7582
	7583	<id
	7584	nullFlavor ="NA"
	7585	/>
	7586
	7587	<code
	7588	code="CONC "
	7589	codeSystem ="2.16.840 .1.113883. 5.6"
	7590	codeSystem Name="HL7A ctClass"
	7591	displayNam e="Concern "
	7592	/>
	7593
	7594	<statusCod e
	7595	code="acti ve"
	7596	/>
	7597
	7598	<!-- 7.01 PROBLEM DA TE, R2 -->
	7599
	7600	<effective Time>
	7601
	7602	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	7603
	7604	<low
	7605	nullFlavor ="UNK"
	7606	/>
	7607
	7608	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	7609
	7610	<high
	7611	nullFlavor ="UNK"
	7612	/>
	7613
	7614	</effectiv eTime>
	7615
	7616	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	7617
	7618	<performer >
	7619
	7620	<assignedE ntity>
	7621
	7622	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	7623	HealthCare Provider Section -- >
	7624
	7625	<id
	7626	extension= "provider1 002"
	7627	root="2.16 .840.1.113 883.4.349"
	7628	/>
	7629
	7630	<assignedP erson>
	7631
	7632	<name/>
	7633
	7634	</assigned Person>
	7635
	7636	</assigned Entity>
	7637
	7638	</performe r>
	7639
	7640	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	7641
	7642	<author>
	7643
	7644	<time
	7645	nullFlavor ="NA"
	7646	/>
	7647
	7648	<assignedA uthor>
	7649
	7650	<id
	7651	nullFlavor ="NA"
	7652	/>
	7653
	7654	<represent edOrganiza tion>
	7655
	7656	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	7657	FA CILITY NBR -->
	7658
	7659	<id
	7660	extension= "552"
	7661	root="2.16 .840.1.113 883.4.349"
	7662	/>
	7663
	7664	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	7665
	7666	<name>
	7667	DAYTON
	7668	</name>
	7669
	7670	<telecom
	7671	nullFlavor ="NA"
	7672	/>
	7673
	7674	<addr
	7675	nullFlavor ="NA"
	7676	/>
	7677
	7678	</represen tedOrganiz ation>
	7679
	7680	</assigned Author>
	7681
	7682	</author>
	7683
	7684	<entryRela tionship
	7685	typeCode=" SUBJ"
	7686	>
	7687
	7688	<!-- CCD P roblem Obs ervation - ->
	7689
	7690	<observati on
	7691	classCode= "OBS"
	7692	moodCode=" EVN"
	7693	>
	7694
	7695	<templateI d
	7696	root="2.16 .840.1.113 883.10.20. 22.4.4"
	7697	/>
	7698
	7699	<id
	7700	nullFlavor ="NA"
	7701	/>
	7702
	7703	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	7704	b/c data n ot yet ava ilable via VA VistA RPCs -->
	7705
	7706	<code
	7707	codeSystem ="2.16.840 .1.113883. 6.96"
	7708	codeSystem Name="SNOM ED CT"
	7709	nullFlavor ="UNK"
	7710	>
	7711
	7712	<originalT ext>
	7713	Problem Ty pe Not Ava ilable
	7714	</original Text>
	7715
	7716	</code>
	7717
	7718	<!-- 7.03 PROBLEM NA ME, R2 -->
	7719
	7720	<text>
	7721
	7722	<reference
	7723	value="#pn dProblem10 02"
	7724	/>
	7725
	7726	</text>
	7727
	7728	<statusCod e
	7729	code="comp leted"
	7730	/>
	7731
	7732	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	7733	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	7734
	7735	<value
	7736	code="4421 76004"
	7737	codeSystem ="2.16.840 .1.113883. 6.96"
	7738	codeSystem Name="SNOM ED CT"
	7739	displayNam e="Sleep d ysfunction with arou sal distur bance (dis order)"
	7740	xsi:type=" CD"
	7741	>
	7742
	7743	<originalT ext>
	7744
	7745	<reference
	7746	value="#pn dProblem10 02"
	7747	/>
	7748
	7749	</original Text>
	7750
	7751	<translati on
	7752	code="307. 46"
	7753	codeSystem ="2.16.840 .1.113883. 6.103"
	7754	codeSystem Name="ICD- 9-CM"
	7755	/>
	7756
	7757	</value>
	7758
	7759	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	7760
	7761	<entryRela tionship
	7762	typeCode=" SUBJ"
	7763	>
	7764
	7765	<observati on
	7766	classCode= "OBS"
	7767	moodCode=" EVN"
	7768	>
	7769
	7770	<templateI d
	7771	root="2.16 .840.1.113 883.10.20. 22.4.6"
	7772	/>
	7773
	7774	<code
	7775	code="3399 9-4"
	7776	codeSystem ="2.16.840 .1.113883. 6.1"
	7777	codeSystem Name="LOIN C"
	7778	displayNam e="Status"
	7779	/>
	7780
	7781	<statusCod e
	7782	code="comp leted"
	7783	/>
	7784
	7785	<value
	7786	code="5556 1003"
	7787	codeSystem ="2.16.840 .1.113883. 6.96"
	7788	codeSystem Name="SNOM ED CT"
	7789	displayNam e="Active"
	7790	xsi:type=" CD"
	7791	>
	7792
	7793	<originalT ext>
	7794	ACTIVE
	7795	</original Text>
	7796
	7797	<translati on/>
	7798
	7799	</value>
	7800
	7801	</observat ion>
	7802
	7803	</entryRel ationship>
	7804
	7805	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	7806
	7807	<entryRela tionship
	7808	inversionI nd="true"
	7809	typeCode=" MFST"
	7810	>
	7811
	7812	<act
	7813	classCode= "ACT"
	7814	moodCode=" EVN"
	7815	>
	7816
	7817	<templateI d
	7818	root="2.16 .840.1.113 883.10.20. 22.4.64"
	7819	/>
	7820
	7821	<code
	7822	code="4876 7-8"
	7823	codeSystem ="2.16.840 .1.113883. 6.1"
	7824	codeSystem Name="LOIN C"
	7825	displayNam e="Annotat ion commen t"
	7826	/>
	7827
	7828	<text>
	7829
	7830	<reference
	7831	value="#pn dComment10 02"
	7832	/>
	7833
	7834	</text>
	7835
	7836	</act>
	7837
	7838	</entryRel ationship>
	7839
	7840	</observat ion>
	7841
	7842	</entryRel ationship>
	7843
	7844	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	7845	via VA VistA RPC s -->
	7846
	7847	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	7848	availa ble via VA VistA RPC s -->
	7849
	7850	</act>
	7851
	7852	</entry>
	7853	<entry>
	7854
	7855	<act
	7856	classCode= "ACT"
	7857	moodCode=" EVN"
	7858	>
	7859
	7860	<templateI d
	7861	root="2.16 .840.1.113 883.10.20. 22.4.3"
	7862	/>
	7863
	7864	<id
	7865	nullFlavor ="NA"
	7866	/>
	7867
	7868	<code
	7869	code="CONC "
	7870	codeSystem ="2.16.840 .1.113883. 5.6"
	7871	codeSystem Name="HL7A ctClass"
	7872	displayNam e="Concern "
	7873	/>
	7874
	7875	<statusCod e
	7876	code="acti ve"
	7877	/>
	7878
	7879	<!-- 7.01 PROBLEM DA TE, R2 -->
	7880
	7881	<effective Time>
	7882
	7883	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	7884
	7885	<low
	7886	value="201 20930"
	7887	/>
	7888
	7889	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	7890
	7891	<high
	7892	nullFlavor ="UNK"
	7893	/>
	7894
	7895	</effectiv eTime>
	7896
	7897	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	7898
	7899	<performer >
	7900
	7901	<assignedE ntity>
	7902
	7903	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	7904	HealthCare Provider Section -- >
	7905
	7906	<id
	7907	extension= "provider1 003"
	7908	root="2.16 .840.1.113 883.4.349"
	7909	/>
	7910
	7911	<assignedP erson>
	7912
	7913	<name/>
	7914
	7915	</assigned Person>
	7916
	7917	</assigned Entity>
	7918
	7919	</performe r>
	7920
	7921	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	7922
	7923	<author>
	7924
	7925	<time
	7926	nullFlavor ="NA"
	7927	/>
	7928
	7929	<assignedA uthor>
	7930
	7931	<id
	7932	nullFlavor ="NA"
	7933	/>
	7934
	7935	<represent edOrganiza tion>
	7936
	7937	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	7938	FA CILITY NBR -->
	7939
	7940	<id
	7941	extension= "552"
	7942	root="2.16 .840.1.113 883.4.349"
	7943	/>
	7944
	7945	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	7946
	7947	<name>
	7948	DAYTON
	7949	</name>
	7950
	7951	<telecom
	7952	nullFlavor ="NA"
	7953	/>
	7954
	7955	<addr
	7956	nullFlavor ="NA"
	7957	/>
	7958
	7959	</represen tedOrganiz ation>
	7960
	7961	</assigned Author>
	7962
	7963	</author>
	7964
	7965	<entryRela tionship
	7966	typeCode=" SUBJ"
	7967	>
	7968
	7969	<!-- CCD P roblem Obs ervation - ->
	7970
	7971	<observati on
	7972	classCode= "OBS"
	7973	moodCode=" EVN"
	7974	>
	7975
	7976	<templateI d
	7977	root="2.16 .840.1.113 883.10.20. 22.4.4"
	7978	/>
	7979
	7980	<id
	7981	nullFlavor ="NA"
	7982	/>
	7983
	7984	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	7985	b/c data n ot yet ava ilable via VA VistA RPCs -->
	7986
	7987	<code
	7988	codeSystem ="2.16.840 .1.113883. 6.96"
	7989	codeSystem Name="SNOM ED CT"
	7990	nullFlavor ="UNK"
	7991	>
	7992
	7993	<originalT ext>
	7994	Problem Ty pe Not Ava ilable
	7995	</original Text>
	7996
	7997	</code>
	7998
	7999	<!-- 7.03 PROBLEM NA ME, R2 -->
	8000
	8001	<text>
	8002
	8003	<reference
	8004	value="#pn dProblem10 03"
	8005	/>
	8006
	8007	</text>
	8008
	8009	<statusCod e
	8010	code="comp leted"
	8011	/>
	8012
	8013	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	8014	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	8015
	8016	<value
	8017	code="5275 6005"
	8018	codeSystem ="2.16.840 .1.113883. 6.96"
	8019	codeSystem Name="SNOM ED CT"
	8020	displayNam e="Nasal p olyp (diso rder)"
	8021	xsi:type=" CD"
	8022	>
	8023
	8024	<originalT ext>
	8025
	8026	<reference
	8027	value="#pn dProblem10 03"
	8028	/>
	8029
	8030	</original Text>
	8031
	8032	<translati on
	8033	code="471. 9"
	8034	codeSystem ="2.16.840 .1.113883. 6.103"
	8035	codeSystem Name="ICD- 9-CM"
	8036	/>
	8037
	8038	</value>
	8039
	8040	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	8041
	8042	<entryRela tionship
	8043	typeCode=" SUBJ"
	8044	>
	8045
	8046	<observati on
	8047	classCode= "OBS"
	8048	moodCode=" EVN"
	8049	>
	8050
	8051	<templateI d
	8052	root="2.16 .840.1.113 883.10.20. 22.4.6"
	8053	/>
	8054
	8055	<code
	8056	code="3399 9-4"
	8057	codeSystem ="2.16.840 .1.113883. 6.1"
	8058	codeSystem Name="LOIN C"
	8059	displayNam e="Status"
	8060	/>
	8061
	8062	<statusCod e
	8063	code="comp leted"
	8064	/>
	8065
	8066	<value
	8067	code="5556 1003"
	8068	codeSystem ="2.16.840 .1.113883. 6.96"
	8069	codeSystem Name="SNOM ED CT"
	8070	displayNam e="Active"
	8071	xsi:type=" CD"
	8072	>
	8073
	8074	<originalT ext>
	8075	ACTIVE
	8076	</original Text>
	8077
	8078	<translati on/>
	8079
	8080	</value>
	8081
	8082	</observat ion>
	8083
	8084	</entryRel ationship>
	8085
	8086	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	8087
	8088	<entryRela tionship
	8089	inversionI nd="true"
	8090	typeCode=" MFST"
	8091	>
	8092
	8093	<act
	8094	classCode= "ACT"
	8095	moodCode=" EVN"
	8096	>
	8097
	8098	<templateI d
	8099	root="2.16 .840.1.113 883.10.20. 22.4.64"
	8100	/>
	8101
	8102	<code
	8103	code="4876 7-8"
	8104	codeSystem ="2.16.840 .1.113883. 6.1"
	8105	codeSystem Name="LOIN C"
	8106	displayNam e="Annotat ion commen t"
	8107	/>
	8108
	8109	<text>
	8110
	8111	<reference
	8112	value="#pn dComment10 03"
	8113	/>
	8114
	8115	</text>
	8116
	8117	</act>
	8118
	8119	</entryRel ationship>
	8120
	8121	</observat ion>
	8122
	8123	</entryRel ationship>
	8124
	8125	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	8126	via VA VistA RPC s -->
	8127
	8128	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	8129	availa ble via VA VistA RPC s -->
	8130
	8131	</act>
	8132
	8133	</entry>
	8134	<entry>
	8135
	8136	<act
	8137	classCode= "ACT"
	8138	moodCode=" EVN"
	8139	>
	8140
	8141	<templateI d
	8142	root="2.16 .840.1.113 883.10.20. 22.4.3"
	8143	/>
	8144
	8145	<id
	8146	nullFlavor ="NA"
	8147	/>
	8148
	8149	<code
	8150	code="CONC "
	8151	codeSystem ="2.16.840 .1.113883. 5.6"
	8152	codeSystem Name="HL7A ctClass"
	8153	displayNam e="Concern "
	8154	/>
	8155
	8156	<statusCod e
	8157	code="acti ve"
	8158	/>
	8159
	8160	<!-- 7.01 PROBLEM DA TE, R2 -->
	8161
	8162	<effective Time>
	8163
	8164	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	8165
	8166	<low
	8167	value="201 21101"
	8168	/>
	8169
	8170	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	8171
	8172	<high
	8173	nullFlavor ="UNK"
	8174	/>
	8175
	8176	</effectiv eTime>
	8177
	8178	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	8179
	8180	<performer >
	8181
	8182	<assignedE ntity>
	8183
	8184	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	8185	HealthCare Provider Section -- >
	8186
	8187	<id
	8188	extension= "provider1 004"
	8189	root="2.16 .840.1.113 883.4.349"
	8190	/>
	8191
	8192	<assignedP erson>
	8193
	8194	<name/>
	8195
	8196	</assigned Person>
	8197
	8198	</assigned Entity>
	8199
	8200	</performe r>
	8201
	8202	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	8203
	8204	<author>
	8205
	8206	<time
	8207	nullFlavor ="NA"
	8208	/>
	8209
	8210	<assignedA uthor>
	8211
	8212	<id
	8213	nullFlavor ="NA"
	8214	/>
	8215
	8216	<represent edOrganiza tion>
	8217
	8218	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	8219	FA CILITY NBR -->
	8220
	8221	<id
	8222	extension= "552"
	8223	root="2.16 .840.1.113 883.4.349"
	8224	/>
	8225
	8226	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	8227
	8228	<name>
	8229	DAYTON
	8230	</name>
	8231
	8232	<telecom
	8233	nullFlavor ="NA"
	8234	/>
	8235
	8236	<addr
	8237	nullFlavor ="NA"
	8238	/>
	8239
	8240	</represen tedOrganiz ation>
	8241
	8242	</assigned Author>
	8243
	8244	</author>
	8245
	8246	<entryRela tionship
	8247	typeCode=" SUBJ"
	8248	>
	8249
	8250	<!-- CCD P roblem Obs ervation - ->
	8251
	8252	<observati on
	8253	classCode= "OBS"
	8254	moodCode=" EVN"
	8255	>
	8256
	8257	<templateI d
	8258	root="2.16 .840.1.113 883.10.20. 22.4.4"
	8259	/>
	8260
	8261	<id
	8262	nullFlavor ="NA"
	8263	/>
	8264
	8265	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	8266	b/c data n ot yet ava ilable via VA VistA RPCs -->
	8267
	8268	<code
	8269	codeSystem ="2.16.840 .1.113883. 6.96"
	8270	codeSystem Name="SNOM ED CT"
	8271	nullFlavor ="UNK"
	8272	>
	8273
	8274	<originalT ext>
	8275	Problem Ty pe Not Ava ilable
	8276	</original Text>
	8277
	8278	</code>
	8279
	8280	<!-- 7.03 PROBLEM NA ME, R2 -->
	8281
	8282	<text>
	8283
	8284	<reference
	8285	value="#pn dProblem10 04"
	8286	/>
	8287
	8288	</text>
	8289
	8290	<statusCod e
	8291	code="comp leted"
	8292	/>
	8293
	8294	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	8295	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	8296
	8297	<value
	8298	codeSystem ="2.16.840 .1.113883. 6.96"
	8299	codeSystem Name="SNOM ED CT"
	8300	nullFlavor ="UNK"
	8301	xsi:type=" CD"
	8302	>
	8303
	8304	<originalT ext>
	8305
	8306	<reference
	8307	value="#pn dProblem10 04"
	8308	/>
	8309
	8310	</original Text>
	8311
	8312	<translati on
	8313	code="799. 9"
	8314	codeSystem ="2.16.840 .1.113883. 6.103"
	8315	codeSystem Name="ICD- 9-CM"
	8316	/>
	8317
	8318	</value>
	8319
	8320	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	8321
	8322	<entryRela tionship
	8323	typeCode=" SUBJ"
	8324	>
	8325
	8326	<observati on
	8327	classCode= "OBS"
	8328	moodCode=" EVN"
	8329	>
	8330
	8331	<templateI d
	8332	root="2.16 .840.1.113 883.10.20. 22.4.6"
	8333	/>
	8334
	8335	<code
	8336	code="3399 9-4"
	8337	codeSystem ="2.16.840 .1.113883. 6.1"
	8338	codeSystem Name="LOIN C"
	8339	displayNam e="Status"
	8340	/>
	8341
	8342	<statusCod e
	8343	code="comp leted"
	8344	/>
	8345
	8346	<value
	8347	code="5556 1003"
	8348	codeSystem ="2.16.840 .1.113883. 6.96"
	8349	codeSystem Name="SNOM ED CT"
	8350	displayNam e="Active"
	8351	xsi:type=" CD"
	8352	>
	8353
	8354	<originalT ext>
	8355	ACTIVE
	8356	</original Text>
	8357
	8358	<translati on/>
	8359
	8360	</value>
	8361
	8362	</observat ion>
	8363
	8364	</entryRel ationship>
	8365
	8366	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	8367
	8368	<entryRela tionship
	8369	inversionI nd="true"
	8370	typeCode=" MFST"
	8371	>
	8372
	8373	<act
	8374	classCode= "ACT"
	8375	moodCode=" EVN"
	8376	>
	8377
	8378	<templateI d
	8379	root="2.16 .840.1.113 883.10.20. 22.4.64"
	8380	/>
	8381
	8382	<code
	8383	code="4876 7-8"
	8384	codeSystem ="2.16.840 .1.113883. 6.1"
	8385	codeSystem Name="LOIN C"
	8386	displayNam e="Annotat ion commen t"
	8387	/>
	8388
	8389	<text>
	8390
	8391	<reference
	8392	value="#pn dComment10 04"
	8393	/>
	8394
	8395	</text>
	8396
	8397	</act>
	8398
	8399	</entryRel ationship>
	8400
	8401	</observat ion>
	8402
	8403	</entryRel ationship>
	8404
	8405	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	8406	via VA VistA RPC s -->
	8407
	8408	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	8409	availa ble via VA VistA RPC s -->
	8410
	8411	</act>
	8412
	8413	</entry>
	8414	<entry>
	8415
	8416	<act
	8417	classCode= "ACT"
	8418	moodCode=" EVN"
	8419	>
	8420
	8421	<templateI d
	8422	root="2.16 .840.1.113 883.10.20. 22.4.3"
	8423	/>
	8424
	8425	<id
	8426	nullFlavor ="NA"
	8427	/>
	8428
	8429	<code
	8430	code="CONC "
	8431	codeSystem ="2.16.840 .1.113883. 5.6"
	8432	codeSystem Name="HL7A ctClass"
	8433	displayNam e="Concern "
	8434	/>
	8435
	8436	<statusCod e
	8437	code="acti ve"
	8438	/>
	8439
	8440	<!-- 7.01 PROBLEM DA TE, R2 -->
	8441
	8442	<effective Time>
	8443
	8444	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	8445
	8446	<low
	8447	nullFlavor ="UNK"
	8448	/>
	8449
	8450	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	8451
	8452	<high
	8453	nullFlavor ="UNK"
	8454	/>
	8455
	8456	</effectiv eTime>
	8457
	8458	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	8459
	8460	<performer >
	8461
	8462	<assignedE ntity>
	8463
	8464	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	8465	HealthCare Provider Section -- >
	8466
	8467	<id
	8468	extension= "provider1 005"
	8469	root="2.16 .840.1.113 883.4.349"
	8470	/>
	8471
	8472	<assignedP erson>
	8473
	8474	<name/>
	8475
	8476	</assigned Person>
	8477
	8478	</assigned Entity>
	8479
	8480	</performe r>
	8481
	8482	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	8483
	8484	<author>
	8485
	8486	<time
	8487	nullFlavor ="NA"
	8488	/>
	8489
	8490	<assignedA uthor>
	8491
	8492	<id
	8493	nullFlavor ="NA"
	8494	/>
	8495
	8496	<represent edOrganiza tion>
	8497
	8498	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	8499	FA CILITY NBR -->
	8500
	8501	<id
	8502	extension= "552"
	8503	root="2.16 .840.1.113 883.4.349"
	8504	/>
	8505
	8506	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	8507
	8508	<name>
	8509	DAYTON
	8510	</name>
	8511
	8512	<telecom
	8513	nullFlavor ="NA"
	8514	/>
	8515
	8516	<addr
	8517	nullFlavor ="NA"
	8518	/>
	8519
	8520	</represen tedOrganiz ation>
	8521
	8522	</assigned Author>
	8523
	8524	</author>
	8525
	8526	<entryRela tionship
	8527	typeCode=" SUBJ"
	8528	>
	8529
	8530	<!-- CCD P roblem Obs ervation - ->
	8531
	8532	<observati on
	8533	classCode= "OBS"
	8534	moodCode=" EVN"
	8535	>
	8536
	8537	<templateI d
	8538	root="2.16 .840.1.113 883.10.20. 22.4.4"
	8539	/>
	8540
	8541	<id
	8542	nullFlavor ="NA"
	8543	/>
	8544
	8545	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	8546	b/c data n ot yet ava ilable via VA VistA RPCs -->
	8547
	8548	<code
	8549	codeSystem ="2.16.840 .1.113883. 6.96"
	8550	codeSystem Name="SNOM ED CT"
	8551	nullFlavor ="UNK"
	8552	>
	8553
	8554	<originalT ext>
	8555	Problem Ty pe Not Ava ilable
	8556	</original Text>
	8557
	8558	</code>
	8559
	8560	<!-- 7.03 PROBLEM NA ME, R2 -->
	8561
	8562	<text>
	8563
	8564	<reference
	8565	value="#pn dProblem10 05"
	8566	/>
	8567
	8568	</text>
	8569
	8570	<statusCod e
	8571	code="comp leted"
	8572	/>
	8573
	8574	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	8575	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	8576
	8577	<value
	8578	code="8411 4007"
	8579	codeSystem ="2.16.840 .1.113883. 6.96"
	8580	codeSystem Name="SNOM ED CT"
	8581	displayNam e="Heart f ailure (di sorder)"
	8582	xsi:type=" CD"
	8583	>
	8584
	8585	<originalT ext>
	8586
	8587	<reference
	8588	value="#pn dProblem10 05"
	8589	/>
	8590
	8591	</original Text>
	8592
	8593	<translati on
	8594	code="428. 9"
	8595	codeSystem ="2.16.840 .1.113883. 6.103"
	8596	codeSystem Name="ICD- 9-CM"
	8597	/>
	8598
	8599	</value>
	8600
	8601	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	8602
	8603	<entryRela tionship
	8604	typeCode=" SUBJ"
	8605	>
	8606
	8607	<observati on
	8608	classCode= "OBS"
	8609	moodCode=" EVN"
	8610	>
	8611
	8612	<templateI d
	8613	root="2.16 .840.1.113 883.10.20. 22.4.6"
	8614	/>
	8615
	8616	<code
	8617	code="3399 9-4"
	8618	codeSystem ="2.16.840 .1.113883. 6.1"
	8619	codeSystem Name="LOIN C"
	8620	displayNam e="Status"
	8621	/>
	8622
	8623	<statusCod e
	8624	code="comp leted"
	8625	/>
	8626
	8627	<value
	8628	code="5556 1003"
	8629	codeSystem ="2.16.840 .1.113883. 6.96"
	8630	codeSystem Name="SNOM ED CT"
	8631	displayNam e="Active"
	8632	xsi:type=" CD"
	8633	>
	8634
	8635	<originalT ext>
	8636	ACTIVE
	8637	</original Text>
	8638
	8639	<translati on/>
	8640
	8641	</value>
	8642
	8643	</observat ion>
	8644
	8645	</entryRel ationship>
	8646
	8647	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	8648
	8649	<entryRela tionship
	8650	inversionI nd="true"
	8651	typeCode=" MFST"
	8652	>
	8653
	8654	<act
	8655	classCode= "ACT"
	8656	moodCode=" EVN"
	8657	>
	8658
	8659	<templateI d
	8660	root="2.16 .840.1.113 883.10.20. 22.4.64"
	8661	/>
	8662
	8663	<code
	8664	code="4876 7-8"
	8665	codeSystem ="2.16.840 .1.113883. 6.1"
	8666	codeSystem Name="LOIN C"
	8667	displayNam e="Annotat ion commen t"
	8668	/>
	8669
	8670	<text>
	8671
	8672	<reference
	8673	value="#pn dComment10 05"
	8674	/>
	8675
	8676	</text>
	8677
	8678	</act>
	8679
	8680	</entryRel ationship>
	8681
	8682	</observat ion>
	8683
	8684	</entryRel ationship>
	8685
	8686	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	8687	via VA VistA RPC s -->
	8688
	8689	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	8690	availa ble via VA VistA RPC s -->
	8691
	8692	</act>
	8693
	8694	</entry>
	8695	<entry>
	8696
	8697	<act
	8698	classCode= "ACT"
	8699	moodCode=" EVN"
	8700	>
	8701
	8702	<templateI d
	8703	root="2.16 .840.1.113 883.10.20. 22.4.3"
	8704	/>
	8705
	8706	<id
	8707	nullFlavor ="NA"
	8708	/>
	8709
	8710	<code
	8711	code="CONC "
	8712	codeSystem ="2.16.840 .1.113883. 5.6"
	8713	codeSystem Name="HL7A ctClass"
	8714	displayNam e="Concern "
	8715	/>
	8716
	8717	<statusCod e
	8718	code="acti ve"
	8719	/>
	8720
	8721	<!-- 7.01 PROBLEM DA TE, R2 -->
	8722
	8723	<effective Time>
	8724
	8725	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	8726
	8727	<low
	8728	nullFlavor ="UNK"
	8729	/>
	8730
	8731	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	8732
	8733	<high
	8734	nullFlavor ="UNK"
	8735	/>
	8736
	8737	</effectiv eTime>
	8738
	8739	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	8740
	8741	<performer >
	8742
	8743	<assignedE ntity>
	8744
	8745	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	8746	HealthCare Provider Section -- >
	8747
	8748	<id
	8749	extension= "provider1 006"
	8750	root="2.16 .840.1.113 883.4.349"
	8751	/>
	8752
	8753	<assignedP erson>
	8754
	8755	<name/>
	8756
	8757	</assigned Person>
	8758
	8759	</assigned Entity>
	8760
	8761	</performe r>
	8762
	8763	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	8764
	8765	<author>
	8766
	8767	<time
	8768	nullFlavor ="NA"
	8769	/>
	8770
	8771	<assignedA uthor>
	8772
	8773	<id
	8774	nullFlavor ="NA"
	8775	/>
	8776
	8777	<represent edOrganiza tion>
	8778
	8779	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	8780	FA CILITY NBR -->
	8781
	8782	<id
	8783	extension= "552"
	8784	root="2.16 .840.1.113 883.4.349"
	8785	/>
	8786
	8787	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	8788
	8789	<name>
	8790	DAYTON
	8791	</name>
	8792
	8793	<telecom
	8794	nullFlavor ="NA"
	8795	/>
	8796
	8797	<addr
	8798	nullFlavor ="NA"
	8799	/>
	8800
	8801	</represen tedOrganiz ation>
	8802
	8803	</assigned Author>
	8804
	8805	</author>
	8806
	8807	<entryRela tionship
	8808	typeCode=" SUBJ"
	8809	>
	8810
	8811	<!-- CCD P roblem Obs ervation - ->
	8812
	8813	<observati on
	8814	classCode= "OBS"
	8815	moodCode=" EVN"
	8816	>
	8817
	8818	<templateI d
	8819	root="2.16 .840.1.113 883.10.20. 22.4.4"
	8820	/>
	8821
	8822	<id
	8823	nullFlavor ="NA"
	8824	/>
	8825
	8826	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	8827	b/c data n ot yet ava ilable via VA VistA RPCs -->
	8828
	8829	<code
	8830	codeSystem ="2.16.840 .1.113883. 6.96"
	8831	codeSystem Name="SNOM ED CT"
	8832	nullFlavor ="UNK"
	8833	>
	8834
	8835	<originalT ext>
	8836	Problem Ty pe Not Ava ilable
	8837	</original Text>
	8838
	8839	</code>
	8840
	8841	<!-- 7.03 PROBLEM NA ME, R2 -->
	8842
	8843	<text>
	8844
	8845	<reference
	8846	value="#pn dProblem10 06"
	8847	/>
	8848
	8849	</text>
	8850
	8851	<statusCod e
	8852	code="comp leted"
	8853	/>
	8854
	8855	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	8856	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	8857
	8858	<value
	8859	code="4750 5003"
	8860	codeSystem ="2.16.840 .1.113883. 6.96"
	8861	codeSystem Name="SNOM ED CT"
	8862	displayNam e="Posttra umatic str ess disord er (disord er)"
	8863	xsi:type=" CD"
	8864	>
	8865
	8866	<originalT ext>
	8867
	8868	<reference
	8869	value="#pn dProblem10 06"
	8870	/>
	8871
	8872	</original Text>
	8873
	8874	<translati on
	8875	code="309. 81"
	8876	codeSystem ="2.16.840 .1.113883. 6.103"
	8877	codeSystem Name="ICD- 9-CM"
	8878	/>
	8879
	8880	</value>
	8881
	8882	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	8883
	8884	<entryRela tionship
	8885	typeCode=" SUBJ"
	8886	>
	8887
	8888	<observati on
	8889	classCode= "OBS"
	8890	moodCode=" EVN"
	8891	>
	8892
	8893	<templateI d
	8894	root="2.16 .840.1.113 883.10.20. 22.4.6"
	8895	/>
	8896
	8897	<code
	8898	code="3399 9-4"
	8899	codeSystem ="2.16.840 .1.113883. 6.1"
	8900	codeSystem Name="LOIN C"
	8901	displayNam e="Status"
	8902	/>
	8903
	8904	<statusCod e
	8905	code="comp leted"
	8906	/>
	8907
	8908	<value
	8909	code="5556 1003"
	8910	codeSystem ="2.16.840 .1.113883. 6.96"
	8911	codeSystem Name="SNOM ED CT"
	8912	displayNam e="Active"
	8913	xsi:type=" CD"
	8914	>
	8915
	8916	<originalT ext>
	8917	ACTIVE
	8918	</original Text>
	8919
	8920	<translati on/>
	8921
	8922	</value>
	8923
	8924	</observat ion>
	8925
	8926	</entryRel ationship>
	8927
	8928	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	8929
	8930	<entryRela tionship
	8931	inversionI nd="true"
	8932	typeCode=" MFST"
	8933	>
	8934
	8935	<act
	8936	classCode= "ACT"
	8937	moodCode=" EVN"
	8938	>
	8939
	8940	<templateI d
	8941	root="2.16 .840.1.113 883.10.20. 22.4.64"
	8942	/>
	8943
	8944	<code
	8945	code="4876 7-8"
	8946	codeSystem ="2.16.840 .1.113883. 6.1"
	8947	codeSystem Name="LOIN C"
	8948	displayNam e="Annotat ion commen t"
	8949	/>
	8950
	8951	<text>
	8952
	8953	<reference
	8954	value="#pn dComment10 06"
	8955	/>
	8956
	8957	</text>
	8958
	8959	</act>
	8960
	8961	</entryRel ationship>
	8962
	8963	</observat ion>
	8964
	8965	</entryRel ationship>
	8966
	8967	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	8968	via VA VistA RPC s -->
	8969
	8970	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	8971	availa ble via VA VistA RPC s -->
	8972
	8973	</act>
	8974
	8975	</entry>
	8976	<entry>
	8977
	8978	<act
	8979	classCode= "ACT"
	8980	moodCode=" EVN"
	8981	>
	8982
	8983	<templateI d
	8984	root="2.16 .840.1.113 883.10.20. 22.4.3"
	8985	/>
	8986
	8987	<id
	8988	nullFlavor ="NA"
	8989	/>
	8990
	8991	<code
	8992	code="CONC "
	8993	codeSystem ="2.16.840 .1.113883. 5.6"
	8994	codeSystem Name="HL7A ctClass"
	8995	displayNam e="Concern "
	8996	/>
	8997
	8998	<statusCod e
	8999	code="acti ve"
	9000	/>
	9001
	9002	<!-- 7.01 PROBLEM DA TE, R2 -->
	9003
	9004	<effective Time>
	9005
	9006	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	9007
	9008	<low
	9009	value="201 61202"
	9010	/>
	9011
	9012	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	9013
	9014	<high
	9015	nullFlavor ="UNK"
	9016	/>
	9017
	9018	</effectiv eTime>
	9019
	9020	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	9021
	9022	<performer >
	9023
	9024	<assignedE ntity>
	9025
	9026	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	9027	HealthCare Provider Section -- >
	9028
	9029	<id
	9030	extension= "provider1 007"
	9031	root="2.16 .840.1.113 883.4.349"
	9032	/>
	9033
	9034	<assignedP erson>
	9035
	9036	<name/>
	9037
	9038	</assigned Person>
	9039
	9040	</assigned Entity>
	9041
	9042	</performe r>
	9043
	9044	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	9045
	9046	<author>
	9047
	9048	<time
	9049	nullFlavor ="NA"
	9050	/>
	9051
	9052	<assignedA uthor>
	9053
	9054	<id
	9055	nullFlavor ="NA"
	9056	/>
	9057
	9058	<represent edOrganiza tion>
	9059
	9060	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	9061	FA CILITY NBR -->
	9062
	9063	<id
	9064	extension= "983"
	9065	root="2.16 .840.1.113 883.4.349"
	9066	/>
	9067
	9068	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	9069
	9070	<name>
	9071	CHYSHR TES T LAB
	9072	</name>
	9073
	9074	<telecom
	9075	nullFlavor ="NA"
	9076	/>
	9077
	9078	<addr
	9079	nullFlavor ="NA"
	9080	/>
	9081
	9082	</represen tedOrganiz ation>
	9083
	9084	</assigned Author>
	9085
	9086	</author>
	9087
	9088	<entryRela tionship
	9089	typeCode=" SUBJ"
	9090	>
	9091
	9092	<!-- CCD P roblem Obs ervation - ->
	9093
	9094	<observati on
	9095	classCode= "OBS"
	9096	moodCode=" EVN"
	9097	>
	9098
	9099	<templateI d
	9100	root="2.16 .840.1.113 883.10.20. 22.4.4"
	9101	/>
	9102
	9103	<id
	9104	nullFlavor ="NA"
	9105	/>
	9106
	9107	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	9108	b/c data n ot yet ava ilable via VA VistA RPCs -->
	9109
	9110	<code
	9111	codeSystem ="2.16.840 .1.113883. 6.96"
	9112	codeSystem Name="SNOM ED CT"
	9113	nullFlavor ="UNK"
	9114	>
	9115
	9116	<originalT ext>
	9117	Problem Ty pe Not Ava ilable
	9118	</original Text>
	9119
	9120	</code>
	9121
	9122	<!-- 7.03 PROBLEM NA ME, R2 -->
	9123
	9124	<text>
	9125
	9126	<reference
	9127	value="#pn dProblem10 07"
	9128	/>
	9129
	9130	</text>
	9131
	9132	<statusCod e
	9133	code="comp leted"
	9134	/>
	9135
	9136	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	9137	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	9138
	9139	<value
	9140	code="2741 62005"
	9141	codeSystem ="2.16.840 .1.113883. 6.96"
	9142	codeSystem Name="SNOM ED CT"
	9143	displayNam e="Thoraci c back spr ain"
	9144	xsi:type=" CD"
	9145	>
	9146
	9147	<originalT ext>
	9148
	9149	<reference
	9150	value="#pn dProblem10 07"
	9151	/>
	9152
	9153	</original Text>
	9154
	9155
	9156	</value>
	9157
	9158	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	9159
	9160	<entryRela tionship
	9161	typeCode=" SUBJ"
	9162	>
	9163
	9164	<observati on
	9165	classCode= "OBS"
	9166	moodCode=" EVN"
	9167	>
	9168
	9169	<templateI d
	9170	root="2.16 .840.1.113 883.10.20. 22.4.6"
	9171	/>
	9172
	9173	<code
	9174	code="3399 9-4"
	9175	codeSystem ="2.16.840 .1.113883. 6.1"
	9176	codeSystem Name="LOIN C"
	9177	displayNam e="Status"
	9178	/>
	9179
	9180	<statusCod e
	9181	code="comp leted"
	9182	/>
	9183
	9184	<value
	9185	code="5556 1003"
	9186	codeSystem ="2.16.840 .1.113883. 6.96"
	9187	codeSystem Name="SNOM ED CT"
	9188	displayNam e="Active"
	9189	xsi:type=" CD"
	9190	>
	9191
	9192	<originalT ext>
	9193	ACTIVE
	9194	</original Text>
	9195
	9196	<translati on/>
	9197
	9198	</value>
	9199
	9200	</observat ion>
	9201
	9202	</entryRel ationship>
	9203
	9204	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	9205
	9206	<entryRela tionship
	9207	inversionI nd="true"
	9208	typeCode=" MFST"
	9209	>
	9210
	9211	<act
	9212	classCode= "ACT"
	9213	moodCode=" EVN"
	9214	>
	9215
	9216	<templateI d
	9217	root="2.16 .840.1.113 883.10.20. 22.4.64"
	9218	/>
	9219
	9220	<code
	9221	code="4876 7-8"
	9222	codeSystem ="2.16.840 .1.113883. 6.1"
	9223	codeSystem Name="LOIN C"
	9224	displayNam e="Annotat ion commen t"
	9225	/>
	9226
	9227	<text>
	9228
	9229	<reference
	9230	value="#pn dComment10 07"
	9231	/>
	9232
	9233	</text>
	9234
	9235	</act>
	9236
	9237	</entryRel ationship>
	9238
	9239	</observat ion>
	9240
	9241	</entryRel ationship>
	9242
	9243	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	9244	via VA VistA RPC s -->
	9245
	9246	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	9247	availa ble via VA VistA RPC s -->
	9248
	9249	</act>
	9250
	9251	</entry>
	9252	<entry>
	9253
	9254	<act
	9255	classCode= "ACT"
	9256	moodCode=" EVN"
	9257	>
	9258
	9259	<templateI d
	9260	root="2.16 .840.1.113 883.10.20. 22.4.3"
	9261	/>
	9262
	9263	<id
	9264	nullFlavor ="NA"
	9265	/>
	9266
	9267	<code
	9268	code="CONC "
	9269	codeSystem ="2.16.840 .1.113883. 5.6"
	9270	codeSystem Name="HL7A ctClass"
	9271	displayNam e="Concern "
	9272	/>
	9273
	9274	<statusCod e
	9275	code="acti ve"
	9276	/>
	9277
	9278	<!-- 7.01 PROBLEM DA TE, R2 -->
	9279
	9280	<effective Time>
	9281
	9282	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	9283
	9284	<low
	9285	value="201 61202"
	9286	/>
	9287
	9288	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	9289
	9290	<high
	9291	nullFlavor ="UNK"
	9292	/>
	9293
	9294	</effectiv eTime>
	9295
	9296	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	9297
	9298	<performer >
	9299
	9300	<assignedE ntity>
	9301
	9302	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	9303	HealthCare Provider Section -- >
	9304
	9305	<id
	9306	extension= "provider1 008"
	9307	root="2.16 .840.1.113 883.4.349"
	9308	/>
	9309
	9310	<assignedP erson>
	9311
	9312	<name/>
	9313
	9314	</assigned Person>
	9315
	9316	</assigned Entity>
	9317
	9318	</performe r>
	9319
	9320	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	9321
	9322	<author>
	9323
	9324	<time
	9325	nullFlavor ="NA"
	9326	/>
	9327
	9328	<assignedA uthor>
	9329
	9330	<id
	9331	nullFlavor ="NA"
	9332	/>
	9333
	9334	<represent edOrganiza tion>
	9335
	9336	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	9337	FA CILITY NBR -->
	9338
	9339	<id
	9340	extension= "983"
	9341	root="2.16 .840.1.113 883.4.349"
	9342	/>
	9343
	9344	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	9345
	9346	<name>
	9347	CHYSHR TES T LAB
	9348	</name>
	9349
	9350	<telecom
	9351	nullFlavor ="NA"
	9352	/>
	9353
	9354	<addr
	9355	nullFlavor ="NA"
	9356	/>
	9357
	9358	</represen tedOrganiz ation>
	9359
	9360	</assigned Author>
	9361
	9362	</author>
	9363
	9364	<entryRela tionship
	9365	typeCode=" SUBJ"
	9366	>
	9367
	9368	<!-- CCD P roblem Obs ervation - ->
	9369
	9370	<observati on
	9371	classCode= "OBS"
	9372	moodCode=" EVN"
	9373	>
	9374
	9375	<templateI d
	9376	root="2.16 .840.1.113 883.10.20. 22.4.4"
	9377	/>
	9378
	9379	<id
	9380	nullFlavor ="NA"
	9381	/>
	9382
	9383	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	9384	b/c data n ot yet ava ilable via VA VistA RPCs -->
	9385
	9386	<code
	9387	codeSystem ="2.16.840 .1.113883. 6.96"
	9388	codeSystem Name="SNOM ED CT"
	9389	nullFlavor ="UNK"
	9390	>
	9391
	9392	<originalT ext>
	9393	Problem Ty pe Not Ava ilable
	9394	</original Text>
	9395
	9396	</code>
	9397
	9398	<!-- 7.03 PROBLEM NA ME, R2 -->
	9399
	9400	<text>
	9401
	9402	<reference
	9403	value="#pn dProblem10 08"
	9404	/>
	9405
	9406	</text>
	9407
	9408	<statusCod e
	9409	code="comp leted"
	9410	/>
	9411
	9412	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	9413	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	9414
	9415	<value
	9416	code="2716 81002"
	9417	codeSystem ="2.16.840 .1.113883. 6.96"
	9418	codeSystem Name="SNOM ED CT"
	9419	displayNam e="Stomach ache"
	9420	xsi:type=" CD"
	9421	>
	9422
	9423	<originalT ext>
	9424
	9425	<reference
	9426	value="#pn dProblem10 08"
	9427	/>
	9428
	9429	</original Text>
	9430
	9431
	9432	</value>
	9433
	9434	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	9435
	9436	<entryRela tionship
	9437	typeCode=" SUBJ"
	9438	>
	9439
	9440	<observati on
	9441	classCode= "OBS"
	9442	moodCode=" EVN"
	9443	>
	9444
	9445	<templateI d
	9446	root="2.16 .840.1.113 883.10.20. 22.4.6"
	9447	/>
	9448
	9449	<code
	9450	code="3399 9-4"
	9451	codeSystem ="2.16.840 .1.113883. 6.1"
	9452	codeSystem Name="LOIN C"
	9453	displayNam e="Status"
	9454	/>
	9455
	9456	<statusCod e
	9457	code="comp leted"
	9458	/>
	9459
	9460	<value
	9461	code="5556 1003"
	9462	codeSystem ="2.16.840 .1.113883. 6.96"
	9463	codeSystem Name="SNOM ED CT"
	9464	displayNam e="Active"
	9465	xsi:type=" CD"
	9466	>
	9467
	9468	<originalT ext>
	9469	ACTIVE
	9470	</original Text>
	9471
	9472	<translati on/>
	9473
	9474	</value>
	9475
	9476	</observat ion>
	9477
	9478	</entryRel ationship>
	9479
	9480	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	9481
	9482	<entryRela tionship
	9483	inversionI nd="true"
	9484	typeCode=" MFST"
	9485	>
	9486
	9487	<act
	9488	classCode= "ACT"
	9489	moodCode=" EVN"
	9490	>
	9491
	9492	<templateI d
	9493	root="2.16 .840.1.113 883.10.20. 22.4.64"
	9494	/>
	9495
	9496	<code
	9497	code="4876 7-8"
	9498	codeSystem ="2.16.840 .1.113883. 6.1"
	9499	codeSystem Name="LOIN C"
	9500	displayNam e="Annotat ion commen t"
	9501	/>
	9502
	9503	<text>
	9504
	9505	<reference
	9506	value="#pn dComment10 08"
	9507	/>
	9508
	9509	</text>
	9510
	9511	</act>
	9512
	9513	</entryRel ationship>
	9514
	9515	</observat ion>
	9516
	9517	</entryRel ationship>
	9518
	9519	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	9520	via VA VistA RPC s -->
	9521
	9522	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	9523	availa ble via VA VistA RPC s -->
	9524
	9525	</act>
	9526
	9527	</entry>
	9528	<entry>
	9529
	9530	<act
	9531	classCode= "ACT"
	9532	moodCode=" EVN"
	9533	>
	9534
	9535	<templateI d
	9536	root="2.16 .840.1.113 883.10.20. 22.4.3"
	9537	/>
	9538
	9539	<id
	9540	nullFlavor ="NA"
	9541	/>
	9542
	9543	<code
	9544	code="CONC "
	9545	codeSystem ="2.16.840 .1.113883. 5.6"
	9546	codeSystem Name="HL7A ctClass"
	9547	displayNam e="Concern "
	9548	/>
	9549
	9550	<statusCod e
	9551	code="acti ve"
	9552	/>
	9553
	9554	<!-- 7.01 PROBLEM DA TE, R2 -->
	9555
	9556	<effective Time>
	9557
	9558	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	9559
	9560	<low
	9561	value="201 40101"
	9562	/>
	9563
	9564	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	9565
	9566	<high
	9567	nullFlavor ="UNK"
	9568	/>
	9569
	9570	</effectiv eTime>
	9571
	9572	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	9573
	9574	<performer >
	9575
	9576	<assignedE ntity>
	9577
	9578	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	9579	HealthCare Provider Section -- >
	9580
	9581	<id
	9582	extension= "provider1 009"
	9583	root="2.16 .840.1.113 883.4.349"
	9584	/>
	9585
	9586	<assignedP erson>
	9587
	9588	<name/>
	9589
	9590	</assigned Person>
	9591
	9592	</assigned Entity>
	9593
	9594	</performe r>
	9595
	9596	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	9597
	9598	<author>
	9599
	9600	<time
	9601	nullFlavor ="NA"
	9602	/>
	9603
	9604	<assignedA uthor>
	9605
	9606	<id
	9607	nullFlavor ="NA"
	9608	/>
	9609
	9610	<represent edOrganiza tion>
	9611
	9612	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	9613	FA CILITY NBR -->
	9614
	9615	<id
	9616	extension= "983"
	9617	root="2.16 .840.1.113 883.4.349"
	9618	/>
	9619
	9620	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	9621
	9622	<name>
	9623	CHYSHR TES T LAB
	9624	</name>
	9625
	9626	<telecom
	9627	nullFlavor ="NA"
	9628	/>
	9629
	9630	<addr
	9631	nullFlavor ="NA"
	9632	/>
	9633
	9634	</represen tedOrganiz ation>
	9635
	9636	</assigned Author>
	9637
	9638	</author>
	9639
	9640	<entryRela tionship
	9641	typeCode=" SUBJ"
	9642	>
	9643
	9644	<!-- CCD P roblem Obs ervation - ->
	9645
	9646	<observati on
	9647	classCode= "OBS"
	9648	moodCode=" EVN"
	9649	>
	9650
	9651	<templateI d
	9652	root="2.16 .840.1.113 883.10.20. 22.4.4"
	9653	/>
	9654
	9655	<id
	9656	nullFlavor ="NA"
	9657	/>
	9658
	9659	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	9660	b/c data n ot yet ava ilable via VA VistA RPCs -->
	9661
	9662	<code
	9663	codeSystem ="2.16.840 .1.113883. 6.96"
	9664	codeSystem Name="SNOM ED CT"
	9665	nullFlavor ="UNK"
	9666	>
	9667
	9668	<originalT ext>
	9669	Problem Ty pe Not Ava ilable
	9670	</original Text>
	9671
	9672	</code>
	9673
	9674	<!-- 7.03 PROBLEM NA ME, R2 -->
	9675
	9676	<text>
	9677
	9678	<reference
	9679	value="#pn dProblem10 09"
	9680	/>
	9681
	9682	</text>
	9683
	9684	<statusCod e
	9685	code="comp leted"
	9686	/>
	9687
	9688	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	9689	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	9690
	9691	<value
	9692	code="1618 91005"
	9693	codeSystem ="2.16.840 .1.113883. 6.96"
	9694	codeSystem Name="SNOM ED CT"
	9695	displayNam e="Backach e"
	9696	xsi:type=" CD"
	9697	>
	9698
	9699	<originalT ext>
	9700
	9701	<reference
	9702	value="#pn dProblem10 09"
	9703	/>
	9704
	9705	</original Text>
	9706
	9707
	9708	</value>
	9709
	9710	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	9711
	9712	<entryRela tionship
	9713	typeCode=" SUBJ"
	9714	>
	9715
	9716	<observati on
	9717	classCode= "OBS"
	9718	moodCode=" EVN"
	9719	>
	9720
	9721	<templateI d
	9722	root="2.16 .840.1.113 883.10.20. 22.4.6"
	9723	/>
	9724
	9725	<code
	9726	code="3399 9-4"
	9727	codeSystem ="2.16.840 .1.113883. 6.1"
	9728	codeSystem Name="LOIN C"
	9729	displayNam e="Status"
	9730	/>
	9731
	9732	<statusCod e
	9733	code="comp leted"
	9734	/>
	9735
	9736	<value
	9737	code="5556 1003"
	9738	codeSystem ="2.16.840 .1.113883. 6.96"
	9739	codeSystem Name="SNOM ED CT"
	9740	displayNam e="Active"
	9741	xsi:type=" CD"
	9742	>
	9743
	9744	<originalT ext>
	9745	ACTIVE
	9746	</original Text>
	9747
	9748	<translati on/>
	9749
	9750	</value>
	9751
	9752	</observat ion>
	9753
	9754	</entryRel ationship>
	9755
	9756	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	9757
	9758	<entryRela tionship
	9759	inversionI nd="true"
	9760	typeCode=" MFST"
	9761	>
	9762
	9763	<act
	9764	classCode= "ACT"
	9765	moodCode=" EVN"
	9766	>
	9767
	9768	<templateI d
	9769	root="2.16 .840.1.113 883.10.20. 22.4.64"
	9770	/>
	9771
	9772	<code
	9773	code="4876 7-8"
	9774	codeSystem ="2.16.840 .1.113883. 6.1"
	9775	codeSystem Name="LOIN C"
	9776	displayNam e="Annotat ion commen t"
	9777	/>
	9778
	9779	<text>
	9780
	9781	<reference
	9782	value="#pn dComment10 09"
	9783	/>
	9784
	9785	</text>
	9786
	9787	</act>
	9788
	9789	</entryRel ationship>
	9790
	9791	</observat ion>
	9792
	9793	</entryRel ationship>
	9794
	9795	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	9796	via VA VistA RPC s -->
	9797
	9798	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	9799	availa ble via VA VistA RPC s -->
	9800
	9801	</act>
	9802
	9803	</entry>
	9804	<entry>
	9805
	9806	<act
	9807	classCode= "ACT"
	9808	moodCode=" EVN"
	9809	>
	9810
	9811	<templateI d
	9812	root="2.16 .840.1.113 883.10.20. 22.4.3"
	9813	/>
	9814
	9815	<id
	9816	nullFlavor ="NA"
	9817	/>
	9818
	9819	<code
	9820	code="CONC "
	9821	codeSystem ="2.16.840 .1.113883. 5.6"
	9822	codeSystem Name="HL7A ctClass"
	9823	displayNam e="Concern "
	9824	/>
	9825
	9826	<statusCod e
	9827	code="acti ve"
	9828	/>
	9829
	9830	<!-- 7.01 PROBLEM DA TE, R2 -->
	9831
	9832	<effective Time>
	9833
	9834	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	9835
	9836	<low
	9837	nullFlavor ="UNK"
	9838	/>
	9839
	9840	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	9841
	9842	<high
	9843	nullFlavor ="UNK"
	9844	/>
	9845
	9846	</effectiv eTime>
	9847
	9848	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	9849
	9850	<performer >
	9851
	9852	<assignedE ntity>
	9853
	9854	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	9855	HealthCare Provider Section -- >
	9856
	9857	<id
	9858	extension= "provider1 010"
	9859	root="2.16 .840.1.113 883.4.349"
	9860	/>
	9861
	9862	<assignedP erson>
	9863
	9864	<name/>
	9865
	9866	</assigned Person>
	9867
	9868	</assigned Entity>
	9869
	9870	</performe r>
	9871
	9872	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	9873
	9874	<author>
	9875
	9876	<time
	9877	nullFlavor ="NA"
	9878	/>
	9879
	9880	<assignedA uthor>
	9881
	9882	<id
	9883	nullFlavor ="NA"
	9884	/>
	9885
	9886	<represent edOrganiza tion>
	9887
	9888	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	9889	FA CILITY NBR -->
	9890
	9891	<id
	9892	extension= "983"
	9893	root="2.16 .840.1.113 883.4.349"
	9894	/>
	9895
	9896	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	9897
	9898	<name>
	9899	CHYSHR TES T LAB
	9900	</name>
	9901
	9902	<telecom
	9903	nullFlavor ="NA"
	9904	/>
	9905
	9906	<addr
	9907	nullFlavor ="NA"
	9908	/>
	9909
	9910	</represen tedOrganiz ation>
	9911
	9912	</assigned Author>
	9913
	9914	</author>
	9915
	9916	<entryRela tionship
	9917	typeCode=" SUBJ"
	9918	>
	9919
	9920	<!-- CCD P roblem Obs ervation - ->
	9921
	9922	<observati on
	9923	classCode= "OBS"
	9924	moodCode=" EVN"
	9925	>
	9926
	9927	<templateI d
	9928	root="2.16 .840.1.113 883.10.20. 22.4.4"
	9929	/>
	9930
	9931	<id
	9932	nullFlavor ="NA"
	9933	/>
	9934
	9935	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	9936	b/c data n ot yet ava ilable via VA VistA RPCs -->
	9937
	9938	<code
	9939	codeSystem ="2.16.840 .1.113883. 6.96"
	9940	codeSystem Name="SNOM ED CT"
	9941	nullFlavor ="UNK"
	9942	>
	9943
	9944	<originalT ext>
	9945	Problem Ty pe Not Ava ilable
	9946	</original Text>
	9947
	9948	</code>
	9949
	9950	<!-- 7.03 PROBLEM NA ME, R2 -->
	9951
	9952	<text>
	9953
	9954	<reference
	9955	value="#pn dProblem10 10"
	9956	/>
	9957
	9958	</text>
	9959
	9960	<statusCod e
	9961	code="comp leted"
	9962	/>
	9963
	9964	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	9965	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	9966
	9967	<value
	9968	code="6146 2000"
	9969	codeSystem ="2.16.840 .1.113883. 6.96"
	9970	codeSystem Name="SNOM ED CT"
	9971	displayNam e="Malaria "
	9972	xsi:type=" CD"
	9973	>
	9974
	9975	<originalT ext>
	9976
	9977	<reference
	9978	value="#pn dProblem10 10"
	9979	/>
	9980
	9981	</original Text>
	9982
	9983
	9984	</value>
	9985
	9986	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	9987
	9988	<entryRela tionship
	9989	typeCode=" SUBJ"
	9990	>
	9991
	9992	<observati on
	9993	classCode= "OBS"
	9994	moodCode=" EVN"
	9995	>
	9996
	9997	<templateI d
	9998	root="2.16 .840.1.113 883.10.20. 22.4.6"
	9999	/>
	10000
	10001	<code
	10002	code="3399 9-4"
	10003	codeSystem ="2.16.840 .1.113883. 6.1"
	10004	codeSystem Name="LOIN C"
	10005	displayNam e="Status"
	10006	/>
	10007
	10008	<statusCod e
	10009	code="comp leted"
	10010	/>
	10011
	10012	<value
	10013	code="5556 1003"
	10014	codeSystem ="2.16.840 .1.113883. 6.96"
	10015	codeSystem Name="SNOM ED CT"
	10016	displayNam e="Active"
	10017	xsi:type=" CD"
	10018	>
	10019
	10020	<originalT ext>
	10021	ACTIVE
	10022	</original Text>
	10023
	10024	<translati on/>
	10025
	10026	</value>
	10027
	10028	</observat ion>
	10029
	10030	</entryRel ationship>
	10031
	10032	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	10033
	10034	<entryRela tionship
	10035	inversionI nd="true"
	10036	typeCode=" MFST"
	10037	>
	10038
	10039	<act
	10040	classCode= "ACT"
	10041	moodCode=" EVN"
	10042	>
	10043
	10044	<templateI d
	10045	root="2.16 .840.1.113 883.10.20. 22.4.64"
	10046	/>
	10047
	10048	<code
	10049	code="4876 7-8"
	10050	codeSystem ="2.16.840 .1.113883. 6.1"
	10051	codeSystem Name="LOIN C"
	10052	displayNam e="Annotat ion commen t"
	10053	/>
	10054
	10055	<text>
	10056
	10057	<reference
	10058	value="#pn dComment10 10"
	10059	/>
	10060
	10061	</text>
	10062
	10063	</act>
	10064
	10065	</entryRel ationship>
	10066
	10067	</observat ion>
	10068
	10069	</entryRel ationship>
	10070
	10071	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	10072	via VA VistA RPC s -->
	10073
	10074	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	10075	availa ble via VA VistA RPC s -->
	10076
	10077	</act>
	10078
	10079	</entry>
	10080	<entry>
	10081
	10082	<act
	10083	classCode= "ACT"
	10084	moodCode=" EVN"
	10085	>
	10086
	10087	<templateI d
	10088	root="2.16 .840.1.113 883.10.20. 22.4.3"
	10089	/>
	10090
	10091	<id
	10092	nullFlavor ="NA"
	10093	/>
	10094
	10095	<code
	10096	code="CONC "
	10097	codeSystem ="2.16.840 .1.113883. 5.6"
	10098	codeSystem Name="HL7A ctClass"
	10099	displayNam e="Concern "
	10100	/>
	10101
	10102	<statusCod e
	10103	code="acti ve"
	10104	/>
	10105
	10106	<!-- 7.01 PROBLEM DA TE, R2 -->
	10107
	10108	<effective Time>
	10109
	10110	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	10111
	10112	<low
	10113	value="201 11111"
	10114	/>
	10115
	10116	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	10117
	10118	<high
	10119	nullFlavor ="UNK"
	10120	/>
	10121
	10122	</effectiv eTime>
	10123
	10124	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	10125
	10126	<performer >
	10127
	10128	<assignedE ntity>
	10129
	10130	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	10131	HealthCare Provider Section -- >
	10132
	10133	<id
	10134	extension= "provider1 011"
	10135	root="2.16 .840.1.113 883.4.349"
	10136	/>
	10137
	10138	<assignedP erson>
	10139
	10140	<name/>
	10141
	10142	</assigned Person>
	10143
	10144	</assigned Entity>
	10145
	10146	</performe r>
	10147
	10148	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	10149
	10150	<author>
	10151
	10152	<time
	10153	nullFlavor ="NA"
	10154	/>
	10155
	10156	<assignedA uthor>
	10157
	10158	<id
	10159	nullFlavor ="NA"
	10160	/>
	10161
	10162	<represent edOrganiza tion>
	10163
	10164	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	10165	FA CILITY NBR -->
	10166
	10167	<id
	10168	extension= "983"
	10169	root="2.16 .840.1.113 883.4.349"
	10170	/>
	10171
	10172	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	10173
	10174	<name>
	10175	CHYSHR TES T LAB
	10176	</name>
	10177
	10178	<telecom
	10179	nullFlavor ="NA"
	10180	/>
	10181
	10182	<addr
	10183	nullFlavor ="NA"
	10184	/>
	10185
	10186	</represen tedOrganiz ation>
	10187
	10188	</assigned Author>
	10189
	10190	</author>
	10191
	10192	<entryRela tionship
	10193	typeCode=" SUBJ"
	10194	>
	10195
	10196	<!-- CCD P roblem Obs ervation - ->
	10197
	10198	<observati on
	10199	classCode= "OBS"
	10200	moodCode=" EVN"
	10201	>
	10202
	10203	<templateI d
	10204	root="2.16 .840.1.113 883.10.20. 22.4.4"
	10205	/>
	10206
	10207	<id
	10208	nullFlavor ="NA"
	10209	/>
	10210
	10211	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	10212	b/c data n ot yet ava ilable via VA VistA RPCs -->
	10213
	10214	<code
	10215	codeSystem ="2.16.840 .1.113883. 6.96"
	10216	codeSystem Name="SNOM ED CT"
	10217	nullFlavor ="UNK"
	10218	>
	10219
	10220	<originalT ext>
	10221	Problem Ty pe Not Ava ilable
	10222	</original Text>
	10223
	10224	</code>
	10225
	10226	<!-- 7.03 PROBLEM NA ME, R2 -->
	10227
	10228	<text>
	10229
	10230	<reference
	10231	value="#pn dProblem10 11"
	10232	/>
	10233
	10234	</text>
	10235
	10236	<statusCod e
	10237	code="comp leted"
	10238	/>
	10239
	10240	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	10241	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	10242
	10243	<value
	10244	code="4972 7002"
	10245	codeSystem ="2.16.840 .1.113883. 6.96"
	10246	codeSystem Name="SNOM ED CT"
	10247	displayNam e="Cough ( finding)"
	10248	xsi:type=" CD"
	10249	>
	10250
	10251	<originalT ext>
	10252
	10253	<reference
	10254	value="#pn dProblem10 11"
	10255	/>
	10256
	10257	</original Text>
	10258
	10259	<translati on
	10260	code="786. 2"
	10261	codeSystem ="2.16.840 .1.113883. 6.103"
	10262	codeSystem Name="ICD- 9-CM"
	10263	/>
	10264
	10265	</value>
	10266
	10267	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	10268
	10269	<entryRela tionship
	10270	typeCode=" SUBJ"
	10271	>
	10272
	10273	<observati on
	10274	classCode= "OBS"
	10275	moodCode=" EVN"
	10276	>
	10277
	10278	<templateI d
	10279	root="2.16 .840.1.113 883.10.20. 22.4.6"
	10280	/>
	10281
	10282	<code
	10283	code="3399 9-4"
	10284	codeSystem ="2.16.840 .1.113883. 6.1"
	10285	codeSystem Name="LOIN C"
	10286	displayNam e="Status"
	10287	/>
	10288
	10289	<statusCod e
	10290	code="comp leted"
	10291	/>
	10292
	10293	<value
	10294	code="5556 1003"
	10295	codeSystem ="2.16.840 .1.113883. 6.96"
	10296	codeSystem Name="SNOM ED CT"
	10297	displayNam e="Active"
	10298	xsi:type=" CD"
	10299	>
	10300
	10301	<originalT ext>
	10302	ACTIVE
	10303	</original Text>
	10304
	10305	<translati on/>
	10306
	10307	</value>
	10308
	10309	</observat ion>
	10310
	10311	</entryRel ationship>
	10312
	10313	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	10314
	10315	<entryRela tionship
	10316	inversionI nd="true"
	10317	typeCode=" MFST"
	10318	>
	10319
	10320	<act
	10321	classCode= "ACT"
	10322	moodCode=" EVN"
	10323	>
	10324
	10325	<templateI d
	10326	root="2.16 .840.1.113 883.10.20. 22.4.64"
	10327	/>
	10328
	10329	<code
	10330	code="4876 7-8"
	10331	codeSystem ="2.16.840 .1.113883. 6.1"
	10332	codeSystem Name="LOIN C"
	10333	displayNam e="Annotat ion commen t"
	10334	/>
	10335
	10336	<text>
	10337
	10338	<reference
	10339	value="#pn dComment10 11"
	10340	/>
	10341
	10342	</text>
	10343
	10344	</act>
	10345
	10346	</entryRel ationship>
	10347
	10348	</observat ion>
	10349
	10350	</entryRel ationship>
	10351
	10352	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	10353	via VA VistA RPC s -->
	10354
	10355	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	10356	availa ble via VA VistA RPC s -->
	10357
	10358	</act>
	10359
	10360	</entry>
	10361	<entry>
	10362
	10363	<act
	10364	classCode= "ACT"
	10365	moodCode=" EVN"
	10366	>
	10367
	10368	<templateI d
	10369	root="2.16 .840.1.113 883.10.20. 22.4.3"
	10370	/>
	10371
	10372	<id
	10373	nullFlavor ="NA"
	10374	/>
	10375
	10376	<code
	10377	code="CONC "
	10378	codeSystem ="2.16.840 .1.113883. 5.6"
	10379	codeSystem Name="HL7A ctClass"
	10380	displayNam e="Concern "
	10381	/>
	10382
	10383	<statusCod e
	10384	code="acti ve"
	10385	/>
	10386
	10387	<!-- 7.01 PROBLEM DA TE, R2 -->
	10388
	10389	<effective Time>
	10390
	10391	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	10392
	10393	<low
	10394	nullFlavor ="UNK"
	10395	/>
	10396
	10397	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	10398
	10399	<high
	10400	nullFlavor ="UNK"
	10401	/>
	10402
	10403	</effectiv eTime>
	10404
	10405	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	10406
	10407	<performer >
	10408
	10409	<assignedE ntity>
	10410
	10411	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	10412	HealthCare Provider Section -- >
	10413
	10414	<id
	10415	extension= "provider1 012"
	10416	root="2.16 .840.1.113 883.4.349"
	10417	/>
	10418
	10419	<assignedP erson>
	10420
	10421	<name/>
	10422
	10423	</assigned Person>
	10424
	10425	</assigned Entity>
	10426
	10427	</performe r>
	10428
	10429	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	10430
	10431	<author>
	10432
	10433	<time
	10434	nullFlavor ="NA"
	10435	/>
	10436
	10437	<assignedA uthor>
	10438
	10439	<id
	10440	nullFlavor ="NA"
	10441	/>
	10442
	10443	<represent edOrganiza tion>
	10444
	10445	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	10446	FA CILITY NBR -->
	10447
	10448	<id
	10449	extension= "983"
	10450	root="2.16 .840.1.113 883.4.349"
	10451	/>
	10452
	10453	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	10454
	10455	<name>
	10456	CHYSHR TES T LAB
	10457	</name>
	10458
	10459	<telecom
	10460	nullFlavor ="NA"
	10461	/>
	10462
	10463	<addr
	10464	nullFlavor ="NA"
	10465	/>
	10466
	10467	</represen tedOrganiz ation>
	10468
	10469	</assigned Author>
	10470
	10471	</author>
	10472
	10473	<entryRela tionship
	10474	typeCode=" SUBJ"
	10475	>
	10476
	10477	<!-- CCD P roblem Obs ervation - ->
	10478
	10479	<observati on
	10480	classCode= "OBS"
	10481	moodCode=" EVN"
	10482	>
	10483
	10484	<templateI d
	10485	root="2.16 .840.1.113 883.10.20. 22.4.4"
	10486	/>
	10487
	10488	<id
	10489	nullFlavor ="NA"
	10490	/>
	10491
	10492	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	10493	b/c data n ot yet ava ilable via VA VistA RPCs -->
	10494
	10495	<code
	10496	codeSystem ="2.16.840 .1.113883. 6.96"
	10497	codeSystem Name="SNOM ED CT"
	10498	nullFlavor ="UNK"
	10499	>
	10500
	10501	<originalT ext>
	10502	Problem Ty pe Not Ava ilable
	10503	</original Text>
	10504
	10505	</code>
	10506
	10507	<!-- 7.03 PROBLEM NA ME, R2 -->
	10508
	10509	<text>
	10510
	10511	<reference
	10512	value="#pn dProblem10 12"
	10513	/>
	10514
	10515	</text>
	10516
	10517	<statusCod e
	10518	code="comp leted"
	10519	/>
	10520
	10521	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	10522	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	10523
	10524	<value
	10525	code="5962 1000"
	10526	codeSystem ="2.16.840 .1.113883. 6.96"
	10527	codeSystem Name="SNOM ED CT"
	10528	displayNam e="Essenti al hyperte nsion (dis order)"
	10529	xsi:type=" CD"
	10530	>
	10531
	10532	<originalT ext>
	10533
	10534	<reference
	10535	value="#pn dProblem10 12"
	10536	/>
	10537
	10538	</original Text>
	10539
	10540	<translati on
	10541	code="401. 9"
	10542	codeSystem ="2.16.840 .1.113883. 6.103"
	10543	codeSystem Name="ICD- 9-CM"
	10544	/>
	10545
	10546	</value>
	10547
	10548	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	10549
	10550	<entryRela tionship
	10551	typeCode=" SUBJ"
	10552	>
	10553
	10554	<observati on
	10555	classCode= "OBS"
	10556	moodCode=" EVN"
	10557	>
	10558
	10559	<templateI d
	10560	root="2.16 .840.1.113 883.10.20. 22.4.6"
	10561	/>
	10562
	10563	<code
	10564	code="3399 9-4"
	10565	codeSystem ="2.16.840 .1.113883. 6.1"
	10566	codeSystem Name="LOIN C"
	10567	displayNam e="Status"
	10568	/>
	10569
	10570	<statusCod e
	10571	code="comp leted"
	10572	/>
	10573
	10574	<value
	10575	code="5556 1003"
	10576	codeSystem ="2.16.840 .1.113883. 6.96"
	10577	codeSystem Name="SNOM ED CT"
	10578	displayNam e="Active"
	10579	xsi:type=" CD"
	10580	>
	10581
	10582	<originalT ext>
	10583	ACTIVE
	10584	</original Text>
	10585
	10586	<translati on/>
	10587
	10588	</value>
	10589
	10590	</observat ion>
	10591
	10592	</entryRel ationship>
	10593
	10594	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	10595
	10596	<entryRela tionship
	10597	inversionI nd="true"
	10598	typeCode=" MFST"
	10599	>
	10600
	10601	<act
	10602	classCode= "ACT"
	10603	moodCode=" EVN"
	10604	>
	10605
	10606	<templateI d
	10607	root="2.16 .840.1.113 883.10.20. 22.4.64"
	10608	/>
	10609
	10610	<code
	10611	code="4876 7-8"
	10612	codeSystem ="2.16.840 .1.113883. 6.1"
	10613	codeSystem Name="LOIN C"
	10614	displayNam e="Annotat ion commen t"
	10615	/>
	10616
	10617	<text>
	10618
	10619	<reference
	10620	value="#pn dComment10 12_1001"
	10621	/>
	10622
	10623	</text>
	10624
	10625	</act>
	10626
	10627	</entryRel ationship>
	10628
	10629	</observat ion>
	10630
	10631	</entryRel ationship>
	10632
	10633	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	10634	via VA VistA RPC s -->
	10635
	10636	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	10637	availa ble via VA VistA RPC s -->
	10638
	10639	</act>
	10640
	10641	</entry>
	10642	<entry>
	10643
	10644	<act
	10645	classCode= "ACT"
	10646	moodCode=" EVN"
	10647	>
	10648
	10649	<templateI d
	10650	root="2.16 .840.1.113 883.10.20. 22.4.3"
	10651	/>
	10652
	10653	<id
	10654	nullFlavor ="NA"
	10655	/>
	10656
	10657	<code
	10658	code="CONC "
	10659	codeSystem ="2.16.840 .1.113883. 5.6"
	10660	codeSystem Name="HL7A ctClass"
	10661	displayNam e="Concern "
	10662	/>
	10663
	10664	<statusCod e
	10665	code="acti ve"
	10666	/>
	10667
	10668	<!-- 7.01 PROBLEM DA TE, R2 -->
	10669
	10670	<effective Time>
	10671
	10672	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	10673
	10674	<low
	10675	value="201 61202"
	10676	/>
	10677
	10678	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	10679
	10680	<high
	10681	value="201 61202"
	10682	/>
	10683
	10684	</effectiv eTime>
	10685
	10686	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	10687
	10688	<performer >
	10689
	10690	<assignedE ntity>
	10691
	10692	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	10693	HealthCare Provider Section -- >
	10694
	10695	<id
	10696	extension= "provider1 013"
	10697	root="2.16 .840.1.113 883.4.349"
	10698	/>
	10699
	10700	<assignedP erson>
	10701
	10702	<name/>
	10703
	10704	</assigned Person>
	10705
	10706	</assigned Entity>
	10707
	10708	</performe r>
	10709
	10710	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	10711
	10712	<author>
	10713
	10714	<time
	10715	nullFlavor ="NA"
	10716	/>
	10717
	10718	<assignedA uthor>
	10719
	10720	<id
	10721	nullFlavor ="NA"
	10722	/>
	10723
	10724	<represent edOrganiza tion>
	10725
	10726	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	10727	FA CILITY NBR -->
	10728
	10729	<id
	10730	extension= "983"
	10731	root="2.16 .840.1.113 883.4.349"
	10732	/>
	10733
	10734	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	10735
	10736	<name>
	10737	CHYSHR TES T LAB
	10738	</name>
	10739
	10740	<telecom
	10741	nullFlavor ="NA"
	10742	/>
	10743
	10744	<addr
	10745	nullFlavor ="NA"
	10746	/>
	10747
	10748	</represen tedOrganiz ation>
	10749
	10750	</assigned Author>
	10751
	10752	</author>
	10753
	10754	<entryRela tionship
	10755	typeCode=" SUBJ"
	10756	>
	10757
	10758	<!-- CCD P roblem Obs ervation - ->
	10759
	10760	<observati on
	10761	classCode= "OBS"
	10762	moodCode=" EVN"
	10763	>
	10764
	10765	<templateI d
	10766	root="2.16 .840.1.113 883.10.20. 22.4.4"
	10767	/>
	10768
	10769	<id
	10770	nullFlavor ="NA"
	10771	/>
	10772
	10773	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	10774	b/c data n ot yet ava ilable via VA VistA RPCs -->
	10775
	10776	<code
	10777	codeSystem ="2.16.840 .1.113883. 6.96"
	10778	codeSystem Name="SNOM ED CT"
	10779	nullFlavor ="UNK"
	10780	>
	10781
	10782	<originalT ext>
	10783	Problem Ty pe Not Ava ilable
	10784	</original Text>
	10785
	10786	</code>
	10787
	10788	<!-- 7.03 PROBLEM NA ME, R2 -->
	10789
	10790	<text>
	10791
	10792	<reference
	10793	value="#pn dProblem10 13"
	10794	/>
	10795
	10796	</text>
	10797
	10798	<statusCod e
	10799	code="comp leted"
	10800	/>
	10801
	10802	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	10803	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	10804
	10805	<value
	10806	code="1618 91005"
	10807	codeSystem ="2.16.840 .1.113883. 6.96"
	10808	codeSystem Name="SNOM ED CT"
	10809	displayNam e="Backach e"
	10810	xsi:type=" CD"
	10811	>
	10812
	10813	<originalT ext>
	10814
	10815	<reference
	10816	value="#pn dProblem10 13"
	10817	/>
	10818
	10819	</original Text>
	10820
	10821
	10822	</value>
	10823
	10824	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	10825
	10826	<entryRela tionship
	10827	typeCode=" SUBJ"
	10828	>
	10829
	10830	<observati on
	10831	classCode= "OBS"
	10832	moodCode=" EVN"
	10833	>
	10834
	10835	<templateI d
	10836	root="2.16 .840.1.113 883.10.20. 22.4.6"
	10837	/>
	10838
	10839	<code
	10840	code="3399 9-4"
	10841	codeSystem ="2.16.840 .1.113883. 6.1"
	10842	codeSystem Name="LOIN C"
	10843	displayNam e="Status"
	10844	/>
	10845
	10846	<statusCod e
	10847	code="comp leted"
	10848	/>
	10849
	10850	<value
	10851	code="7342 5007"
	10852	codeSystem ="2.16.840 .1.113883. 6.96"
	10853	codeSystem Name="SNOM ED CT"
	10854	displayNam e="Inactiv e"
	10855	xsi:type=" CD"
	10856	>
	10857
	10858	<originalT ext>
	10859	INACTIVE
	10860	</original Text>
	10861
	10862	<translati on/>
	10863
	10864	</value>
	10865
	10866	</observat ion>
	10867
	10868	</entryRel ationship>
	10869
	10870	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	10871
	10872	<entryRela tionship
	10873	inversionI nd="true"
	10874	typeCode=" MFST"
	10875	>
	10876
	10877	<act
	10878	classCode= "ACT"
	10879	moodCode=" EVN"
	10880	>
	10881
	10882	<templateI d
	10883	root="2.16 .840.1.113 883.10.20. 22.4.64"
	10884	/>
	10885
	10886	<code
	10887	code="4876 7-8"
	10888	codeSystem ="2.16.840 .1.113883. 6.1"
	10889	codeSystem Name="LOIN C"
	10890	displayNam e="Annotat ion commen t"
	10891	/>
	10892
	10893	<text>
	10894
	10895	<reference
	10896	value="#pn dComment10 13"
	10897	/>
	10898
	10899	</text>
	10900
	10901	</act>
	10902
	10903	</entryRel ationship>
	10904
	10905	</observat ion>
	10906
	10907	</entryRel ationship>
	10908
	10909	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	10910	via VA VistA RPC s -->
	10911
	10912	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	10913	availa ble via VA VistA RPC s -->
	10914
	10915	</act>
	10916
	10917	</entry>
	10918	<entry>
	10919
	10920	<act
	10921	classCode= "ACT"
	10922	moodCode=" EVN"
	10923	>
	10924
	10925	<templateI d
	10926	root="2.16 .840.1.113 883.10.20. 22.4.3"
	10927	/>
	10928
	10929	<id
	10930	nullFlavor ="NA"
	10931	/>
	10932
	10933	<code
	10934	code="CONC "
	10935	codeSystem ="2.16.840 .1.113883. 5.6"
	10936	codeSystem Name="HL7A ctClass"
	10937	displayNam e="Concern "
	10938	/>
	10939
	10940	<statusCod e
	10941	code="acti ve"
	10942	/>
	10943
	10944	<!-- 7.01 PROBLEM DA TE, R2 -->
	10945
	10946	<effective Time>
	10947
	10948	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	10949
	10950	<low
	10951	value="201 61202"
	10952	/>
	10953
	10954	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	10955
	10956	<high
	10957	value="201 61202"
	10958	/>
	10959
	10960	</effectiv eTime>
	10961
	10962	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	10963
	10964	<performer >
	10965
	10966	<assignedE ntity>
	10967
	10968	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	10969	HealthCare Provider Section -- >
	10970
	10971	<id
	10972	extension= "provider1 014"
	10973	root="2.16 .840.1.113 883.4.349"
	10974	/>
	10975
	10976	<assignedP erson>
	10977
	10978	<name/>
	10979
	10980	</assigned Person>
	10981
	10982	</assigned Entity>
	10983
	10984	</performe r>
	10985
	10986	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	10987
	10988	<author>
	10989
	10990	<time
	10991	nullFlavor ="NA"
	10992	/>
	10993
	10994	<assignedA uthor>
	10995
	10996	<id
	10997	nullFlavor ="NA"
	10998	/>
	10999
	11000	<represent edOrganiza tion>
	11001
	11002	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	11003	FA CILITY NBR -->
	11004
	11005	<id
	11006	extension= "983"
	11007	root="2.16 .840.1.113 883.4.349"
	11008	/>
	11009
	11010	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	11011
	11012	<name>
	11013	CHYSHR TES T LAB
	11014	</name>
	11015
	11016	<telecom
	11017	nullFlavor ="NA"
	11018	/>
	11019
	11020	<addr
	11021	nullFlavor ="NA"
	11022	/>
	11023
	11024	</represen tedOrganiz ation>
	11025
	11026	</assigned Author>
	11027
	11028	</author>
	11029
	11030	<entryRela tionship
	11031	typeCode=" SUBJ"
	11032	>
	11033
	11034	<!-- CCD P roblem Obs ervation - ->
	11035
	11036	<observati on
	11037	classCode= "OBS"
	11038	moodCode=" EVN"
	11039	>
	11040
	11041	<templateI d
	11042	root="2.16 .840.1.113 883.10.20. 22.4.4"
	11043	/>
	11044
	11045	<id
	11046	nullFlavor ="NA"
	11047	/>
	11048
	11049	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	11050	b/c data n ot yet ava ilable via VA VistA RPCs -->
	11051
	11052	<code
	11053	codeSystem ="2.16.840 .1.113883. 6.96"
	11054	codeSystem Name="SNOM ED CT"
	11055	nullFlavor ="UNK"
	11056	>
	11057
	11058	<originalT ext>
	11059	Problem Ty pe Not Ava ilable
	11060	</original Text>
	11061
	11062	</code>
	11063
	11064	<!-- 7.03 PROBLEM NA ME, R2 -->
	11065
	11066	<text>
	11067
	11068	<reference
	11069	value="#pn dProblem10 14"
	11070	/>
	11071
	11072	</text>
	11073
	11074	<statusCod e
	11075	code="comp leted"
	11076	/>
	11077
	11078	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	11079	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	11080
	11081	<value
	11082	code="6562 1006"
	11083	codeSystem ="2.16.840 .1.113883. 6.96"
	11084	codeSystem Name="SNOM ED CT"
	11085	displayNam e="Hyperex tension de formity of knee"
	11086	xsi:type=" CD"
	11087	>
	11088
	11089	<originalT ext>
	11090
	11091	<reference
	11092	value="#pn dProblem10 14"
	11093	/>
	11094
	11095	</original Text>
	11096
	11097
	11098	</value>
	11099
	11100	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	11101
	11102	<entryRela tionship
	11103	typeCode=" SUBJ"
	11104	>
	11105
	11106	<observati on
	11107	classCode= "OBS"
	11108	moodCode=" EVN"
	11109	>
	11110
	11111	<templateI d
	11112	root="2.16 .840.1.113 883.10.20. 22.4.6"
	11113	/>
	11114
	11115	<code
	11116	code="3399 9-4"
	11117	codeSystem ="2.16.840 .1.113883. 6.1"
	11118	codeSystem Name="LOIN C"
	11119	displayNam e="Status"
	11120	/>
	11121
	11122	<statusCod e
	11123	code="comp leted"
	11124	/>
	11125
	11126	<value
	11127	code="7342 5007"
	11128	codeSystem ="2.16.840 .1.113883. 6.96"
	11129	codeSystem Name="SNOM ED CT"
	11130	displayNam e="Inactiv e"
	11131	xsi:type=" CD"
	11132	>
	11133
	11134	<originalT ext>
	11135	INACTIVE
	11136	</original Text>
	11137
	11138	<translati on/>
	11139
	11140	</value>
	11141
	11142	</observat ion>
	11143
	11144	</entryRel ationship>
	11145
	11146	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	11147
	11148	<entryRela tionship
	11149	inversionI nd="true"
	11150	typeCode=" MFST"
	11151	>
	11152
	11153	<act
	11154	classCode= "ACT"
	11155	moodCode=" EVN"
	11156	>
	11157
	11158	<templateI d
	11159	root="2.16 .840.1.113 883.10.20. 22.4.64"
	11160	/>
	11161
	11162	<code
	11163	code="4876 7-8"
	11164	codeSystem ="2.16.840 .1.113883. 6.1"
	11165	codeSystem Name="LOIN C"
	11166	displayNam e="Annotat ion commen t"
	11167	/>
	11168
	11169	<text>
	11170
	11171	<reference
	11172	value="#pn dComment10 14"
	11173	/>
	11174
	11175	</text>
	11176
	11177	</act>
	11178
	11179	</entryRel ationship>
	11180
	11181	</observat ion>
	11182
	11183	</entryRel ationship>
	11184
	11185	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	11186	via VA VistA RPC s -->
	11187
	11188	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	11189	availa ble via VA VistA RPC s -->
	11190
	11191	</act>
	11192
	11193	</entry>
	11194	<entry>
	11195
	11196	<act
	11197	classCode= "ACT"
	11198	moodCode=" EVN"
	11199	>
	11200
	11201	<templateI d
	11202	root="2.16 .840.1.113 883.10.20. 22.4.3"
	11203	/>
	11204
	11205	<id
	11206	nullFlavor ="NA"
	11207	/>
	11208
	11209	<code
	11210	code="CONC "
	11211	codeSystem ="2.16.840 .1.113883. 5.6"
	11212	codeSystem Name="HL7A ctClass"
	11213	displayNam e="Concern "
	11214	/>
	11215
	11216	<statusCod e
	11217	code="acti ve"
	11218	/>
	11219
	11220	<!-- 7.01 PROBLEM DA TE, R2 -->
	11221
	11222	<effective Time>
	11223
	11224	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	11225
	11226	<low
	11227	nullFlavor ="UNK"
	11228	/>
	11229
	11230	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	11231
	11232	<high
	11233	value="201 61201"
	11234	/>
	11235
	11236	</effectiv eTime>
	11237
	11238	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	11239
	11240	<performer >
	11241
	11242	<assignedE ntity>
	11243
	11244	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	11245	HealthCare Provider Section -- >
	11246
	11247	<id
	11248	extension= "provider1 015"
	11249	root="2.16 .840.1.113 883.4.349"
	11250	/>
	11251
	11252	<assignedP erson>
	11253
	11254	<name/>
	11255
	11256	</assigned Person>
	11257
	11258	</assigned Entity>
	11259
	11260	</performe r>
	11261
	11262	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	11263
	11264	<author>
	11265
	11266	<time
	11267	nullFlavor ="NA"
	11268	/>
	11269
	11270	<assignedA uthor>
	11271
	11272	<id
	11273	nullFlavor ="NA"
	11274	/>
	11275
	11276	<represent edOrganiza tion>
	11277
	11278	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	11279	FA CILITY NBR -->
	11280
	11281	<id
	11282	extension= "983"
	11283	root="2.16 .840.1.113 883.4.349"
	11284	/>
	11285
	11286	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	11287
	11288	<name>
	11289	CHYSHR TES T LAB
	11290	</name>
	11291
	11292	<telecom
	11293	nullFlavor ="NA"
	11294	/>
	11295
	11296	<addr
	11297	nullFlavor ="NA"
	11298	/>
	11299
	11300	</represen tedOrganiz ation>
	11301
	11302	</assigned Author>
	11303
	11304	</author>
	11305
	11306	<entryRela tionship
	11307	typeCode=" SUBJ"
	11308	>
	11309
	11310	<!-- CCD P roblem Obs ervation - ->
	11311
	11312	<observati on
	11313	classCode= "OBS"
	11314	moodCode=" EVN"
	11315	>
	11316
	11317	<templateI d
	11318	root="2.16 .840.1.113 883.10.20. 22.4.4"
	11319	/>
	11320
	11321	<id
	11322	nullFlavor ="NA"
	11323	/>
	11324
	11325	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	11326	b/c data n ot yet ava ilable via VA VistA RPCs -->
	11327
	11328	<code
	11329	codeSystem ="2.16.840 .1.113883. 6.96"
	11330	codeSystem Name="SNOM ED CT"
	11331	nullFlavor ="UNK"
	11332	>
	11333
	11334	<originalT ext>
	11335	Problem Ty pe Not Ava ilable
	11336	</original Text>
	11337
	11338	</code>
	11339
	11340	<!-- 7.03 PROBLEM NA ME, R2 -->
	11341
	11342	<text>
	11343
	11344	<reference
	11345	value="#pn dProblem10 15"
	11346	/>
	11347
	11348	</text>
	11349
	11350	<statusCod e
	11351	code="comp leted"
	11352	/>
	11353
	11354	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	11355	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	11356
	11357	<value
	11358	code="2815 98004"
	11359	codeSystem ="2.16.840 .1.113883. 6.96"
	11360	codeSystem Name="SNOM ED CT"
	11361	displayNam e="Sprain of spinal ligament"
	11362	xsi:type=" CD"
	11363	>
	11364
	11365	<originalT ext>
	11366
	11367	<reference
	11368	value="#pn dProblem10 15"
	11369	/>
	11370
	11371	</original Text>
	11372
	11373
	11374	</value>
	11375
	11376	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	11377
	11378	<entryRela tionship
	11379	typeCode=" SUBJ"
	11380	>
	11381
	11382	<observati on
	11383	classCode= "OBS"
	11384	moodCode=" EVN"
	11385	>
	11386
	11387	<templateI d
	11388	root="2.16 .840.1.113 883.10.20. 22.4.6"
	11389	/>
	11390
	11391	<code
	11392	code="3399 9-4"
	11393	codeSystem ="2.16.840 .1.113883. 6.1"
	11394	codeSystem Name="LOIN C"
	11395	displayNam e="Status"
	11396	/>
	11397
	11398	<statusCod e
	11399	code="comp leted"
	11400	/>
	11401
	11402	<value
	11403	code="7342 5007"
	11404	codeSystem ="2.16.840 .1.113883. 6.96"
	11405	codeSystem Name="SNOM ED CT"
	11406	displayNam e="Inactiv e"
	11407	xsi:type=" CD"
	11408	>
	11409
	11410	<originalT ext>
	11411	INACTIVE
	11412	</original Text>
	11413
	11414	<translati on/>
	11415
	11416	</value>
	11417
	11418	</observat ion>
	11419
	11420	</entryRel ationship>
	11421
	11422	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	11423
	11424	<entryRela tionship
	11425	inversionI nd="true"
	11426	typeCode=" MFST"
	11427	>
	11428
	11429	<act
	11430	classCode= "ACT"
	11431	moodCode=" EVN"
	11432	>
	11433
	11434	<templateI d
	11435	root="2.16 .840.1.113 883.10.20. 22.4.64"
	11436	/>
	11437
	11438	<code
	11439	code="4876 7-8"
	11440	codeSystem ="2.16.840 .1.113883. 6.1"
	11441	codeSystem Name="LOIN C"
	11442	displayNam e="Annotat ion commen t"
	11443	/>
	11444
	11445	<text>
	11446
	11447	<reference
	11448	value="#pn dComment10 15"
	11449	/>
	11450
	11451	</text>
	11452
	11453	</act>
	11454
	11455	</entryRel ationship>
	11456
	11457	</observat ion>
	11458
	11459	</entryRel ationship>
	11460
	11461	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	11462	via VA VistA RPC s -->
	11463
	11464	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	11465	availa ble via VA VistA RPC s -->
	11466
	11467	</act>
	11468
	11469	</entry>
	11470	<entry>
	11471
	11472	<act
	11473	classCode= "ACT"
	11474	moodCode=" EVN"
	11475	>
	11476
	11477	<templateI d
	11478	root="2.16 .840.1.113 883.10.20. 22.4.3"
	11479	/>
	11480
	11481	<id
	11482	nullFlavor ="NA"
	11483	/>
	11484
	11485	<code
	11486	code="CONC "
	11487	codeSystem ="2.16.840 .1.113883. 5.6"
	11488	codeSystem Name="HL7A ctClass"
	11489	displayNam e="Concern "
	11490	/>
	11491
	11492	<statusCod e
	11493	code="acti ve"
	11494	/>
	11495
	11496	<!-- 7.01 PROBLEM DA TE, R2 -->
	11497
	11498	<effective Time>
	11499
	11500	<!-- 7.01 PROBLEM DA TE, cda:lo w=Date of Onset -->
	11501
	11502	<low
	11503	nullFlavor ="UNK"
	11504	/>
	11505
	11506	<!-- 7.01 PROBLEM DA TE, cda:hi gh=Date Re solved -->
	11507
	11508	<high
	11509	value="201 61201"
	11510	/>
	11511
	11512	</effectiv eTime>
	11513
	11514	<!-- TREAT ING PROVID ER Perform er Block, Optional - ->
	11515
	11516	<performer >
	11517
	11518	<assignedE ntity>
	11519
	11520	<!-- 7.05 TREATING P ROVIDER, e xtension = VA Provide r ID, link ed to
	11521	HealthCare Provider Section -- >
	11522
	11523	<id
	11524	extension= "provider1 016"
	11525	root="2.16 .840.1.113 883.4.349"
	11526	/>
	11527
	11528	<assignedP erson>
	11529
	11530	<name/>
	11531
	11532	</assigned Person>
	11533
	11534	</assigned Entity>
	11535
	11536	</performe r>
	11537
	11538	<!-- INFOR MATION SOU RCE FOR PR OBLEM, Opt ional -->
	11539
	11540	<author>
	11541
	11542	<time
	11543	nullFlavor ="NA"
	11544	/>
	11545
	11546	<assignedA uthor>
	11547
	11548	<id
	11549	nullFlavor ="NA"
	11550	/>
	11551
	11552	<represent edOrganiza tion>
	11553
	11554	<!-- INFOR MATION SOU RCE ID, ro ot=VA OID, extension = VAMC TRE ATING
	11555	FA CILITY NBR -->
	11556
	11557	<id
	11558	extension= "983"
	11559	root="2.16 .840.1.113 883.4.349"
	11560	/>
	11561
	11562	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	11563
	11564	<name>
	11565	CHYSHR TES T LAB
	11566	</name>
	11567
	11568	<telecom
	11569	nullFlavor ="NA"
	11570	/>
	11571
	11572	<addr
	11573	nullFlavor ="NA"
	11574	/>
	11575
	11576	</represen tedOrganiz ation>
	11577
	11578	</assigned Author>
	11579
	11580	</author>
	11581
	11582	<entryRela tionship
	11583	typeCode=" SUBJ"
	11584	>
	11585
	11586	<!-- CCD P roblem Obs ervation - ->
	11587
	11588	<observati on
	11589	classCode= "OBS"
	11590	moodCode=" EVN"
	11591	>
	11592
	11593	<templateI d
	11594	root="2.16 .840.1.113 883.10.20. 22.4.4"
	11595	/>
	11596
	11597	<id
	11598	nullFlavor ="NA"
	11599	/>
	11600
	11601	<!-- 7.02 PROBLEM TY PE, REQUIR ED, SNOMED CT, provi ded as nul lFalvor
	11602	b/c data n ot yet ava ilable via VA VistA RPCs -->
	11603
	11604	<code
	11605	codeSystem ="2.16.840 .1.113883. 6.96"
	11606	codeSystem Name="SNOM ED CT"
	11607	nullFlavor ="UNK"
	11608	>
	11609
	11610	<originalT ext>
	11611	Problem Ty pe Not Ava ilable
	11612	</original Text>
	11613
	11614	</code>
	11615
	11616	<!-- 7.03 PROBLEM NA ME, R2 -->
	11617
	11618	<text>
	11619
	11620	<reference
	11621	value="#pn dProblem10 16"
	11622	/>
	11623
	11624	</text>
	11625
	11626	<statusCod e
	11627	code="comp leted"
	11628	/>
	11629
	11630	<!-- 7.04 PROBLEM CO DE, Option al, When u ncoded onl y xsi:type ="CD"
	11631	allowed, A vailable a s ICD-9, n ot SNOMED CT, -->
	11632
	11633	<value
	11634	code="3962 30008"
	11635	codeSystem ="2.16.840 .1.113883. 6.96"
	11636	codeSystem Name="SNOM ED CT"
	11637	displayNam e="Dermato myositis ( disorder)"
	11638	xsi:type=" CD"
	11639	>
	11640
	11641	<originalT ext>
	11642
	11643	<reference
	11644	value="#pn dProblem10 16"
	11645	/>
	11646
	11647	</original Text>
	11648
	11649	<translati on
	11650	code="710. 3"
	11651	codeSystem ="2.16.840 .1.113883. 6.103"
	11652	codeSystem Name="ICD- 9-CM"
	11653	/>
	11654
	11655	</value>
	11656
	11657	<!-- PROBL EM STATUS entryRelat ionship bl ock, Optio nal, -->
	11658
	11659	<entryRela tionship
	11660	typeCode=" SUBJ"
	11661	>
	11662
	11663	<observati on
	11664	classCode= "OBS"
	11665	moodCode=" EVN"
	11666	>
	11667
	11668	<templateI d
	11669	root="2.16 .840.1.113 883.10.20. 22.4.6"
	11670	/>
	11671
	11672	<code
	11673	code="3399 9-4"
	11674	codeSystem ="2.16.840 .1.113883. 6.1"
	11675	codeSystem Name="LOIN C"
	11676	displayNam e="Status"
	11677	/>
	11678
	11679	<statusCod e
	11680	code="comp leted"
	11681	/>
	11682
	11683	<value
	11684	code="7342 5007"
	11685	codeSystem ="2.16.840 .1.113883. 6.96"
	11686	codeSystem Name="SNOM ED CT"
	11687	displayNam e="Inactiv e"
	11688	xsi:type=" CD"
	11689	>
	11690
	11691	<originalT ext>
	11692	INACTIVE
	11693	</original Text>
	11694
	11695	<translati on/>
	11696
	11697	</value>
	11698
	11699	</observat ion>
	11700
	11701	</entryRel ationship>
	11702
	11703	<!-- PROBL EM COMMENT (for SSA) entryRela tionship b lock, Opti onal, -->
	11704
	11705	<entryRela tionship
	11706	inversionI nd="true"
	11707	typeCode=" MFST"
	11708	>
	11709
	11710	<act
	11711	classCode= "ACT"
	11712	moodCode=" EVN"
	11713	>
	11714
	11715	<templateI d
	11716	root="2.16 .840.1.113 883.10.20. 22.4.64"
	11717	/>
	11718
	11719	<code
	11720	code="4876 7-8"
	11721	codeSystem ="2.16.840 .1.113883. 6.1"
	11722	codeSystem Name="LOIN C"
	11723	displayNam e="Annotat ion commen t"
	11724	/>
	11725
	11726	<text>
	11727
	11728	<reference
	11729	value="#pn dComment10 16_1002"
	11730	/>
	11731
	11732	</text>
	11733
	11734	</act>
	11735
	11736	</entryRel ationship>
	11737
	11738	</observat ion>
	11739
	11740	</entryRel ationship>
	11741
	11742	<!-- CCD P roblem Age Observati on, not pr ovided b/c data not yet availa ble
	11743	via VA VistA RPC s -->
	11744
	11745	<!-- CCD H ealth Stat us Observa tion, not provided b /c data no t yet
	11746	availa ble via VA VistA RPC s -->
	11747
	11748	</act>
	11749
	11750	</entry>
	11751
	11752	</section>
	11753
	11754	</componen t>
	11755
	11756	<component >
	11757
	11758	<!-- *** ****** ****** ****** ****** ****** ****** ****** *****
	11759	INSURANCE PROVIDERS (PAYERS) S ECTION, Op tional * ****** ****** ****** ****** ****** ****** ****** ******* -->
	11760
	11761	<section>
	11762
	11763	<templateI d
	11764	root="2.16 .840.1.113 883.10.20. 22.2.18"
	11765	/>
	11766
	11767	<code
	11768	code="4876 8-6"
	11769	codeSystem ="2.16.840 .1.113883. 6.1"
	11770	codeSystem Name="LOIN C"
	11771	displayNam e="Payers"
	11772	/>
	11773
	11774	<title>
	11775	Insurance Providers (Payers) S ection
	11776	</title>
	11777
	11778	<!-- PAYER S NARRATIV E BLOCK -- >
	11779
	11780	<text>
	11781
	11782	<!-- VA In surance Pr oviders Bu siness Rul es for Med ical Conte nt -->
	11783
	11784	<paragraph >
	11785	This secti on contain s the name s of all a ctive insu rance
	11786	prov iders for the patien t from all VA treatm ent facili ties.
	11787	</paragrap h>
	11788
	11789	<table
	11790	ID="insura nceNarrati ve"
	11791	border="1"
	11792	width="100 %"
	11793	>
	11794
	11795	<thead>
	11796
	11797	<tr>
	11798
	11799	<th>
	11800	Insurance Provider
	11801	</th>
	11802
	11803	<th>
	11804	Type of Co verage
	11805	</th>
	11806
	11807	<th>
	11808	Plan Name
	11809	</th>
	11810
	11811	<th>
	11812	Start of P olicy Cove rage
	11813	</th>
	11814
	11815	<th>
	11816	End of Pol icy Covera ge
	11817	</th>
	11818
	11819	<th>
	11820	Group Numb er
	11821	</th>
	11822
	11823	<th>
	11824	Member ID
	11825	</th>
	11826
	11827	<th>
	11828	Insurance Provider's Telephone Number
	11829	</th>
	11830
	11831	<th>
	11832	Policy Hol der's Name
	11833	</th>
	11834
	11835	<th>
	11836	Patient's Relationsh ip to Poli cy Holder
	11837	</th>
	11838
	11839	</tr>
	11840
	11841
	11842	</thead>
	11843
	11844	<tbody>
	11845
	11846	<tr>
	11847
	11848	<td>
	11849
	11850	<content
	11851	ID="insCom pany1001"
	11852	>
	11853	MEDICARE ( WNR)
	11854	</content>
	11855
	11856	</td>
	11857
	11858	<td>
	11859
	11860	<content
	11861	ID="insIns urance1001 "
	11862	>
	11863	MEDICARE ( M)
	11864	</content>
	11865
	11866	</td>
	11867
	11868	<td>
	11869
	11870	<content
	11871	ID="insGro upName1001 "
	11872	>
	11873	PART A
	11874	</content>
	11875
	11876	</td>
	11877
	11878
	11879
	11880	<td>
	11881
	11882	<content
	11883	ID="insEff ectiveDate 1001"
	11884	>
	11885	Jan 14, 20 15
	11886	</content>
	11887
	11888	</td>
	11889
	11890	<td>
	11891
	11892	<content
	11893	ID="insExp irationDat e1001"
	11894	/>
	11895
	11896	</td>
	11897
	11898
	11899	<td>
	11900
	11901	<content
	11902	ID="insGro up1001"
	11903	>
	11904	PART A
	11905	</content>
	11906
	11907	</td>
	11908
	11909	<td>
	11910
	11911	<content
	11912	ID="insMem berId1001"
	11913	>
	11914	DFG876549
	11915	</content>
	11916
	11917	</td>
	11918
	11919	<td>
	11920
	11921	<content/>
	11922
	11923	</td>
	11924
	11925	<td>
	11926
	11927	<content
	11928	ID="insMem berName100 1"
	11929	>
	11930	NWHINZZZTE STPATIENT, NWHINONE
	11931	</content>
	11932
	11933	</td>
	11934
	11935
	11936	<td>
	11937
	11938	<content
	11939	ID="insRel ationship1 001"
	11940	>
	11941	PATIENT
	11942	</content>
	11943
	11944	</td>
	11945
	11946
	11947	</tr>
	11948	<tr>
	11949
	11950	<td>
	11951
	11952	<content
	11953	ID="insCom pany1002"
	11954	>
	11955	MEDICARE ( WNR)
	11956	</content>
	11957
	11958	</td>
	11959
	11960	<td>
	11961
	11962	<content
	11963	ID="insIns urance1002 "
	11964	>
	11965	MEDICARE ( M)
	11966	</content>
	11967
	11968	</td>
	11969
	11970	<td>
	11971
	11972	<content
	11973	ID="insGro upName1002 "
	11974	>
	11975	PART B
	11976	</content>
	11977
	11978	</td>
	11979
	11980
	11981
	11982	<td>
	11983
	11984	<content
	11985	ID="insEff ectiveDate 1002"
	11986	>
	11987	Jan 14, 20 15
	11988	</content>
	11989
	11990	</td>
	11991
	11992	<td>
	11993
	11994	<content
	11995	ID="insExp irationDat e1002"
	11996	/>
	11997
	11998	</td>
	11999
	12000
	12001	<td>
	12002
	12003	<content
	12004	ID="insGro up1002"
	12005	>
	12006	PART B
	12007	</content>
	12008
	12009	</td>
	12010
	12011	<td>
	12012
	12013	<content
	12014	ID="insMem berId1002"
	12015	>
	12016	DFG876549
	12017	</content>
	12018
	12019	</td>
	12020
	12021	<td>
	12022
	12023	<content/>
	12024
	12025	</td>
	12026
	12027	<td>
	12028
	12029	<content
	12030	ID="insMem berName100 2"
	12031	>
	12032	NWHINZZZTE STPATIENT, NWHINONE
	12033	</content>
	12034
	12035	</td>
	12036
	12037
	12038	<td>
	12039
	12040	<content
	12041	ID="insRel ationship1 002"
	12042	>
	12043	PATIENT
	12044	</content>
	12045
	12046	</td>
	12047
	12048
	12049	</tr>
	12050
	12051	</tbody>
	12052
	12053	</table>
	12054
	12055	</text>
	12056
	12057	<!-- PAYER S STRUCTUR ED DATA -- >
	12058
	12059	<!-- CCD C overage Ac tivity -->
	12060
	12061	<entry>
	12062
	12063	<act
	12064	classCode= "ACT"
	12065	moodCode=" EVN"
	12066	>
	12067
	12068	<templateI d
	12069	root="2.16 .840.1.113 883.10.20. 22.4.60"
	12070	/>
	12071
	12072	<id
	12073	nullFlavor ="NA"
	12074	/>
	12075
	12076	<code
	12077	code="4876 8-6"
	12078	codeSystem ="2.16.840 .1.113883. 6.1"
	12079	codeSystem Name="LOIN C"
	12080	displayNam e="Payment Sources"
	12081	/>
	12082
	12083	<statusCod e
	12084	code="comp leted"
	12085	/>
	12086
	12087	<!-- CCD P ayment Pro vider Even t Entry -- >
	12088
	12089	<entryRela tionship
	12090	typeCode=" COMP"
	12091	>
	12092
	12093	<act
	12094	classCode= "ACT"
	12095	moodCode=" EVN"
	12096	>
	12097
	12098	<templateI d
	12099	root="2.16 .840.1.113 883.10.20. 22.4.61"
	12100	/>
	12101
	12102	<!-- 5.01 GROUP NUMB ER, REQUIR ED -->
	12103
	12104	<id
	12105	extension= "PART A"
	12106	root="2.16 .840.1.113 883.4.349"
	12107	/>
	12108
	12109	<!-- 5.02 HEALTH INS URANCE TYP E, REQURIE D -->
	12110
	12111	<code
	12112	code="33"
	12113	codeSystem ="2.16.840 .1.113883. 6.255.1336 "
	12114	codeSystem Name="X12N -1336"
	12115	displayNam e="MEDICAR E (M)"
	12116	/>
	12117
	12118	<statusCod e
	12119	code="comp leted"
	12120	/>
	12121
	12122	<!-- 5.07 - Health P lan Covera ge Dates, R2-Optiona l -->
	12123
	12124	<effective Time>
	12125
	12126	<!-- 5.07 VistA Poli cy Effecti ve Date -- >
	12127
	12128	<low
	12129	value="201 50114"
	12130	/>
	12131
	12132	<!-- 5.07 VistA Poli cy Expirat ion Date -->
	12133
	12134	<high/>
	12135
	12136	</effectiv eTime>
	12137
	12138	<performer
	12139	typeCode=" PRF"
	12140	>
	12141
	12142	<templateI d
	12143	root="2.16 .840.1.113 883.10.20. 22.4.87"
	12144	/>
	12145
	12146	<!-- CCD P ayer Info -->
	12147
	12148	<assignedE ntity>
	12149
	12150	<!-- 5.03 HEALTH PLA N INSURANC E INFO SOU RCE ID, RE QUIRED -->
	12151
	12152	<id
	12153	root="2.16 .840.1.113 883.4.349"
	12154	/>
	12155
	12156	<code/>
	12157
	12158	<!-- 5.04 HEALTH PLA N INSURANC E INFO SOU RCE ADDRES S, Optiona l -->
	12159
	12160	<addr>
	12161
	12162	<streetAdd ressLine>
	12163	WILL NOT R EIMBURSE
	12164	</streetAd dressLine>
	12165
	12166
	12167
	12168	<state/>
	12169
	12170	<postalCod e/>
	12171
	12172	</addr>
	12173
	12174	<!-- 5.05 HEALTH PLA N INSURANC E INFO SOU RCE PHONE/ EMAIL/URL, Optional -->
	12175
	12176
	12177	<represent edOrganiza tion>
	12178
	12179	<!-- 5.06 HEALTH PLA N INSURANC E INFO SOU RCE NAME ( Insurance
	12180	Compan y Name), R 2 -->
	12181
	12182	<name>
	12183	MEDICARE ( WNR)
	12184	</name>
	12185
	12186	<addr/>
	12187
	12188	</represen tedOrganiz ation>
	12189
	12190	</assigned Entity>
	12191
	12192	</performe r>
	12193
	12194	<author>
	12195
	12196	<time
	12197	nullFlavor ="UNK"
	12198	/>
	12199
	12200	<assignedA uthor>
	12201
	12202	<id
	12203	nullFlavor ="NI"
	12204	/>
	12205
	12206	<represent edOrganiza tion>
	12207
	12208	<id
	12209	extension= "983"
	12210	root="2.16 .840.1.113 883.4.349"
	12211	/>
	12212
	12213	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	12214
	12215	<name>
	12216	CHYSHR TES T LAB
	12217	</name>
	12218
	12219	<telecom
	12220	nullFlavor ="NA"
	12221	/>
	12222
	12223	<addr
	12224	nullFlavor ="NA"
	12225	/>
	12226
	12227	</represen tedOrganiz ation>
	12228
	12229	</assigned Author>
	12230
	12231	</author>
	12232
	12233	<participa nt
	12234	typeCode=" COV"
	12235	>
	12236
	12237	<templateI d
	12238	root="2.16 .840.1.113 883.10.20. 22.4.89"
	12239	/>
	12240
	12241	<participa ntRole>
	12242
	12243	<id
	12244	extension= "DFG876549 "
	12245	root="2.16 .840.1.113 883.4.349"
	12246	/>
	12247
	12248	<!-- 5.09 PATIENT RE LATIONSHIP TO SUBSCR IBER, REQU IRED, HL7 Coverage
	12249	Role Type -->
	12250
	12251	<code
	12252	code="SELF "
	12253	codeSystem ="2.16.840 .1.113883. 5.111"
	12254	codeSystem Name="Role Code"
	12255	displayNam e="self"
	12256	>
	12257
	12258	<originalT ext>
	12259
	12260	<reference
	12261	value="#in sRelations hip1001"
	12262	/>
	12263
	12264	</original Text>
	12265
	12266	</code>
	12267
	12268	<playingEn tity>
	12269
	12270	<!-- 5.12 PATIENT NA ME, REQUIR ED -->
	12271
	12272	<name
	12273	use="L"
	12274	>
	12275
	12276
	12277	<given>
	12278	NWHINONE
	12279	</given>
	12280
	12281	<family>
	12282	NWHINZZZTE STPATIENT
	12283	</family>
	12284
	12285
	12286	</name>
	12287
	12288	<!-- 5.13 PATIENT DA TE OF BIRT H, R2 -->
	12289
	12290	<sdtc:birt hTime
	12291	nullFlavor ="UNK"
	12292	/>
	12293
	12294	</playingE ntity>
	12295
	12296	</particip antRole>
	12297
	12298	</particip ant>
	12299
	12300
	12301	<!-- 5.24 HEALTH PLA N NAME, op tional -->
	12302
	12303	<entryRela tionship
	12304	typeCode=" REFR"
	12305	>
	12306
	12307	<act
	12308	classCode= "ACT"
	12309	moodCode=" DEF"
	12310	>
	12311
	12312	<id
	12313	extension= "PART A"
	12314	root="2.16 .840.1.113 883.4.349"
	12315	/>
	12316
	12317	<code
	12318	nullFlavor ="NA"
	12319	/>
	12320
	12321	<text>
	12322	MEDICARE ( M)
	12323	</text>
	12324
	12325	</act>
	12326
	12327	</entryRel ationship>
	12328
	12329	</act>
	12330
	12331	</entryRel ationship>
	12332
	12333	</act>
	12334
	12335	</entry>
	12336	<entry>
	12337
	12338	<act
	12339	classCode= "ACT"
	12340	moodCode=" EVN"
	12341	>
	12342
	12343	<templateI d
	12344	root="2.16 .840.1.113 883.10.20. 22.4.60"
	12345	/>
	12346
	12347	<id
	12348	nullFlavor ="NA"
	12349	/>
	12350
	12351	<code
	12352	code="4876 8-6"
	12353	codeSystem ="2.16.840 .1.113883. 6.1"
	12354	codeSystem Name="LOIN C"
	12355	displayNam e="Payment Sources"
	12356	/>
	12357
	12358	<statusCod e
	12359	code="comp leted"
	12360	/>
	12361
	12362	<!-- CCD P ayment Pro vider Even t Entry -- >
	12363
	12364	<entryRela tionship
	12365	typeCode=" COMP"
	12366	>
	12367
	12368	<act
	12369	classCode= "ACT"
	12370	moodCode=" EVN"
	12371	>
	12372
	12373	<templateI d
	12374	root="2.16 .840.1.113 883.10.20. 22.4.61"
	12375	/>
	12376
	12377	<!-- 5.01 GROUP NUMB ER, REQUIR ED -->
	12378
	12379	<id
	12380	extension= "PART B"
	12381	root="2.16 .840.1.113 883.4.349"
	12382	/>
	12383
	12384	<!-- 5.02 HEALTH INS URANCE TYP E, REQURIE D -->
	12385
	12386	<code
	12387	code="33"
	12388	codeSystem ="2.16.840 .1.113883. 6.255.1336 "
	12389	codeSystem Name="X12N -1336"
	12390	displayNam e="MEDICAR E (M)"
	12391	/>
	12392
	12393	<statusCod e
	12394	code="comp leted"
	12395	/>
	12396
	12397	<!-- 5.07 - Health P lan Covera ge Dates, R2-Optiona l -->
	12398
	12399	<effective Time>
	12400
	12401	<!-- 5.07 VistA Poli cy Effecti ve Date -- >
	12402
	12403	<low
	12404	value="201 50114"
	12405	/>
	12406
	12407	<!-- 5.07 VistA Poli cy Expirat ion Date -->
	12408
	12409	<high/>
	12410
	12411	</effectiv eTime>
	12412
	12413	<performer
	12414	typeCode=" PRF"
	12415	>
	12416
	12417	<templateI d
	12418	root="2.16 .840.1.113 883.10.20. 22.4.87"
	12419	/>
	12420
	12421	<!-- CCD P ayer Info -->
	12422
	12423	<assignedE ntity>
	12424
	12425	<!-- 5.03 HEALTH PLA N INSURANC E INFO SOU RCE ID, RE QUIRED -->
	12426
	12427	<id
	12428	root="2.16 .840.1.113 883.4.349"
	12429	/>
	12430
	12431	<code/>
	12432
	12433	<!-- 5.04 HEALTH PLA N INSURANC E INFO SOU RCE ADDRES S, Optiona l -->
	12434
	12435	<addr>
	12436
	12437	<streetAdd ressLine>
	12438	WILL NOT R EIMBURSE
	12439	</streetAd dressLine>
	12440
	12441
	12442
	12443	<state/>
	12444
	12445	<postalCod e/>
	12446
	12447	</addr>
	12448
	12449	<!-- 5.05 HEALTH PLA N INSURANC E INFO SOU RCE PHONE/ EMAIL/URL, Optional -->
	12450
	12451
	12452	<represent edOrganiza tion>
	12453
	12454	<!-- 5.06 HEALTH PLA N INSURANC E INFO SOU RCE NAME ( Insurance
	12455	Compan y Name), R 2 -->
	12456
	12457	<name>
	12458	MEDICARE ( WNR)
	12459	</name>
	12460
	12461	<addr/>
	12462
	12463	</represen tedOrganiz ation>
	12464
	12465	</assigned Entity>
	12466
	12467	</performe r>
	12468
	12469	<author>
	12470
	12471	<time
	12472	nullFlavor ="UNK"
	12473	/>
	12474
	12475	<assignedA uthor>
	12476
	12477	<id
	12478	nullFlavor ="NI"
	12479	/>
	12480
	12481	<represent edOrganiza tion>
	12482
	12483	<id
	12484	extension= "983"
	12485	root="2.16 .840.1.113 883.4.349"
	12486	/>
	12487
	12488	<!-- INFOR MATION SOU RCE NAME, name=VAMC TREATING F ACILITY NA ME -->
	12489
	12490	<name>
	12491	CHYSHR TES T LAB
	12492	</name>
	12493
	12494	<telecom
	12495	nullFlavor ="NA"
	12496	/>
	12497
	12498	<addr
	12499	nullFlavor ="NA"
	12500	/>
	12501
	12502	</represen tedOrganiz ation>
	12503
	12504	</assigned Author>
	12505
	12506	</author>
	12507
	12508	<participa nt
	12509	typeCode=" COV"
	12510	>
	12511
	12512	<templateI d
	12513	root="2.16 .840.1.113 883.10.20. 22.4.89"
	12514	/>
	12515
	12516	<participa ntRole>
	12517
	12518	<id
	12519	extension= "DFG876549 "
	12520	root="2.16 .840.1.113 883.4.349"
	12521	/>
	12522
	12523	<!-- 5.09 PATIENT RE LATIONSHIP TO SUBSCR IBER, REQU IRED, HL7 Coverage
	12524	Role Type -->
	12525
	12526	<code
	12527	code="SELF "
	12528	codeSystem ="2.16.840 .1.113883. 5.111"
	12529	codeSystem Name="Role Code"
	12530	displayNam e="self"
	12531	>
	12532
	12533	<originalT ext>
	12534
	12535	<reference
	12536	value="#in sRelations hip1002"
	12537	/>
	12538
	12539	</original Text>
	12540
	12541	</code>
	12542
	12543	<playingEn tity>
	12544
	12545	<!-- 5.12 PATIENT NA ME, REQUIR ED -->
	12546
	12547	<name
	12548	use="L"
	12549	>
	12550
	12551
	12552	<given>
	12553	NWHINONE
	12554	</given>
	12555
	12556	<family>
	12557	NWHINZZZTE STPATIENT
	12558	</family>
	12559
	12560
	12561	</name>
	12562
	12563	<!-- 5.13 PATIENT DA TE OF BIRT H, R2 -->
	12564
	12565	<sdtc:birt hTime
	12566	nullFlavor ="UNK"
	12567	/>
	12568
	12569	</playingE ntity>
	12570
	12571	</particip antRole>
	12572
	12573	</particip ant>
	12574
	12575
	12576	<!-- 5.24 HEALTH PLA N NAME, op tional -->
	12577
	12578	<entryRela tionship
	12579	typeCode=" REFR"
	12580	>
	12581
	12582	<act
	12583	classCode= "ACT"
	12584	moodCode=" DEF"
	12585	>
	12586
	12587	<id
	12588	extension= "PART B"
	12589	root="2.16 .840.1.113 883.4.349"
	12590	/>
	12591
	12592	<code
	12593	nullFlavor ="NA"
	12594	/>
	12595
	12596	<text>
	12597	MEDICARE ( M)
	12598	</text>
	12599
	12600	</act>
	12601
	12602	</entryRel ationship>
	12603
	12604	</act>
	12605
	12606	</entryRel ationship>
	12607
	12608	</act>
	12609
	12610	</entry>
	12611
	12612	</section>
	12613
	12614	</componen t>
	12615
	12616	<component >
	12617
	12618	<!-- *** ****** ****** ****** ****** ******** * ADVANCED
	12619	DIRECTIVE SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	12620
	12621	<section>
	12622
	12623	<!-- C-CDA Advanced Directive Section Te mplate Ent ries REQUI RED -->
	12624
	12625	<templateI d
	12626	root="2.16 .840.1.113 883.10.20. 22.2.21.1"
	12627	/>
	12628
	12629	<templateI d
	12630	root="2.16 .840.1.113 883.10.20. 22.2.21"
	12631	/>
	12632
	12633	<code
	12634	code="4234 8-3"
	12635	codeSystem ="2.16.840 .1.113883. 6.1"
	12636	codeSystem Name="LOIN C"
	12637	displayNam e="Advance Directive s"
	12638	/>
	12639
	12640	<title>
	12641	Advance Di rectives
	12642	</title>
	12643
	12644	<!-- ADVAN CED DIRECT IVES NARRA TIVE BLOCK -->
	12645
	12646	<text>
	12647
	12648	<paragraph >
	12649	This secti on contain s ALL of a patient's completed or amende d
	12650	VA A dvance and Rescinded Directive s. Entries below ind icate that
	12651	a di rective ex ists for t he patient , but an a ctual copy is not
	12652	incl uded with this docum ent.
	12653	</paragrap h>
	12654
	12655	<table
	12656	ID="advanc edirective snarrative "
	12657	border="1"
	12658	width="100 %"
	12659	>
	12660
	12661	<thead>
	12662
	12663	<tr>
	12664
	12665	<th>
	12666	Date
	12667	</th>
	12668
	12669	<th>
	12670	Advance Di rectives
	12671	</th>
	12672
	12673	<th>
	12674	Provider
	12675	</th>
	12676
	12677	<th>
	12678	Source
	12679	</th>
	12680
	12681	</tr>
	12682
	12683	</thead>
	12684
	12685	<tbody>
	12686
	12687	<tr>
	12688
	12689	<td>
	12690	Jan 15, 20 15
	12691	</td>
	12692
	12693
	12694	<td>
	12695
	12696	<content
	12697	ID="advanc eDirective 1001"
	12698	>
	12699	ADVANCE DI RECTIVE
	12700	</content>
	12701
	12702	</td>
	12703
	12704	<td>
	12705
	12706	<content
	12707	ID="advDir Provider10 01"
	12708	>
	12709	FORREST,ZA CHARY H
	12710	</content>
	12711
	12712	</td>
	12713
	12714	<td>
	12715
	12716	<content
	12717	ID="advDir Source1001 "
	12718	>
	12719	CHEYENNE V AMC
	12720	</content>
	12721
	12722	</td>
	12723
	12724	</tr>
	12725
	12726	</tbody>
	12727
	12728	</table>
	12729
	12730	</text>
	12731
	12732	<!-- ADVAN CED DIRECT IVES STRUC TURED DATA -->
	12733
	12734	<entry>
	12735
	12736	<!-- CCD A dvanced Di rective Ob servation, R2 -->
	12737
	12738	<observati on
	12739	classCode= "OBS"
	12740	moodCode=" EVN"
	12741	>
	12742
	12743	<templateI d
	12744	root="2.16 .840.1.113 883.10.20. 22.4.48"
	12745	/>
	12746
	12747	<id
	12748	nullFlavor ="NA"
	12749	/>
	12750
	12751	<!-- 12.01 ADVANCED DIRECTIVE TYPE, REQU IRED, SNOM ED CT -->
	12752
	12753	<code
	12754	codeSystem ="2.16.840 .1.113883. 6.96"
	12755	codeSystem Name="SNOM ED CT"
	12756	nullFlavor ="UNK"
	12757	>
	12758
	12759	<originalT ext>
	12760
	12761	<reference
	12762	value="#ad vanceDirec tive1001"
	12763	/>
	12764
	12765	</original Text>
	12766
	12767	</code>
	12768
	12769	<statusCod e
	12770	code="comp leted"
	12771	/>
	12772
	12773	<!-- 12.03 ADVANCED DIRECTIVE EFFECTIVE DATE, REQU IRED -->
	12774
	12775	<effective Time>
	12776
	12777	<!-- ADVAN CED DIRECT IVE EFFECT IVE DATE l ow = start ing time, REQUIRED - ->
	12778
	12779	<low
	12780	value="201 501151136"
	12781	/>
	12782
	12783	<!-- ADVAN CED DIRECT IVE EFFECT IVE DATE h igh= endin g time, RE QUIRED -->
	12784
	12785	<high
	12786	nullFlavor ="NA"
	12787	/>
	12788
	12789	</effectiv eTime>
	12790
	12791
	12792	<author>
	12793
	12794	<time
	12795	nullFlavor ="UNK"
	12796	/>
	12797
	12798	<assignedA uthor>
	12799
	12800	<id
	12801	nullFlavor ="UNK"
	12802	/>
	12803
	12804	<represent edOrganiza tion>
	12805
	12806	<id
	12807	root="2.16 .840.1.113 883.4.349"
	12808	/>
	12809
	12810	<name/>
	12811
	12812	</represen tedOrganiz ation>
	12813
	12814	</assigned Author>
	12815
	12816	</author>
	12817
	12818
	12819	<participa nt
	12820	typeCode=" VRF"
	12821	>
	12822
	12823	<time/>
	12824
	12825	<participa ntRole>
	12826
	12827	<addr
	12828	nullFlavor ="NA"
	12829	/>
	12830
	12831	<!-- VERIF IER PHONE/ EMAIL/URL, R2 -->
	12832
	12833	<telecom
	12834	nullFlavor ="NA"
	12835	/>
	12836
	12837	<playingEn tity>
	12838
	12839	<!-- VERIF IER NAME, RQUIRED -- >
	12840
	12841	<name>
	12842	Department of Vetera ns Affairs
	12843	</name>
	12844
	12845	</playingE ntity>
	12846
	12847	</particip antRole>
	12848
	12849	</particip ant>
	12850
	12851	<!-- CUSTO DIAN OF DO CUMENT, RE QUIRED -->
	12852
	12853	<participa nt
	12854	typeCode=" CST"
	12855	>
	12856
	12857	<participa ntRole
	12858	classCode= "AGNT"
	12859	>
	12860
	12861	<!-- CUSTO DIAN ADDRE SS, R2 -->
	12862
	12863	<addr>
	12864	810 Vermon t Avenue N W Washingt on, DC 204 20
	12865	</addr>
	12866
	12867	<!-- CUSTO DIAN PHONE ?EMAIL/URL , R2 -->
	12868
	12869	<telecom
	12870	nullFlavor ="NA"
	12871	/>
	12872
	12873	<playingEn tity>
	12874
	12875	<!-- CUSTO DIAN NAME, REQUIRED -->
	12876
	12877	<name>
	12878	FORREST,ZA CHARY H
	12879	</name>
	12880
	12881	</playingE ntity>
	12882
	12883	</particip antRole>
	12884
	12885	</particip ant>
	12886
	12887
	12888
	12889
	12890	<!-- ADVAN CED DIRECT IVE REFERE NCE, R2, n ot provide d by VA -- >
	12891
	12892
	12893	</observat ion>
	12894
	12895	</entry>
	12896
	12897	</section>
	12898
	12899	</componen t>
	12900
	12901	<component >
	12902
	12903	<!-- *** ****** ****** ****** ****** ****** *******
	12904	MEDICATION S (RX & No n-RX) SECT ION, REQUI RED **** ****** ****** ****** ****** ****** ****** - ->
	12905
	12906	<section>
	12907
	12908	<!-- C-CDA Medicatio ns Section Template Entries RE QUIRED -->
	12909
	12910	<templateI d
	12911	root="2.16 .840.1.113 883.10.20. 22.2.1.1"
	12912	/>
	12913
	12914	<templateI d
	12915	root="2.16 .840.1.113 883.10.20. 22.2.1"
	12916	/>
	12917
	12918	<code
	12919	code="1016 0-0"
	12920	codeSystem ="2.16.840 .1.113883. 6.1"
	12921	codeSystem Name="LOIN C"
	12922	displayNam e="History of medica tion use"
	12923	/>
	12924
	12925	<title>
	12926	Medication s Section
	12927	</title>
	12928
	12929	<!-- MEDIC ATIONS NAR RATIVE BLO CK -->
	12930
	12931	<text>
	12932
	12933	<!-- VA Me dication B usiness Ru les for Me dical Cont ent -->
	12934
	12935	<paragraph >
	12936	This secti on contain s Prescrip tion and N on-Prescri ption
	12937	Medi cations on record at VA for th e patient. Data come s from all
	12938	VA t reatment f acilities. It shows all medica tions disp ensed
	12939	with in the las t 15 month s. The lis t includes the presc ription
	12940	stat us as acti ve or non- active.
	12941	</paragrap h>
	12942
	12943	<table
	12944	ID="medica tionNarrat ive"
	12945	border="1"
	12946	width="100 %"
	12947	>
	12948
	12949	<thead>
	12950
	12951	<tr>
	12952
	12953	<th>
	12954	Medication
	12955	</th>
	12956
	12957	<th>
	12958	Status
	12959	</th>
	12960
	12961	<th>
	12962	Quantity
	12963	</th>
	12964
	12965	<th>
	12966	Order Numb er
	12967	</th>
	12968
	12969	<th>
	12970	Order Expi ration
	12971	</th>
	12972
	12973	<th>
	12974	Ordering P rovider
	12975	</th>
	12976
	12977	<th>
	12978	Rx Number
	12979	</th>
	12980
	12981	<th>
	12982	Last Fille d
	12983	</th>
	12984
	12985	<th>
	12986	Sig
	12987	</th>
	12988
	12989	<th>
	12990	Source
	12991	</th>
	12992
	12993	</tr>
	12994
	12995	</thead>
	12996
	12997	<tbody>
	12998
	12999	<tr>
	13000
	13001	<td>
	13002
	13003	<content
	13004	ID="mndMed ication100 1"
	13005	>
	13006	SERTRALINE HCL 25MG TAB
	13007	</content>
	13008
	13009	</td>
	13010
	13011	<td>
	13012
	13013	<content
	13014	ID="mndSta tus1001"
	13015	>
	13016	Active
	13017	</content>
	13018
	13019	</td>
	13020
	13021	<td>
	13022
	13023	<content
	13024	ID="mndQua ntity1001"
	13025	/>
	13026
	13027	</td>
	13028
	13029	<td>
	13030
	13031	<content
	13032	ID="mndOrd erNumber10 01"
	13033	>
	13034	12980368
	13035	</content>
	13036
	13037	</td>
	13038
	13039	<td/>
	13040
	13041
	13042	<td>
	13043
	13044	<content
	13045	ID="mndPro vider1001"
	13046	>
	13047	ANKOLKAR,I RFAN
	13048	</content>
	13049
	13050	</td>
	13051
	13052	<td>
	13053
	13054	<content
	13055	ID="mndPre scription1 001"
	13056	/>
	13057
	13058	</td>
	13059
	13060	<td/>
	13061
	13062
	13063	<td>
	13064
	13065	<content
	13066	ID="mndSig 1001"
	13067	>
	13068	TAKE ONE T ABLET BY M OUTH MO-TU -WE-TH-FR@ 0700
	13069	</content>
	13070
	13071	</td>
	13072
	13073	<td>
	13074
	13075	<content
	13076	ID="mndSou rce1001"
	13077	>
	13078	DAYTON
	13079	</content>
	13080
	13081	</td>
	13082
	13083	</tr>
	13084	<tr>
	13085
	13086	<td>
	13087
	13088	<content
	13089	ID="mndMed ication100 2"
	13090	>
	13091	ACETAMINOP HEN ELIXIR
	13092	</content>
	13093
	13094	</td>
	13095
	13096	<td>
	13097
	13098	<content
	13099	ID="mndSta tus1002"
	13100	>
	13101	Active
	13102	</content>
	13103
	13104	</td>
	13105
	13106	<td>
	13107
	13108	<content
	13109	ID="mndQua ntity1002"
	13110	>
	13111	1
	13112	</content>
	13113
	13114	</td>
	13115
	13116	<td>
	13117
	13118	<content
	13119	ID="mndOrd erNumber10 02"
	13120	>
	13121	2675799
	13122	</content>
	13123
	13124	</td>
	13125
	13126	<td>
	13127	Mar 29, 20 17
	13128	</td>
	13129
	13130
	13131	<td>
	13132
	13133	<content
	13134	ID="mndPro vider1002"
	13135	>
	13136	BODDULURI, PADMA
	13137	</content>
	13138
	13139	</td>
	13140
	13141	<td>
	13142
	13143	<content
	13144	ID="mndPre scription1 002"
	13145	>
	13146	762993
	13147	</content>
	13148
	13149	</td>
	13150
	13151	<td>
	13152	Mar 28, 20 16
	13153	</td>
	13154
	13155
	13156	<td>
	13157
	13158	<content
	13159	ID="mndSig 1002"
	13160	>
	13161	TAKE 5MG B Y MOUTH EV ERY FOUR H OURS AS NE EDED
	13162	</content>
	13163
	13164	</td>
	13165
	13166	<td>
	13167
	13168	<content
	13169	ID="mndSou rce1002"
	13170	>
	13171	CHEYENNE V AMC
	13172	</content>
	13173
	13174	</td>
	13175
	13176	</tr>
	13177	<tr>
	13178
	13179	<td>
	13180
	13181	<content
	13182	ID="mndMed ication100 3"
	13183	>
	13184	DOXYCYCLIN E CAP,ORAL
	13185	</content>
	13186
	13187	</td>
	13188
	13189	<td>
	13190
	13191	<content
	13192	ID="mndSta tus1003"
	13193	>
	13194	Active
	13195	</content>
	13196
	13197	</td>
	13198
	13199	<td>
	13200
	13201	<content
	13202	ID="mndQua ntity1003"
	13203	/>
	13204
	13205	</td>
	13206
	13207	<td>
	13208
	13209	<content
	13210	ID="mndOrd erNumber10 03"
	13211	>
	13212	2675826
	13213	</content>
	13214
	13215	</td>
	13216
	13217	<td/>
	13218
	13219
	13220	<td>
	13221
	13222	<content
	13223	ID="mndPro vider1003"
	13224	>
	13225	SWALL,MARI E
	13226	</content>
	13227
	13228	</td>
	13229
	13230	<td>
	13231
	13232	<content
	13233	ID="mndPre scription1 003"
	13234	/>
	13235
	13236	</td>
	13237
	13238	<td/>
	13239
	13240
	13241	<td>
	13242
	13243	<content
	13244	ID="mndSig 1003"
	13245	>
	13246	TAKE 2 CAP SULES BY M OUTH TWICE A DAY
	13247	</content>
	13248
	13249	</td>
	13250
	13251	<td>
	13252
	13253	<content
	13254	ID="mndSou rce1003"
	13255	>
	13256	CHEYENNE V AMC
	13257	</content>
	13258
	13259	</td>
	13260
	13261	</tr>
	13262
	13263	</tbody>
	13264
	13265	</table>
	13266
	13267	</text>
	13268
	13269	<!-- MEDIC ATIONS STR UCTURED DA TA -->
	13270
	13271	<!-- CCD M edication Activity E ntry -->
	13272
	13273	<entry>
	13274
	13275	<substance Administra tion
	13276	classCode= "SBADM"
	13277	moodCode=" EVN"
	13278	>
	13279
	13280	<templateI d
	13281	root="2.16 .840.1.113 883.10.20. 22.4.16"
	13282	/>
	13283
	13284	<id
	13285	nullFlavor ="UNK"
	13286	/>
	13287
	13288	<id
	13289	assigningA uthorityNa me="Depart ment of Ve terans Aff airs"
	13290	extension= "nullFlavo r"
	13291	root="2.16 .840.1.113 883.4.349"
	13292	/>
	13293
	13294	<!-- 8.12 DELIVERY M ETHOD, Opt ional, No value set defined, N ot provide d
	13295	by VA b/c data f rom VA Vis tA RPCs no t yet avai lable -->
	13296
	13297	<!-- 8.01 FREE TEXT SIG REFERE NCE, Optio nal -->
	13298
	13299	<text>
	13300
	13301	<reference
	13302	value="#mn dSig1001"
	13303	/>
	13304
	13305	</text>
	13306
	13307	<statusCod e
	13308	code="comp leted"
	13309	/>
	13310
	13311	<effective Time
	13312	xsi:type=" IVL_TS"
	13313	>
	13314
	13315	<low
	13316	nullFlavor ="UNK"
	13317	/>
	13318
	13319	<!-- INDIC ATE MEDICA TION STOPP PED, high= Indicate M edication Stopped,
	13320	Optional -->
	13321
	13322	<high
	13323	nullFlavor ="UNK"
	13324	/>
	13325
	13326	</effectiv eTime>
	13327
	13328	<!-- 8.02 INDICATE M EDICATION STOPPPED, Optional, Removed b/ c data
	13329	not ye t availabl e via VA V istA RPCs -->
	13330
	13331	<!-- 8.03 ADMINISTRA TION TIMIN G (xsi:typ e='EIVL' o perator='A '), Option al,
	13332	Not pr ovided by VA b/c dat a not yet available via VA Vis tA RPCs -- >
	13333
	13334	<!-- 8.04 FREQUENCY (xsi:type= 'PIVL_TS i nstitution Specified= 'false'
	13335	operat or='A''), Optional, Not provid ed by VA b /c data no t yet avai lable via
	13336	VA Vis tA RPCs -- >
	13337
	13338	<!--8.05 I NTERVAL ( xsi:type=' PIVL_TS' i nstitution Specified= 'false'
	13339	operat or='A'), O ptional,No t provided by VA b/c data not yet availa ble via
	13340	VA Vis tA RPCs -- >
	13341
	13342	<!--8.06 D URATION ( xsi:type=' PIVL_TS' o perator='A '), Option al, Not
	13343	provid ed by VA b /c data no t yet avai lable via VA VistA R PCs -->
	13344
	13345	<!-- 8.08 DOSE, Opti onal, Not provided b y VA b/c d ata not ye t availabl e
	13346	via VA VistA RPC s -->
	13347
	13348	<doseQuant ity
	13349	nullFlavor ="UNK"
	13350	/>
	13351
	13352	<consumabl e>
	13353
	13354	<manufactu redProduct
	13355	classCode= "MANU"
	13356	>
	13357
	13358	<templateI d
	13359	root="2.16 .840.1.113 883.10.20. 22.4.23"
	13360	/>
	13361
	13362	<manufactu redMateria l>
	13363
	13364	<!-- 8.13 CODED PROD UCT NAME, REQUIRED, UNII, RxNo rm, NDF-RT , NDC,
	13365	No t provided by VA b/c data not yet availa ble via VA VistA RPC s -->
	13366
	13367	<code
	13368	code="3129 40"
	13369	codeSystem ="2.16.840 .1.113883. 6.88"
	13370	codeSystem Name="RxNo rm"
	13371	displayNam e="Sertral ine 25 MG Oral Table t"
	13372	>
	13373
	13374	<!-- 8.14 CODED BRAN D NAME, R2 , Not prov ided by VA b/c data not
	13375	yet available via VA Vis tA RPCs -- >
	13376
	13377	<!-- 8.15 FREE TEXT PRODUCT NA ME, REQUIR ED -->
	13378
	13379	<originalT ext>
	13380
	13381	<reference
	13382	value="#mn dMedicatio n1001"
	13383	/>
	13384
	13385	</original Text>
	13386
	13387	<translati on
	13388	code="4010 125"
	13389	codeSystem ="2.16.840 .1.113883. 6.233"
	13390	codeSystem Name="VHA Enterprise Reference Terminolo gy"
	13391	displayNam e="SERTRAL INE 25MG T AB "
	13392	/>
	13393
	13394	</code>
	13395
	13396	<!-- 8.16 FREE TEXT BRAND NAME , R2, Not provided b y VA b/c d ata
	13397	no t yet avai lable via VA VistA R PCs -->
	13398
	13399	</manufact uredMateri al>
	13400
	13401	</manufact uredProduc t>
	13402
	13403	</consumab le>
	13404
	13405	<!-- Infor mation Sou rce for Me dication E ntry, Opti onal -->
	13406
	13407	<author>
	13408
	13409	<time
	13410	nullFlavor ="UNK"
	13411	/>
	13412
	13413	<assignedA uthor>
	13414
	13415	<id
	13416	nullFlavor ="NI"
	13417	/>
	13418
	13419	<assignedP erson>
	13420
	13421	<name/>
	13422
	13423	</assigned Person>
	13424
	13425	<represent edOrganiza tion>
	13426
	13427	<id
	13428	extension= "552"
	13429	root="2.16 .840.1.113 883.4.349"
	13430	/>
	13431
	13432	<name>
	13433	DAYTON
	13434	</name>
	13435
	13436	<telecom
	13437	nullFlavor ="NA"
	13438	/>
	13439
	13440	<addr
	13441	nullFlavor ="NA"
	13442	/>
	13443
	13444	</represen tedOrganiz ation>
	13445
	13446	</assigned Author>
	13447
	13448	</author>
	13449
	13450
	13451	<!-- 8.20- STATUS OF MEDICATION , Optional -R2, SNOME D CT -->
	13452
	13453	<entryRela tionship
	13454	typeCode=" REFR"
	13455	>
	13456
	13457	<!--To Ide ntify Stat us -->
	13458
	13459	<observati on
	13460	classCode= "OBS"
	13461	moodCode=" EVN"
	13462	>
	13463
	13464	<templateI d
	13465	root="2.16 .840.1.113 883. IP "
	13466	/>
	13467
	13468	<code
	13469	code="3399 9-4"
	13470	codeSystem ="2.16.840 .1.113883. 6.1"
	13471	codeSystem Name="LOIN C"
	13472	displayNam e="Status"
	13473	/>
	13474
	13475	<value
	13476	code="acti ve"
	13477	codeSystem ="2.16.840 .1.113883. 6.96"
	13478	codeSystem Name="SNOM ED CT"
	13479	displayNam e="Active"
	13480	xsi:type=" CE"
	13481	>
	13482
	13483	<originalT ext>
	13484	ACTIVE
	13485	</original Text>
	13486
	13487	</value>
	13488
	13489	</observat ion>
	13490
	13491	</entryRel ationship>
	13492
	13493	<!-- CCD P atient Ins tructions Entry, Opt ional -->
	13494
	13495
	13496	<entryRela tionship
	13497	typeCode=" SUBJ"
	13498	>
	13499
	13500	<observati on
	13501	classCode= "OBS"
	13502	moodCode=" EVN"
	13503	>
	13504
	13505	<!-- VLER SEG 1B: 8. 19-TYPE OF MEDICATIO N, Optiona l-R2, SNOM ED CT -->
	13506
	13507	<code
	13508	code="3295 05003"
	13509	codeSystem ="2.16.840 .1.113883. 6.96"
	13510	codeSystem Name="SNOM ED CT"
	13511	displayNam e="Over th e counter products"
	13512	>
	13513
	13514	<originalT ext>
	13515	OTC
	13516	</original Text>
	13517
	13518	</code>
	13519
	13520	<statusCod e
	13521	code="comp leted"
	13522	/>
	13523
	13524	</observat ion>
	13525
	13526	</entryRel ationship>
	13527
	13528
	13529	<entryRela tionship
	13530	inversionI nd="true"
	13531	typeCode=" SUBJ"
	13532	>
	13533
	13534	<act
	13535	classCode= "ACT"
	13536	moodCode=" INT"
	13537	>
	13538
	13539	<templateI d
	13540	root="2.16 .840.1.113 883.10.20. 22.4.20"
	13541	/>
	13542
	13543	<code
	13544	codeSystem ="2.16.840 .1.113883. 6.96"
	13545	codeSystem Name="SNOM ED CT"
	13546	/>
	13547
	13548	<statusCod e
	13549	code="comp leted"
	13550	/>
	13551
	13552	</act>
	13553
	13554	</entryRel ationship>
	13555
	13556	<!-- CCD D rug Vehicl e Entry, O ptional, N ot provide d by VA b/ c data
	13557	not ye t availabl e via VA V istA RPCs -->
	13558
	13559	<!-- 8.24 VEHICLE, O ptional, N ot provide d by VA b/ c data not yet avail able
	13560	via VA VistA RPC s -->
	13561
	13562	<!-- CCD I ndication Entry, Opt ional, Not provided by VA b/c data not
	13563	yet av ailable vi a VA VistA RPCs -->
	13564
	13565	<!-- 8.21 INDICATION VALUE, Op tional, SN OMED CT, N ot provide d by VA
	13566	b/c da ta not yet available via VA Vi stA RPCs - ->
	13567
	13568	<!-- CCD M edication Supply Ord er Entry, REQUIRED - ->
	13569
	13570	<entryRela tionship
	13571	typeCode=" REFR"
	13572	>
	13573
	13574	<supply
	13575	classCode= "SPLY"
	13576	moodCode=" INT"
	13577	>
	13578
	13579	<templateI d
	13580	root="2.16 .840.1.113 883.10.20. 22.4.17"
	13581	/>
	13582
	13583	<!-- VLER SEG 1B: 8. 26 ORDER N UMBER, Opt ional-R2 - ->
	13584
	13585	<id
	13586	extension= "12980368"
	13587	root="2.16 .840.1.113 883.4.349"
	13588	/>
	13589
	13590	<statusCod e
	13591	code="comp leted"
	13592	/>
	13593
	13594	<!-- 8.29 ORDER EXPI RATION DAT E/TIME, Op tional-R2 -->
	13595
	13596	<effective Time
	13597	xsi:type=" IVL_TS"
	13598	>
	13599
	13600	<high
	13601	nullFlavor ="UNK"
	13602	/>
	13603
	13604	</effectiv eTime>
	13605
	13606	<!-- VLER SEG 1B: 8. 27 FILLS, Optional - ->
	13607
	13608	<repeatNum ber
	13609	nullFlavor ="UNK"
	13610	/>
	13611
	13612	<!-- 8.28 QUANTITY O RDERED, R2 , Not prov ided by VA b/c data not
	13613	yet availa ble via VA VistA RPC s -->
	13614
	13615	<quantity
	13616	nullFlavor ="UNK"
	13617	/>
	13618
	13619	<product>
	13620
	13621	<manufactu redProduct
	13622	classCode= "MANU"
	13623	>
	13624
	13625	<templateI d
	13626	root="2.16 .840.1.113 883.10.20. 22.4.23"
	13627	/>
	13628
	13629	<manufactu redMateria l>
	13630
	13631	<code
	13632	code="3129 40"
	13633	codeSystem ="2.16.840 .1.113883. 6.88"
	13634	codeSystem Name="RxNo rm"
	13635	displayNam e="Sertral ine 25 MG Oral Table t"
	13636	>
	13637
	13638
	13639	</code>
	13640
	13641	</manufact uredMateri al>
	13642
	13643	</manufact uredProduc t>
	13644
	13645	</product>
	13646
	13647	<author>
	13648
	13649	<!-- 8.30 ORDER DATE /TIME, Opt ional -->
	13650
	13651	<time
	13652	value="201 210301110"
	13653	/>
	13654
	13655	<assignedA uthor>
	13656
	13657	<id
	13658	nullFlavor ="NI"
	13659	/>
	13660
	13661	<assignedP erson>
	13662
	13663	<!-- 8.31 ORDERING P ROVIDER, O ptional -- >
	13664
	13665	<name>
	13666	ANKOLKAR,I RFAN
	13667	</name>
	13668
	13669	</assigned Person>
	13670
	13671	</assigned Author>
	13672
	13673	</author>
	13674
	13675	</supply>
	13676
	13677	</entryRel ationship>
	13678
	13679	<!-- FULFI LLMENT HIS TORY INFOR MATION -->
	13680
	13681	<!-- CCD M edication Dispense E ntry, Opti onal -->
	13682
	13683
	13684	</substanc eAdministr ation>
	13685
	13686	<!-- 8.23 REACTION O BSERVATION Entry, Op tional, No t provided by VA
	13687	b/c data not y et availab le via VA VistA RPCs -->
	13688
	13689	<!-- CCD P RECONDITIO N FOR SUBS TANCE ADMI NISTRATION ENTRY, Op tional,
	13690	Not provided b y VA b/c d ata not ye t availabl e via VA V istA RPCs -->
	13691
	13692	<!--8.25 D OSE INDICA TOR, Optio nal, Not p rovided by VA b/c da ta not
	13693	yet available via VA Vis tA RPCs -- >
	13694
	13695	</entry>
	13696	<entry>
	13697
	13698	<substance Administra tion
	13699	classCode= "SBADM"
	13700	moodCode=" EVN"
	13701	>
	13702
	13703	<templateI d
	13704	root="2.16 .840.1.113 883.10.20. 22.4.16"
	13705	/>
	13706
	13707	<id
	13708	nullFlavor ="UNK"
	13709	/>
	13710
	13711	<id
	13712	assigningA uthorityNa me="Depart ment of Ve terans Aff airs"
	13713	extension= "nullFlavo r"
	13714	root="2.16 .840.1.113 883.4.349"
	13715	/>
	13716
	13717	<!-- 8.12 DELIVERY M ETHOD, Opt ional, No value set defined, N ot provide d
	13718	by VA b/c data f rom VA Vis tA RPCs no t yet avai lable -->
	13719
	13720	<!-- 8.01 FREE TEXT SIG REFERE NCE, Optio nal -->
	13721
	13722	<text>
	13723
	13724	<reference
	13725	value="#mn dSig1002"
	13726	/>
	13727
	13728	</text>
	13729
	13730	<statusCod e
	13731	code="comp leted"
	13732	/>
	13733
	13734	<effective Time
	13735	xsi:type=" IVL_TS"
	13736	>
	13737
	13738	<low
	13739	value="201 60328"
	13740	/>
	13741
	13742	<!-- INDIC ATE MEDICA TION STOPP PED, high= Indicate M edication Stopped,
	13743	Optional -->
	13744
	13745	<high
	13746	value="201 70329"
	13747	/>
	13748
	13749	</effectiv eTime>
	13750
	13751	<!-- 8.02 INDICATE M EDICATION STOPPPED, Optional, Removed b/ c data
	13752	not ye t availabl e via VA V istA RPCs -->
	13753
	13754	<!-- 8.03 ADMINISTRA TION TIMIN G (xsi:typ e='EIVL' o perator='A '), Option al,
	13755	Not pr ovided by VA b/c dat a not yet available via VA Vis tA RPCs -- >
	13756
	13757	<!-- 8.04 FREQUENCY (xsi:type= 'PIVL_TS i nstitution Specified= 'false'
	13758	operat or='A''), Optional, Not provid ed by VA b /c data no t yet avai lable via
	13759	VA Vis tA RPCs -- >
	13760
	13761	<!--8.05 I NTERVAL ( xsi:type=' PIVL_TS' i nstitution Specified= 'false'
	13762	operat or='A'), O ptional,No t provided by VA b/c data not yet availa ble via
	13763	VA Vis tA RPCs -- >
	13764
	13765	<!--8.06 D URATION ( xsi:type=' PIVL_TS' o perator='A '), Option al, Not
	13766	provid ed by VA b /c data no t yet avai lable via VA VistA R PCs -->
	13767
	13768	<!-- 8.08 DOSE, Opti onal, Not provided b y VA b/c d ata not ye t availabl e
	13769	via VA VistA RPC s -->
	13770
	13771	<doseQuant ity
	13772	nullFlavor ="UNK"
	13773	/>
	13774
	13775	<consumabl e>
	13776
	13777	<manufactu redProduct
	13778	classCode= "MANU"
	13779	>
	13780
	13781	<templateI d
	13782	root="2.16 .840.1.113 883.10.20. 22.4.23"
	13783	/>
	13784
	13785	<manufactu redMateria l>
	13786
	13787	<!-- 8.13 CODED PROD UCT NAME, REQUIRED, UNII, RxNo rm, NDF-RT , NDC,
	13788	No t provided by VA b/c data not yet availa ble via VA VistA RPC s -->
	13789
	13790	<code
	13791	codeSystem ="2.16.840 .1.113883. 6.88"
	13792	codeSystem Name="RxNo rm"
	13793	nullFlavor ="UNK"
	13794	>
	13795
	13796	<!-- 8.14 CODED BRAN D NAME, R2 , Not prov ided by VA b/c data not
	13797	yet available via VA Vis tA RPCs -- >
	13798
	13799	<!-- 8.15 FREE TEXT PRODUCT NA ME, REQUIR ED -->
	13800
	13801	<originalT ext>
	13802
	13803	<reference
	13804	value="#mn dMedicatio n1002"
	13805	/>
	13806
	13807	</original Text>
	13808
	13809
	13810	</code>
	13811
	13812	<!-- 8.16 FREE TEXT BRAND NAME , R2, Not provided b y VA b/c d ata
	13813	no t yet avai lable via VA VistA R PCs -->
	13814
	13815	</manufact uredMateri al>
	13816
	13817	</manufact uredProduc t>
	13818
	13819	</consumab le>
	13820
	13821	<!-- Infor mation Sou rce for Me dication E ntry, Opti onal -->
	13822
	13823	<author>
	13824
	13825	<time
	13826	nullFlavor ="UNK"
	13827	/>
	13828
	13829	<assignedA uthor>
	13830
	13831	<id
	13832	nullFlavor ="NI"
	13833	/>
	13834
	13835	<assignedP erson>
	13836
	13837	<name/>
	13838
	13839	</assigned Person>
	13840
	13841	<represent edOrganiza tion>
	13842
	13843	<id
	13844	extension= "442"
	13845	root="2.16 .840.1.113 883.4.349"
	13846	/>
	13847
	13848	<name>
	13849	CHEYENNE V AMC
	13850	</name>
	13851
	13852	<telecom
	13853	nullFlavor ="NA"
	13854	/>
	13855
	13856	<addr
	13857	nullFlavor ="NA"
	13858	/>
	13859
	13860	</represen tedOrganiz ation>
	13861
	13862	</assigned Author>
	13863
	13864	</author>
	13865
	13866
	13867	<!-- 8.20- STATUS OF MEDICATION , Optional -R2, SNOME D CT -->
	13868
	13869	<entryRela tionship
	13870	typeCode=" REFR"
	13871	>
	13872
	13873	<!--To Ide ntify Stat us -->
	13874
	13875	<observati on
	13876	classCode= "OBS"
	13877	moodCode=" EVN"
	13878	>
	13879
	13880	<templateI d
	13881	root="2.16 .840.1.113 883. IP "
	13882	/>
	13883
	13884	<code
	13885	code="3399 9-4"
	13886	codeSystem ="2.16.840 .1.113883. 6.1"
	13887	codeSystem Name="LOIN C"
	13888	displayNam e="Status"
	13889	/>
	13890
	13891	<value
	13892	code="acti ve"
	13893	codeSystem ="2.16.840 .1.113883. 6.96"
	13894	codeSystem Name="SNOM ED CT"
	13895	displayNam e="Active"
	13896	xsi:type=" CE"
	13897	>
	13898
	13899	<originalT ext>
	13900	ACTIVE
	13901	</original Text>
	13902
	13903	</value>
	13904
	13905	</observat ion>
	13906
	13907	</entryRel ationship>
	13908
	13909	<!-- CCD P atient Ins tructions Entry, Opt ional -->
	13910
	13911
	13912	<entryRela tionship
	13913	typeCode=" SUBJ"
	13914	>
	13915
	13916	<observati on
	13917	classCode= "OBS"
	13918	moodCode=" EVN"
	13919	>
	13920
	13921	<!-- VLER SEG 1B: 8. 19-TYPE OF MEDICATIO N, Optiona l-R2, SNOM ED CT -->
	13922
	13923	<code
	13924	code="7363 9000"
	13925	codeSystem ="2.16.840 .1.113883. 6.96"
	13926	codeSystem Name="SNOM ED CT"
	13927	displayNam e="Prescri ption drug "
	13928	>
	13929
	13930	<originalT ext>
	13931	Prescripti on
	13932	</original Text>
	13933
	13934	</code>
	13935
	13936	<statusCod e
	13937	code="comp leted"
	13938	/>
	13939
	13940	</observat ion>
	13941
	13942	</entryRel ationship>
	13943
	13944
	13945	<entryRela tionship
	13946	inversionI nd="true"
	13947	typeCode=" SUBJ"
	13948	>
	13949
	13950	<act
	13951	classCode= "ACT"
	13952	moodCode=" INT"
	13953	>
	13954
	13955	<templateI d
	13956	root="2.16 .840.1.113 883.10.20. 22.4.20"
	13957	/>
	13958
	13959	<code
	13960	codeSystem ="2.16.840 .1.113883. 6.96"
	13961	codeSystem Name="SNOM ED CT"
	13962	/>
	13963
	13964	<statusCod e
	13965	code="comp leted"
	13966	/>
	13967
	13968	</act>
	13969
	13970	</entryRel ationship>
	13971
	13972	<!-- CCD D rug Vehicl e Entry, O ptional, N ot provide d by VA b/ c data
	13973	not ye t availabl e via VA V istA RPCs -->
	13974
	13975	<!-- 8.24 VEHICLE, O ptional, N ot provide d by VA b/ c data not yet avail able
	13976	via VA VistA RPC s -->
	13977
	13978	<!-- CCD I ndication Entry, Opt ional, Not provided by VA b/c data not
	13979	yet av ailable vi a VA VistA RPCs -->
	13980
	13981	<!-- 8.21 INDICATION VALUE, Op tional, SN OMED CT, N ot provide d by VA
	13982	b/c da ta not yet available via VA Vi stA RPCs - ->
	13983
	13984	<!-- CCD M edication Supply Ord er Entry, REQUIRED - ->
	13985
	13986	<entryRela tionship
	13987	typeCode=" REFR"
	13988	>
	13989
	13990	<supply
	13991	classCode= "SPLY"
	13992	moodCode=" INT"
	13993	>
	13994
	13995	<templateI d
	13996	root="2.16 .840.1.113 883.10.20. 22.4.17"
	13997	/>
	13998
	13999	<!-- VLER SEG 1B: 8. 26 ORDER N UMBER, Opt ional-R2 - ->
	14000
	14001	<id
	14002	extension= "2675799"
	14003	root="2.16 .840.1.113 883.4.349"
	14004	/>
	14005
	14006	<statusCod e
	14007	code="comp leted"
	14008	/>
	14009
	14010	<!-- 8.29 ORDER EXPI RATION DAT E/TIME, Op tional-R2 -->
	14011
	14012	<effective Time
	14013	xsi:type=" IVL_TS"
	14014	>
	14015
	14016	<high
	14017	value="201 70329"
	14018	/>
	14019
	14020	</effectiv eTime>
	14021
	14022	<!-- VLER SEG 1B: 8. 27 FILLS, Optional - ->
	14023
	14024	<repeatNum ber
	14025	value="1"
	14026	/>
	14027
	14028	<!-- 8.28 QUANTITY O RDERED, R2 , Not prov ided by VA b/c data not
	14029	yet availa ble via VA VistA RPC s -->
	14030
	14031	<quantity
	14032	nullFlavor ="UNK"
	14033	/>
	14034
	14035	<product>
	14036
	14037	<manufactu redProduct
	14038	classCode= "MANU"
	14039	>
	14040
	14041	<templateI d
	14042	root="2.16 .840.1.113 883.10.20. 22.4.23"
	14043	/>
	14044
	14045	<manufactu redMateria l>
	14046
	14047	<code
	14048	codeSystem ="2.16.840 .1.113883. 6.88"
	14049	codeSystem Name="RxNo rm"
	14050	nullFlavor ="UNK"
	14051	>
	14052
	14053
	14054	</code>
	14055
	14056	</manufact uredMateri al>
	14057
	14058	</manufact uredProduc t>
	14059
	14060	</product>
	14061
	14062	<author>
	14063
	14064	<!-- 8.30 ORDER DATE /TIME, Opt ional -->
	14065
	14066	<time
	14067	value="201 6032822114 2"
	14068	/>
	14069
	14070	<assignedA uthor>
	14071
	14072	<id
	14073	nullFlavor ="NI"
	14074	/>
	14075
	14076	<assignedP erson>
	14077
	14078	<!-- 8.31 ORDERING P ROVIDER, O ptional -- >
	14079
	14080	<name>
	14081	BODDULURI, PADMA
	14082	</name>
	14083
	14084	</assigned Person>
	14085
	14086	</assigned Author>
	14087
	14088	</author>
	14089
	14090	</supply>
	14091
	14092	</entryRel ationship>
	14093
	14094	<!-- FULFI LLMENT HIS TORY INFOR MATION -->
	14095
	14096	<!-- CCD M edication Dispense E ntry, Opti onal -->
	14097
	14098	<entryRela tionship
	14099	typeCode=" REFR"
	14100	>
	14101
	14102	<supply
	14103	classCode= "SPLY"
	14104	moodCode=" EVN"
	14105	>
	14106
	14107	<templateI d
	14108	root="2.16 .840.1.113 883.10.20. 22.4.18"
	14109	/>
	14110
	14111	<!-- 8.34 PRESCRIPTI ON NUMBER, Optional- R2 -->
	14112
	14113	<id
	14114	extension= "762993"
	14115	root="2.16 .840.1.113 883.4.349"
	14116	/>
	14117
	14118	<statusCod e
	14119	code="comp leted"
	14120	/>
	14121
	14122	<effective Time
	14123	xsi:type=" IVL_TS"
	14124	>
	14125
	14126	<high
	14127	value="201 60328"
	14128	/>
	14129
	14130	</effectiv eTime>
	14131
	14132	<repeatNum ber/>
	14133
	14134	<product>
	14135
	14136	<manufactu redProduct
	14137	classCode= "MANU"
	14138	>
	14139
	14140	<templateI d
	14141	root="2.16 .840.1.113 883.10.20. 22.4.23"
	14142	/>
	14143
	14144	<manufactu redMateria l>
	14145
	14146	<code
	14147	codeSystem ="2.16.840 .1.113883. 6.88"
	14148	codeSystem Name="RxNo rm"
	14149	nullFlavor ="UNK"
	14150	>
	14151
	14152	<originalT ext/>
	14153
	14154	</code>
	14155
	14156	</manufact uredMateri al>
	14157
	14158	</manufact uredProduc t>
	14159
	14160	</product>
	14161
	14162	<author>
	14163
	14164	<time/>
	14165
	14166	<assignedA uthor>
	14167
	14168	<id
	14169	nullFlavor ="NI"
	14170	/>
	14171
	14172	<assignedP erson>
	14173
	14174	<name/>
	14175
	14176	</assigned Person>
	14177
	14178	</assigned Author>
	14179
	14180	</author>
	14181
	14182	</supply>
	14183
	14184	</entryRel ationship>
	14185
	14186	</substanc eAdministr ation>
	14187
	14188	<!-- 8.23 REACTION O BSERVATION Entry, Op tional, No t provided by VA
	14189	b/c data not y et availab le via VA VistA RPCs -->
	14190
	14191	<!-- CCD P RECONDITIO N FOR SUBS TANCE ADMI NISTRATION ENTRY, Op tional,
	14192	Not provided b y VA b/c d ata not ye t availabl e via VA V istA RPCs -->
	14193
	14194	<!--8.25 D OSE INDICA TOR, Optio nal, Not p rovided by VA b/c da ta not
	14195	yet available via VA Vis tA RPCs -- >
	14196
	14197	</entry>
	14198	<entry>
	14199
	14200	<substance Administra tion
	14201	classCode= "SBADM"
	14202	moodCode=" EVN"
	14203	>
	14204
	14205	<templateI d
	14206	root="2.16 .840.1.113 883.10.20. 22.4.16"
	14207	/>
	14208
	14209	<id
	14210	nullFlavor ="UNK"
	14211	/>
	14212
	14213	<id
	14214	assigningA uthorityNa me="Depart ment of Ve terans Aff airs"
	14215	extension= "nullFlavo r"
	14216	root="2.16 .840.1.113 883.4.349"
	14217	/>
	14218
	14219	<!-- 8.12 DELIVERY M ETHOD, Opt ional, No value set defined, N ot provide d
	14220	by VA b/c data f rom VA Vis tA RPCs no t yet avai lable -->
	14221
	14222	<!-- 8.01 FREE TEXT SIG REFERE NCE, Optio nal -->
	14223
	14224	<text>
	14225
	14226	<reference
	14227	value="#mn dSig1003"
	14228	/>
	14229
	14230	</text>
	14231
	14232	<statusCod e
	14233	code="comp leted"
	14234	/>
	14235
	14236	<effective Time
	14237	xsi:type=" IVL_TS"
	14238	>
	14239
	14240	<low
	14241	nullFlavor ="UNK"
	14242	/>
	14243
	14244	<!-- INDIC ATE MEDICA TION STOPP PED, high= Indicate M edication Stopped,
	14245	Optional -->
	14246
	14247	<high
	14248	nullFlavor ="UNK"
	14249	/>
	14250
	14251	</effectiv eTime>
	14252
	14253	<!-- 8.02 INDICATE M EDICATION STOPPPED, Optional, Removed b/ c data
	14254	not ye t availabl e via VA V istA RPCs -->
	14255
	14256	<!-- 8.03 ADMINISTRA TION TIMIN G (xsi:typ e='EIVL' o perator='A '), Option al,
	14257	Not pr ovided by VA b/c dat a not yet available via VA Vis tA RPCs -- >
	14258
	14259	<!-- 8.04 FREQUENCY (xsi:type= 'PIVL_TS i nstitution Specified= 'false'
	14260	operat or='A''), Optional, Not provid ed by VA b /c data no t yet avai lable via
	14261	VA Vis tA RPCs -- >
	14262
	14263	<!--8.05 I NTERVAL ( xsi:type=' PIVL_TS' i nstitution Specified= 'false'
	14264	operat or='A'), O ptional,No t provided by VA b/c data not yet availa ble via
	14265	VA Vis tA RPCs -- >
	14266
	14267	<!--8.06 D URATION ( xsi:type=' PIVL_TS' o perator='A '), Option al, Not
	14268	provid ed by VA b /c data no t yet avai lable via VA VistA R PCs -->
	14269
	14270	<!-- 8.08 DOSE, Opti onal, Not provided b y VA b/c d ata not ye t availabl e
	14271	via VA VistA RPC s -->
	14272
	14273	<doseQuant ity
	14274	nullFlavor ="UNK"
	14275	/>
	14276
	14277	<consumabl e>
	14278
	14279	<manufactu redProduct
	14280	classCode= "MANU"
	14281	>
	14282
	14283	<templateI d
	14284	root="2.16 .840.1.113 883.10.20. 22.4.23"
	14285	/>
	14286
	14287	<manufactu redMateria l>
	14288
	14289	<!-- 8.13 CODED PROD UCT NAME, REQUIRED, UNII, RxNo rm, NDF-RT , NDC,
	14290	No t provided by VA b/c data not yet availa ble via VA VistA RPC s -->
	14291
	14292	<code
	14293	codeSystem ="2.16.840 .1.113883. 6.88"
	14294	codeSystem Name="RxNo rm"
	14295	nullFlavor ="UNK"
	14296	>
	14297
	14298	<!-- 8.14 CODED BRAN D NAME, R2 , Not prov ided by VA b/c data not
	14299	yet available via VA Vis tA RPCs -- >
	14300
	14301	<!-- 8.15 FREE TEXT PRODUCT NA ME, REQUIR ED -->
	14302
	14303	<originalT ext>
	14304
	14305	<reference
	14306	value="#mn dMedicatio n1003"
	14307	/>
	14308
	14309	</original Text>
	14310
	14311
	14312	</code>
	14313
	14314	<!-- 8.16 FREE TEXT BRAND NAME , R2, Not provided b y VA b/c d ata
	14315	no t yet avai lable via VA VistA R PCs -->
	14316
	14317	</manufact uredMateri al>
	14318
	14319	</manufact uredProduc t>
	14320
	14321	</consumab le>
	14322
	14323	<!-- Infor mation Sou rce for Me dication E ntry, Opti onal -->
	14324
	14325	<author>
	14326
	14327	<time
	14328	nullFlavor ="UNK"
	14329	/>
	14330
	14331	<assignedA uthor>
	14332
	14333	<id
	14334	nullFlavor ="NI"
	14335	/>
	14336
	14337	<assignedP erson>
	14338
	14339	<name/>
	14340
	14341	</assigned Person>
	14342
	14343	<represent edOrganiza tion>
	14344
	14345	<id
	14346	extension= "442"
	14347	root="2.16 .840.1.113 883.4.349"
	14348	/>
	14349
	14350	<name>
	14351	CHEYENNE V AMC
	14352	</name>
	14353
	14354	<telecom
	14355	nullFlavor ="NA"
	14356	/>
	14357
	14358	<addr
	14359	nullFlavor ="NA"
	14360	/>
	14361
	14362	</represen tedOrganiz ation>
	14363
	14364	</assigned Author>
	14365
	14366	</author>
	14367
	14368
	14369	<!-- 8.20- STATUS OF MEDICATION , Optional -R2, SNOME D CT -->
	14370
	14371	<entryRela tionship
	14372	typeCode=" REFR"
	14373	>
	14374
	14375	<!--To Ide ntify Stat us -->
	14376
	14377	<observati on
	14378	classCode= "OBS"
	14379	moodCode=" EVN"
	14380	>
	14381
	14382	<templateI d
	14383	root="2.16 .840.1.113 883. IP "
	14384	/>
	14385
	14386	<code
	14387	code="3399 9-4"
	14388	codeSystem ="2.16.840 .1.113883. 6.1"
	14389	codeSystem Name="LOIN C"
	14390	displayNam e="Status"
	14391	/>
	14392
	14393	<value
	14394	code="acti ve"
	14395	codeSystem ="2.16.840 .1.113883. 6.96"
	14396	codeSystem Name="SNOM ED CT"
	14397	displayNam e="Active"
	14398	xsi:type=" CE"
	14399	>
	14400
	14401	<originalT ext>
	14402	ACTIVE
	14403	</original Text>
	14404
	14405	</value>
	14406
	14407	</observat ion>
	14408
	14409	</entryRel ationship>
	14410
	14411	<!-- CCD P atient Ins tructions Entry, Opt ional -->
	14412
	14413
	14414	<entryRela tionship
	14415	typeCode=" SUBJ"
	14416	>
	14417
	14418	<observati on
	14419	classCode= "OBS"
	14420	moodCode=" EVN"
	14421	>
	14422
	14423	<!-- VLER SEG 1B: 8. 19-TYPE OF MEDICATIO N, Optiona l-R2, SNOM ED CT -->
	14424
	14425	<code
	14426	code="3295 05003"
	14427	codeSystem ="2.16.840 .1.113883. 6.96"
	14428	codeSystem Name="SNOM ED CT"
	14429	displayNam e="Over th e counter products"
	14430	>
	14431
	14432	<originalT ext>
	14433	OTC
	14434	</original Text>
	14435
	14436	</code>
	14437
	14438	<statusCod e
	14439	code="comp leted"
	14440	/>
	14441
	14442	</observat ion>
	14443
	14444	</entryRel ationship>
	14445
	14446
	14447	<entryRela tionship
	14448	inversionI nd="true"
	14449	typeCode=" SUBJ"
	14450	>
	14451
	14452	<act
	14453	classCode= "ACT"
	14454	moodCode=" INT"
	14455	>
	14456
	14457	<templateI d
	14458	root="2.16 .840.1.113 883.10.20. 22.4.20"
	14459	/>
	14460
	14461	<code
	14462	codeSystem ="2.16.840 .1.113883. 6.96"
	14463	codeSystem Name="SNOM ED CT"
	14464	/>
	14465
	14466	<statusCod e
	14467	code="comp leted"
	14468	/>
	14469
	14470	</act>
	14471
	14472	</entryRel ationship>
	14473
	14474	<!-- CCD D rug Vehicl e Entry, O ptional, N ot provide d by VA b/ c data
	14475	not ye t availabl e via VA V istA RPCs -->
	14476
	14477	<!-- 8.24 VEHICLE, O ptional, N ot provide d by VA b/ c data not yet avail able
	14478	via VA VistA RPC s -->
	14479
	14480	<!-- CCD I ndication Entry, Opt ional, Not provided by VA b/c data not
	14481	yet av ailable vi a VA VistA RPCs -->
	14482
	14483	<!-- 8.21 INDICATION VALUE, Op tional, SN OMED CT, N ot provide d by VA
	14484	b/c da ta not yet available via VA Vi stA RPCs - ->
	14485
	14486	<!-- CCD M edication Supply Ord er Entry, REQUIRED - ->
	14487
	14488	<entryRela tionship
	14489	typeCode=" REFR"
	14490	>
	14491
	14492	<supply
	14493	classCode= "SPLY"
	14494	moodCode=" INT"
	14495	>
	14496
	14497	<templateI d
	14498	root="2.16 .840.1.113 883.10.20. 22.4.17"
	14499	/>
	14500
	14501	<!-- VLER SEG 1B: 8. 26 ORDER N UMBER, Opt ional-R2 - ->
	14502
	14503	<id
	14504	extension= "2675826"
	14505	root="2.16 .840.1.113 883.4.349"
	14506	/>
	14507
	14508	<statusCod e
	14509	code="comp leted"
	14510	/>
	14511
	14512	<!-- 8.29 ORDER EXPI RATION DAT E/TIME, Op tional-R2 -->
	14513
	14514	<effective Time
	14515	xsi:type=" IVL_TS"
	14516	>
	14517
	14518	<high
	14519	nullFlavor ="UNK"
	14520	/>
	14521
	14522	</effectiv eTime>
	14523
	14524	<!-- VLER SEG 1B: 8. 27 FILLS, Optional - ->
	14525
	14526	<repeatNum ber
	14527	nullFlavor ="UNK"
	14528	/>
	14529
	14530	<!-- 8.28 QUANTITY O RDERED, R2 , Not prov ided by VA b/c data not
	14531	yet availa ble via VA VistA RPC s -->
	14532
	14533	<quantity
	14534	nullFlavor ="UNK"
	14535	/>
	14536
	14537	<product>
	14538
	14539	<manufactu redProduct
	14540	classCode= "MANU"
	14541	>
	14542
	14543	<templateI d
	14544	root="2.16 .840.1.113 883.10.20. 22.4.23"
	14545	/>
	14546
	14547	<manufactu redMateria l>
	14548
	14549	<code
	14550	codeSystem ="2.16.840 .1.113883. 6.88"
	14551	codeSystem Name="RxNo rm"
	14552	nullFlavor ="UNK"
	14553	>
	14554
	14555
	14556	</code>
	14557
	14558	</manufact uredMateri al>
	14559
	14560	</manufact uredProduc t>
	14561
	14562	</product>
	14563
	14564	<author>
	14565
	14566	<!-- 8.30 ORDER DATE /TIME, Opt ional -->
	14567
	14568	<time
	14569	value="201 503131733"
	14570	/>
	14571
	14572	<assignedA uthor>
	14573
	14574	<id
	14575	nullFlavor ="NI"
	14576	/>
	14577
	14578	<assignedP erson>
	14579
	14580	<!-- 8.31 ORDERING P ROVIDER, O ptional -- >
	14581
	14582	<name>
	14583	SWALL,MARI E
	14584	</name>
	14585
	14586	</assigned Person>
	14587
	14588	</assigned Author>
	14589
	14590	</author>
	14591
	14592	</supply>
	14593
	14594	</entryRel ationship>
	14595
	14596	<!-- FULFI LLMENT HIS TORY INFOR MATION -->
	14597
	14598	<!-- CCD M edication Dispense E ntry, Opti onal -->
	14599
	14600
	14601	</substanc eAdministr ation>
	14602
	14603	<!-- 8.23 REACTION O BSERVATION Entry, Op tional, No t provided by VA
	14604	b/c data not y et availab le via VA VistA RPCs -->
	14605
	14606	<!-- CCD P RECONDITIO N FOR SUBS TANCE ADMI NISTRATION ENTRY, Op tional,
	14607	Not provided b y VA b/c d ata not ye t availabl e via VA V istA RPCs -->
	14608
	14609	<!--8.25 D OSE INDICA TOR, Optio nal, Not p rovided by VA b/c da ta not
	14610	yet available via VA Vis tA RPCs -- >
	14611
	14612	</entry>
	14613
	14614	</section>
	14615
	14616	</componen t>
	14617
	14618	<component >
	14619
	14620	<!-- *** ****** ****** ****** ****** ******** * ENCOUNTE R
	14621	SECTION, O ptional ****** ****** ****** ****** ****** ** -->
	14622
	14623	<section>
	14624
	14625	<templateI d
	14626	root="2.16 .840.1.113 883.10.20. 22.2.22.1"
	14627	/>
	14628
	14629	<templateI d
	14630	root="2.16 .840.1.113 883.10.20. 22.2.22"
	14631	/>
	14632
	14633	<code
	14634	code="4624 0-8"
	14635	codeSystem ="2.16.840 .1.113883. 6.1"
	14636	codeSystem Name="LOIN C"
	14637	displayNam e="Encount ers"
	14638	/>
	14639
	14640	<title>
	14641	Encounters Section
	14642	</title>
	14643
	14644	<text>
	14645
	14646	<!-- VA En counter Bu siness Rul es for Med ical Conte nt -->
	14647
	14648	<paragraph >
	14649	This
	14650	sect ion contai ns a list of complet ed VA Outp atient Enc ounters fo r
	14651	the patient an d a list o f Discharg e Summarie s, Consult Notes, an d
	14652	Hist ory & Physical N otes for t he patient . The data comes fro m
	14653	all VA treatme nt facilit ies.
	14654
	14655	<br/>
	14656
	14657	<br/>
	14658
	14659	</paragrap h>
	14660
	14661
	14662	<paragraph
	14663	ID="opEncT itle"
	14664	>
	14665	The list o f VA Outpa tient Enco unters sho ws the 150 most
	14666	rece nt Encount er dates w ithin the last 36 mo nths. Each VA
	14667	Outp atient Enc ounter may also incl ude severa l notes wi th the
	14668	comp lete note text. Ther e is a lim it of 10 n otes for e ach
	14669	Enco unter. Fol low-up vis its relate d to the V A Encounte r are not
	14670	incl uded. The data comes from all VA treatme nt facilit ies.
	14671	</paragrap h>
	14672
	14673	<table
	14674	ID="encoun terNarrati ve"
	14675	border="1"
	14676	width="100 %"
	14677	>
	14678
	14679	<thead>
	14680
	14681	<tr>
	14682
	14683	<th>
	14684	Date/Time
	14685	</th>
	14686
	14687	<th>
	14688	Encounter Type
	14689	</th>
	14690
	14691	<th>
	14692	Encounter Descriptio n
	14693	</th>
	14694
	14695	<th>
	14696	Reason
	14697	</th>
	14698
	14699	<th>
	14700	Provider
	14701	</th>
	14702
	14703	<th>
	14704	Source
	14705	</th>
	14706
	14707	</tr>
	14708
	14709	</thead>
	14710
	14711	<tbody>
	14712
	14713	<tr>
	14714
	14715	<td>
	14716	Dec 05, 20 14, 03:35 PM
	14717	</td>
	14718
	14719
	14720	<td>
	14721
	14722	<content
	14723	ID="endEnc ounterType 1001"
	14724	>
	14725	VLER HEALT H FORREST VISIT
	14726	</content>
	14727
	14728	</td>
	14729
	14730	<td>
	14731
	14732	<content
	14733	ID="endEnc ounterDesc ription100 1"
	14734	>
	14735	SURGICAL P ROCEDURE U NIT
	14736	</content>
	14737
	14738	</td>
	14739
	14740	<td>
	14741
	14742	<content
	14743	ID="endRea son1001"
	14744	/>
	14745
	14746	</td>
	14747
	14748	<td>
	14749
	14750	<content
	14751	ID="endPro vider1001"
	14752	>
	14753	BENNETT,JA MIE
	14754	</content>
	14755
	14756	</td>
	14757
	14758	<td>
	14759
	14760	<content
	14761	ID="endSou rce1001"
	14762	>
	14763	CHEYENNE V AMC
	14764	</content>
	14765
	14766	</td>
	14767
	14768	</tr>
	14769
	14770	</tbody>
	14771
	14772	</table>
	14773
	14774	<!-- Start Associate d Notes Na rrative-->
	14775
	14776	<paragraph
	14777	ID="anTitl e"
	14778	>
	14779	The list o f Progress Notes inc ludes the 10 most re cent notes for each Outpatient Encounter . The dat a comes fr om all VA treatment facilities .
	14780	</paragrap h>
	14781
	14782	<table
	14783	ID="anNote Narrative"
	14784	border="1"
	14785	width="100 %"
	14786	>
	14787
	14788	<thead>
	14789
	14790	<tr>
	14791
	14792	<th>
	14793	Date/Time
	14794	</th>
	14795
	14796	<th>
	14797	Encounter Note
	14798	</th>
	14799
	14800	<th>
	14801	Provider
	14802	</th>
	14803
	14804	<th>
	14805	Source
	14806	</th>
	14807
	14808	</tr>
	14809
	14810	</thead>
	14811
	14812	<tbody>
	14813
	14814	<tr>
	14815
	14816	<td>
	14817
	14818	<content
	14819	ID="anNote DateTime10 01"
	14820	>
	14821	Dec 05, 20 14, 03:35 PM
	14822	</content>
	14823
	14824	</td>
	14825
	14826	<td>
	14827
	14828	<content
	14829	ID="anNote EncounterD escription 1001"
	14830	>
	14831	H & P NOTE :
	14832	LOCAL TIT LE: AMB CA RE PAST,FA MILY & SOCIAL HI STORY FORM (TEMPLAT
	14833	STANDARD T ITLE: H &a mp; P NOTE
	14834	DATE OF NO TE: DEC 05 , 2014@15: 35 ENT RY DATE: D EC 05, 201 4@15:36:35
	14835	AUTH OR: FORRES T,ZACHARY H EXP C OSIGNER:
	14836	URGEN CY: STATUS: C OMPLETED
	14837
	14838	Patient: NWHINZZZTE STPATIENT, NWHINONE
	14839	Social Sec urity Numb er: 666-1 0-0001
	14840	Date of Bi rth: JAN 1,1981
	14841	Date: DEC 05, 2014 1 5:36
	14842
	14843	Past Medic al History
	14844
	14845	A. Have y ou experie nced or be en treated for any o f the foll owing
	14846	conditions ?
	14847
	14848	1. Headac hes or a n ervous dis order __X_ YES ___ NO
	14849	2. Thyroi d disorder __X_ YES ___ NO
	14850	3. Heart condition _X__ YES ___ NO
	14851	4. High b lood press ure ___Y ES _X__ NO
	14852	5. Lung d isorder _X__ YES ___ NO
	14853	6. Breast problems ___Y ES __X_ NO
	14854	7. Jaundi ce, hepati tis or oth er liver d isorder ___Y ES _X__ NO
	14855	8. Stomac h, bowel, or gallbla dder probl ems ___Y ES _X__ NO
	14856	9. Female or sexual problems ___Y ES _X__ NO
	14857	10. Anemia or drug l oss ___Y ES _X__ NO
	14858	12. Have y ou ever re ceived a b lood trans fusion ___Y ES _X__ NO
	14859	13. Diabet es ___Y ES _X__ NO
	14860	14. Cancer ___Y ES _X__ NO
	14861	15. Other medical pr oblems ___Y ES _X__ NO
	14862
	14863	B. Are yo u taking a ny medicat ions at pr esent? ___Y ES X___ NO
	14864	If yes, pleas e list bel ow.
	14865
	14866	NAME OF DR UG PRESCRIBIN G DOCTOR
	14867
	14868
	14869
	14870	C. Are yo u Allergic to any me dications? ___Y ES _X__ NO
	14871	If yes, plea se list be low.
	14872
	14873	OUTDOO R MOLD, AS PIRIN, PIS TACHIOS, L ATEX, PEAN UTS, INDOO R MOLD
	14874	FOOTCARE P RODUCTS, E AR DROPS, PENICILLIN , ALCOHOL, GOAT CHEE SE, GELATI N
	14875	ALLERGENIC EXT,HOUSE DUST, ALM ONDS, PEPP ERMINT, RE D ONIONS, NITROUS OX IDE, MILK
	14876	MINT, OATS , BAKED BE ANS, PAINT , GLUTENS, COMMODE L INER
	14877
	14878	D. Hospit alizations
	14879
	14880	MONTH/YEAR REASON
	14881
	14882	/es/ ZACHA RY FORREST
	14883	physician tester
	14884	Signed: 12 /05/2014 1 5:43
	14885	</content>
	14886
	14887	</td>
	14888
	14889	<td>
	14890
	14891	<content
	14892	ID="anNote Provider10 01"
	14893	>
	14894	FORREST,ZA CHARY H
	14895	</content>
	14896
	14897	</td>
	14898
	14899	<td>
	14900
	14901	<content
	14902	ID="anNote Source1001 "
	14903	>
	14904	CHEYENNE V AMC
	14905	</content>
	14906
	14907	</td>
	14908
	14909	</tr>
	14910	<tr>
	14911
	14912	<td>
	14913
	14914	<content
	14915	ID="anNote DateTime10 02"
	14916	>
	14917	Jan 15, 20 15, 11:36 AM
	14918	</content>
	14919
	14920	</td>
	14921
	14922	<td>
	14923
	14924	<content
	14925	ID="anNote EncounterD escription 1002"
	14926	>
	14927	ADVANCE DI RECTIVE :
	14928	LOCAL TIT LE: ADVANC E DIRECTIV E
	14929	STANDARD T ITLE: ADVA NCE DIRECT IVE
	14930	DATE OF NO TE: JAN 15 , 2015@11: 36 ENT RY DATE: J AN 15, 201 5@11:36:19
	14931	AUTH OR: FORRES T,ZACHARY H EXP C OSIGNER:
	14932	URGEN CY: STATUS: C OMPLETED
	14933
	14934	Testing CC DA
	14935
	14936	/es/ ZACHA RY FORREST
	14937	physician tester
	14938	Signed: 01 /15/2015 1 1:36
	14939	</content>
	14940
	14941	</td>
	14942
	14943	<td>
	14944
	14945	<content
	14946	ID="anNote Provider10 02"
	14947	>
	14948	FORREST,ZA CHARY H
	14949	</content>
	14950
	14951	</td>
	14952
	14953	<td>
	14954
	14955	<content
	14956	ID="anNote Source1002 "
	14957	>
	14958	CHEYENNE V AMC
	14959	</content>
	14960
	14961	</td>
	14962
	14963	</tr>
	14964
	14965	</tbody>
	14966
	14967	</table>
	14968
	14969	<!-- Stop Associated Notes Nar rative -->
	14970
	14971	<!-- Consu lt notes b egin -->
	14972
	14973
	14974
	14975	<!-- histo ry and phy sical note s begin -- >
	14976
	14977	<paragraph
	14978	ID="hnpTit le"
	14979	>
	14980	The list of History & Phy sical (H&a mp;P) Note s
	14981	incl udes the 2 0 most rec ent notes within the last 24 m onths. The
	14982	data comes fro m all VA t reatment f acilities.
	14983	</paragrap h>
	14984
	14985	<table
	14986	ID="HnPNot eNarrative "
	14987	border="1"
	14988	width="100 %"
	14989	>
	14990
	14991	<thead>
	14992
	14993	<tr>
	14994
	14995	<th>
	14996	Date/Time
	14997	</th>
	14998
	14999	<th>
	15000	Encounter Note
	15001	</th>
	15002
	15003	<th>
	15004	Provider
	15005	</th>
	15006
	15007	<th>
	15008	Source
	15009	</th>
	15010
	15011	</tr>
	15012
	15013	</thead>
	15014
	15015	<tbody>
	15016
	15017	<tr>
	15018
	15019	<td>
	15020
	15021	<content
	15022	ID="HnPnot eDateTime1 001"
	15023	>
	15024	Mar 06, 20 15, 10:36 AM
	15025	</content>
	15026
	15027	</td>
	15028
	15029	<td>
	15030
	15031	<content
	15032	ID="HnPnot eEncounter Descriptio n1001"
	15033	>
	15034	HISTORY &a mp; PHYSIC AL :
	15035	LOCAL TIT LE: HISTOR Y & PH YSICAL
	15036	STANDARD T ITLE: PHYS ICIAN H &a mp; P NOTE
	15037	DATE OF NO TE: MAR 06 , 2015@10: 36 ENT RY DATE: M AR 06, 201 5@10:36:47
	15038	AUTH OR: FORRES T,ZACHARY H EXP C OSIGNER:
	15039	URGEN CY: STATUS: C OMPLETED
	15040
	15041	CC:
	15042
	15043	HISTORY OF PRESENT I LLNESS:
	15044
	15045	PAST MEDIC AL HISTORY :
	15046
	15047	N
	15048	MEDS: Acti ve Outpati ent Medica tions (exc luding Sup plies):
	15049
	15050	No Medicat ions Found
	15051
	15052
	15053	ALL: OUTD OOR MOLD, ASPIRIN, P ISTACHIOS, LATEX, PE ANUTS, IND OOR MOLD
	15054	FOOTCARE P RODUCTS, E AR DROPS, PENICILLIN , ALCOHOL, GOAT CHEE SE, GELATI N
	15055	ALLERGENIC EXT,HOUSE DUST, ALM ONDS, PEPP ERMINT, RE D ONIONS, NITROUS OX IDE, MILK
	15056	MINT, OATS , BAKED BE ANS, PAINT , GLUTENS, COMMODE L INER
	15057
	15058	FAMILY HIS TORY:
	15059
	15060	)
	15061	SOCIAL HIS TORY:
	15062
	15063	ROS: (-)f or wt loss , SOB, CP, N, V, D, melena, he matochezia , cough,
	15064	fever, chi lls, dysph agia, dysu ria
	15065
	15066	.
	15067	PHYSICAL E XAMINATION :
	15068
	15069	VS: PULSE 60 (11 /21/2011 1 6:46)
	15070	BLOOD PRESSURE 128/10 0 (11/21/2 011 16:46)
	15071	RESPI RATION 60 (11 /21/2011 1 6:46)
	15072	TEMPE RATIRE 98.6 F [37.0 C] (11/21/201 1 16:46)
	15073	SATS
	15074
	15075	N
	15076	GENERAL: Patient al ert and or iented, ap pears in N AD, is ple asant and
	15077	cooperativ e.
	15078
	15079	HEENT: NC AT, PERRLA , EOMI, Po sterior Or opharynx C lear, Neck Supple, n o
	15080	lymphadeno pathy, no thyromegal y
	15081
	15082	)
	15083	CHEST: CT A Bilatera lly, no wh eezes, ral es, or rho nchi, dist ant breath
	15084	sounds, ba rrel chest ed
	15085
	15086	CV: RRR w ithout mur mur or gal lop, dista nt heart s ounds, nl S1 S2, no
	15087	carotid br uits
	15088
	15089	ABD: NABS , soft, ND NT, no HSM , no mass
	15090
	15091	EXT: No c lubbing, n o edema, g ood pulses
	15092
	15093	SKIN: No o bvious les ions, no r ash, dry s kin
	15094
	15095	NEURO: CN II-XII in tact, moto r strength 5/5 senso ry intact. Romberg neg,
	15096	gait stead y, DTR's n ormal
	15097
	15098	GU/RECTAL: Normal m ale anatom y, good re ctal tone, prostate not enlarg ed,
	15099	heme negat ive stools
	15100
	15101	LABS:
	15102
	15103	CXR: No in filtrate, no effusio n, no pneu mothorax, normal hea rt size
	15104
	15105	EKG: No ST changes, normal sin us rhythm, no eviden ce acute M I
	15106
	15107	DIAGNOSIS TREATED, O R THAT REQ UIRE FURTH ER TREATME NT:
	15108
	15109	REASON FOR ORDERING TESTS, CON SULTS OR C HANGES IN MEDICATION S:
	15110
	15111	ASSESSMENT /PLAN: (in cluding fo llow-up tr eatment an d patient instructio ns)
	15112
	15113	/es/ ZACHA RY FORREST
	15114	physician tester
	15115	Signed: 03 /06/2015 1 0:37
	15116	</content>
	15117
	15118	</td>
	15119
	15120	<td>
	15121
	15122	<content
	15123	ID="HnPnot eProvider1 001"
	15124	>
	15125	FORREST,ZA CHARY H
	15126	</content>
	15127
	15128	</td>
	15129
	15130	<td>
	15131
	15132	<content
	15133	ID="HnPnot eSource100 1"
	15134	>
	15135	FORT COLLI NS
	15136	</content>
	15137
	15138	</td>
	15139
	15140	</tr>
	15141	<tr>
	15142
	15143	<td>
	15144
	15145	<content
	15146	ID="HnPnot eDateTime1 002"
	15147	>
	15148	Dec 05, 20 14, 03:35 PM
	15149	</content>
	15150
	15151	</td>
	15152
	15153	<td>
	15154
	15155	<content
	15156	ID="HnPnot eEncounter Descriptio n1002"
	15157	>
	15158	HISTORY &a mp; PHYSIC AL :
	15159	LOCAL TIT LE: AMB CA RE PAST,FA MILY & SOCIAL HI STORY FORM (TEMPLAT
	15160	STANDARD T ITLE: H &a mp; P NOTE
	15161	DATE OF NO TE: DEC 05 , 2014@15: 35 ENT RY DATE: D EC 05, 201 4@15:36:35
	15162	AUTH OR: FORRES T,ZACHARY H EXP C OSIGNER:
	15163	URGEN CY: STATUS: C OMPLETED
	15164
	15165	Patient: NWHINZZZTE STPATIENT, NWHINONE
	15166	Social Sec urity Numb er: 666-1 0-0001
	15167	Date of Bi rth: JAN 1,1981
	15168	Date: DEC 05, 2014 1 5:36
	15169
	15170	Past Medic al History
	15171
	15172	A. Have y ou experie nced or be en treated for any o f the foll owing
	15173	conditions ?
	15174
	15175	1. Headac hes or a n ervous dis order __X_ YES ___ NO
	15176	2. Thyroi d disorder __X_ YES ___ NO
	15177	3. Heart condition _X__ YES ___ NO
	15178	4. High b lood press ure ___Y ES _X__ NO
	15179	5. Lung d isorder _X__ YES ___ NO
	15180	6. Breast problems ___Y ES __X_ NO
	15181	7. Jaundi ce, hepati tis or oth er liver d isorder ___Y ES _X__ NO
	15182	8. Stomac h, bowel, or gallbla dder probl ems ___Y ES _X__ NO
	15183	9. Female or sexual problems ___Y ES _X__ NO
	15184	10. Anemia or drug l oss ___Y ES _X__ NO
	15185	12. Have y ou ever re ceived a b lood trans fusion ___Y ES _X__ NO
	15186	13. Diabet es ___Y ES _X__ NO
	15187	14. Cancer ___Y ES _X__ NO
	15188	15. Other medical pr oblems ___Y ES _X__ NO
	15189
	15190	B. Are yo u taking a ny medicat ions at pr esent? ___Y ES X___ NO
	15191	If yes, pleas e list bel ow.
	15192
	15193	NAME OF DR UG PRESCRIBIN G DOCTOR
	15194
	15195
	15196
	15197	C. Are yo u Allergic to any me dications? ___Y ES _X__ NO
	15198	If yes, plea se list be low.
	15199
	15200	OUTDOO R MOLD, AS PIRIN, PIS TACHIOS, L ATEX, PEAN UTS, INDOO R MOLD
	15201	FOOTCARE P RODUCTS, E AR DROPS, PENICILLIN , ALCOHOL, GOAT CHEE SE, GELATI N
	15202	ALLERGENIC EXT,HOUSE DUST, ALM ONDS, PEPP ERMINT, RE D ONIONS, NITROUS OX IDE, MILK
	15203	MINT, OATS , BAKED BE ANS, PAINT , GLUTENS, COMMODE L INER
	15204
	15205	D. Hospit alizations
	15206
	15207	MONTH/YEAR REASON
	15208
	15209	/es/ ZACHA RY FORREST
	15210	physician tester
	15211	Signed: 12 /05/2014 1 5:43
	15212	</content>
	15213
	15214	</td>
	15215
	15216	<td>
	15217
	15218	<content
	15219	ID="HnPnot eProvider1 002"
	15220	>
	15221	FORREST,ZA CHARY H
	15222	</content>
	15223
	15224	</td>
	15225
	15226	<td>
	15227
	15228	<content
	15229	ID="HnPnot eSource100 2"
	15230	>
	15231	CHEYENNE V AMC
	15232	</content>
	15233
	15234	</td>
	15235
	15236	</tr>
	15237
	15238	</tbody>
	15239
	15240	</table>
	15241
	15242	<!-- Disch arge summa ry notes b egin -->
	15243
	15244	<paragraph
	15245	ID="disTit le"
	15246	>
	15247	The list of Dischar ge Summari es include s the 10 m ost
	15248	rece nt dischar ges in the last 36 m onths. The data come s from all
	15249	VA t reatment f acilities.
	15250	</paragrap h>
	15251
	15252	<table
	15253	ID="DisNot eNarrative "
	15254	border="1"
	15255	width="100 %"
	15256	>
	15257
	15258	<thead>
	15259
	15260	<tr>
	15261
	15262	<th>
	15263	Date/Time
	15264	</th>
	15265
	15266	<th>
	15267	Encounter Note
	15268	</th>
	15269
	15270	<th>
	15271	Provider
	15272	</th>
	15273
	15274	<th>
	15275	Source
	15276	</th>
	15277
	15278	</tr>
	15279
	15280	</thead>
	15281
	15282	<tbody>
	15283
	15284	<tr>
	15285
	15286	<td>
	15287
	15288	<content
	15289	ID="Disnot eDateTime1 001"
	15290	>
	15291	Aug 14, 20 15
	15292	</content>
	15293
	15294	</td>
	15295
	15296	<td>
	15297
	15298	<content
	15299	ID="Disnot eEncounter Descriptio n1001"
	15300	>
	15301	EDUCATION DISCHARGE NOTE :
	15302	LOCAL TIT LE: RESIDE NT DISCHAR GE SUMMARY
	15303	STANDARD T ITLE: EDUC ATION DISC HARGE NOTE
	15304	DICT DA TE: AUG 14 , 2015@10: 59 ENT RY DATE: A UG 14, 201 5@10:59:53
	15305	DICTATED BY: FORRES T,ZACHARY H AT TENDING: F ORREST,ZAC HARY H
	15306	URGEN CY: routin e STATUS: C OMPLETED
	15307
	15308	DISCHARGE SUMMARY
	15309
	15310	ADMIT DATE :
	15311
	15312	DISCHARGE DATE:
	15313
	15314	ATTENDING MD:
	15315
	15316	CONSULTANT S:
	15317
	15318	DISCHARGE DIAGNOSES:
	15319
	15320	PROCEDURES PERFORMED :
	15321
	15322	HPI:
	15323
	15324	PMH:
	15325
	15326	PE:
	15327
	15328	PERTINENT LABS:
	15329
	15330	HOSPITAL C OURSE:
	15331
	15332	CONDITIONS AT DISCHA RGE:
	15333
	15334	DISCHARGE INSTRUCTIO NS:
	15335
	15336	MEDS: Acti ve Inpatie nt Medicat ions (excl uding Supp lies):
	15337
	15338	No Medicat ions Found
	15339
	15340
	15341	DIET:
	15342
	15343	PHYSICAL A CTIVITY:
	15344
	15345	FOLLOW-UP CARE:
	15346
	15347	CALL OR RE TURN IF:
	15348
	15349	DISCHARGE DISPOSITIO N:
	15350
	15351	/es/ ZACHA RY FORREST
	15352	physician tester
	15353	Signed: 08 /14/2015 1 1:06
	15354	</content>
	15355
	15356	</td>
	15357
	15358	<td>
	15359
	15360	<content
	15361	ID="Disnot eProvider1 001"
	15362	>
	15363	FORREST,ZA CHARY H
	15364	</content>
	15365
	15366	</td>
	15367
	15368	<td>
	15369
	15370	<content
	15371	ID="Disnot eSource100 1"
	15372	>
	15373	CHEYENNE V AMC
	15374	</content>
	15375
	15376	</td>
	15377
	15378	</tr>
	15379
	15380	</tbody>
	15381
	15382	</table>
	15383
	15384
	15385	<!-- CDA O bservation Text as a Reference tag -->
	15386
	15387	<content
	15388	ID="encNot e-1"
	15389	revised="d elete"
	15390	>
	15391	IHE Encoun ter Templa te
	15392	Text not used by VA
	15393	</content>
	15394
	15395	</text>
	15396
	15397	<entry>
	15398
	15399	<encounter
	15400	classCode= "ENC"
	15401	moodCode=" EVN"
	15402	>
	15403
	15404	<templateI d
	15405	root="2.16 .840.1.113 883.10.20. 22.4.49"
	15406	/>
	15407
	15408	<id
	15409	nullFlavor ="NI"
	15410	/>
	15411
	15412	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	15413
	15414	<code
	15415	codeSystem ="2.16.840 .1.113883. 6.12"
	15416	codeSystem Name="CPT- 4"
	15417	nullFlavor ="UNK"
	15418	>
	15419
	15420	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	15421
	15422	<originalT ext>
	15423
	15424	<reference
	15425	value="#en dEncounter Descriptio n1001"
	15426	/>
	15427
	15428	</original Text>
	15429
	15430	<translati on>
	15431
	15432	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	15433
	15434	<originalT ext>
	15435
	15436	<reference
	15437	value="#en dEncounter Descriptio n1001"
	15438	/>
	15439
	15440	</original Text>
	15441
	15442	</translat ion>
	15443
	15444
	15445	</code>
	15446
	15447	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	15448
	15449	<effective Time>
	15450
	15451	<low
	15452	value="201 4120515354 8"
	15453	/>
	15454
	15455	</effectiv eTime>
	15456
	15457	<performer >
	15458
	15459	<assignedE ntity>
	15460
	15461	<id
	15462	nullFlavor ="NA"
	15463	/>
	15464
	15465	<assignedP erson>
	15466
	15467	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	15468
	15469	<name>
	15470	BENNETT,JA MIE
	15471	</name>
	15472
	15473	</assigned Person>
	15474
	15475	</assigned Entity>
	15476
	15477	</performe r>
	15478
	15479	<author>
	15480
	15481	<time
	15482	nullFlavor ="NA"
	15483	/>
	15484
	15485	<assignedA uthor>
	15486
	15487	<id
	15488	nullFlavor ="NA"
	15489	/>
	15490
	15491	<represent edOrganiza tion>
	15492
	15493	<id
	15494	extension= "442"
	15495	root="2.16 .840.1.113 883.4.349"
	15496	/>
	15497
	15498	<name>
	15499	CHEYENNE V AMC
	15500	</name>
	15501
	15502	</represen tedOrganiz ation>
	15503
	15504	</assigned Author>
	15505
	15506	</author>
	15507
	15508	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	15509	VistA -->
	15510
	15511	<!--16.11 - FACILITY LOCATION, Optional -->
	15512
	15513	<participa nt
	15514	typeCode=" LOC"
	15515	>
	15516
	15517	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	15518
	15519	<time>
	15520
	15521	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	15522
	15523	<low
	15524	nullFlavor ="UNK"
	15525	/>
	15526
	15527	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	15528
	15529	<high
	15530	nullFlavor ="UNK"
	15531	/>
	15532
	15533	</time>
	15534
	15535	<participa ntRole
	15536	classCode= "SDLOC"
	15537	>
	15538
	15539	<playingEn tity
	15540	classCode= "PLC"
	15541	/>
	15542
	15543	</particip antRole>
	15544
	15545	</particip ant>
	15546
	15547	<entryRela tionship
	15548	typeCode=" RSON"
	15549	>
	15550
	15551	<observati on
	15552	classCode= "OBS"
	15553	moodCode=" EVN"
	15554	>
	15555
	15556	<templateI d
	15557	root="2.16 .840.1.113 883.10.20. 22.4.19"
	15558	/>
	15559
	15560	<id
	15561	nullFlavor ="NI"
	15562	/>
	15563
	15564	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	15565
	15566	<code
	15567	nullFlavor ="UNK"
	15568	/>
	15569
	15570	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	15571
	15572	<text>
	15573
	15574	<reference
	15575	value="#en dReason100 1"
	15576	/>
	15577
	15578	</text>
	15579
	15580	<statusCod e
	15581	code="comp leted"
	15582	/>
	15583
	15584	<value
	15585	codeSystem ="2.16.840 .1.113883. 6.96"
	15586	codeSystem Name="SNOM ED CT"
	15587	xsi:type=" CD"
	15588	/>
	15589
	15590	</observat ion>
	15591
	15592	</entryRel ationship>
	15593
	15594
	15595	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	15596
	15597
	15598	<!-- CCD E NCOUNTER D IAGNOSIS, Optional - ->
	15599
	15600	<entryRela tionship
	15601	inversionI nd="false"
	15602	typeCode=" SUBJ"
	15603	>
	15604
	15605	<act
	15606	classCode= "ACT"
	15607	moodCode=" EVN"
	15608	>
	15609
	15610	<!--Encoun ter diagno sis act -- >
	15611
	15612	<templateI d
	15613	root="2.16 .840.1.113 883.10.20. 22.4.80"
	15614	/>
	15615
	15616	<id
	15617	nullFlavor ="UNK"
	15618	/>
	15619
	15620	<code
	15621	code="2930 8-4"
	15622	codeSystem ="2.16.840 .1.113883. 6.1"
	15623	codeSystem Name="LOIN C"
	15624	displayNam e="ENCOUNT ER DIAGNOS IS"
	15625	xsi:type=" CE"
	15626	/>
	15627
	15628	<statusCod e
	15629	code="acti ve"
	15630	/>
	15631
	15632	<effective Time
	15633	nullFlavor ="UNK"
	15634	/>
	15635
	15636
	15637	<entryRela tionship
	15638	inversionI nd="false"
	15639	typeCode=" SUBJ"
	15640	>
	15641
	15642	<observati on
	15643	classCode= "OBS"
	15644	moodCode=" EVN"
	15645	negationIn d="false"
	15646	>
	15647
	15648	<templateI d
	15649	root="2.16 .840.1.113 883.10.20. 22.4.4"
	15650	/>
	15651
	15652	<!-- Probl em Observa tion -->
	15653
	15654	<id
	15655	nullFlavor ="UNK"
	15656	/>
	15657
	15658
	15659	<code
	15660	nullFlavor ="UNK"
	15661	>
	15662
	15663	<originalT ext>
	15664	Encounter Diagnosis Type Not A vailable
	15665	</original Text>
	15666
	15667	</code>
	15668
	15669
	15670	<statusCod e
	15671	code="comp leted"
	15672	/>
	15673
	15674	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	15675
	15676	<value
	15677	codeSystem ="2.16.840 .1.113883. 6.96"
	15678	codeSystem Name="SNOM ED CT"
	15679	nullFlavor ="UNK"
	15680	xsi:type=" CD"
	15681	>
	15682
	15683	<originalT ext>
	15684
	15685	<reference
	15686	value="#en dReason100 1"
	15687	/>
	15688
	15689	</original Text>
	15690
	15691
	15692
	15693	</value>
	15694
	15695	</observat ion>
	15696
	15697	</entryRel ationship>
	15698
	15699	</act>
	15700
	15701	</entryRel ationship>
	15702
	15703
	15704	<!-- 16.09 DISCHARGE DISPOSITI ON CODE, O ptional, N ot provide d by VA
	15705	b/c da ta not yet available via VA Vi stA RPCs - ->
	15706
	15707	</encounte r>
	15708
	15709	</entry>
	15710
	15711
	15712	<entry
	15713	typeCode=" DRIV"
	15714	>
	15715
	15716	<encounter
	15717	classCode= "ENC"
	15718	moodCode=" EVN"
	15719	>
	15720
	15721	<templateI d
	15722	root="2.16 .840.1.113 883.10.20. 22.4.49"
	15723	/>
	15724
	15725	<id
	15726	nullFlavor ="NI"
	15727	/>
	15728
	15729	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	15730
	15731	<code
	15732	code="9949 9"
	15733	codeSystem ="2.16.840 .1.113883. 6.12"
	15734	codeSystem Name="CPT- 4"
	15735	displayNam e="Unliste d Evaluati on and Man agement Se rvice"
	15736	>
	15737
	15738	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	15739
	15740	<originalT ext>
	15741
	15742	<reference
	15743	value="#Hn PnoteEncou nterDescri ption1001"
	15744	/>
	15745
	15746	</original Text>
	15747
	15748	<translati on
	15749	code="3411 7-2"
	15750	codeSystem ="2.16.840 .1.113883. 6.1"
	15751	codeSystem Name="LOIN C"
	15752	displayNam e="History and Physi cal Note"
	15753	/>
	15754
	15755	</code>
	15756
	15757	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	15758
	15759	<effective Time>
	15760
	15761	<low
	15762	value="201 503061036"
	15763	/>
	15764
	15765	</effectiv eTime>
	15766
	15767	<performer >
	15768
	15769	<assignedE ntity>
	15770
	15771	<id
	15772	nullFlavor ="NA"
	15773	/>
	15774
	15775	<assignedP erson>
	15776
	15777	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	15778
	15779	<name>
	15780	FORREST,ZA CHARY H
	15781	</name>
	15782
	15783	</assigned Person>
	15784
	15785	</assigned Entity>
	15786
	15787	</performe r>
	15788
	15789	<author>
	15790
	15791	<time
	15792	nullFlavor ="NA"
	15793	/>
	15794
	15795	<assignedA uthor>
	15796
	15797	<id
	15798	nullFlavor ="NA"
	15799	/>
	15800
	15801	<represent edOrganiza tion>
	15802
	15803	<id
	15804	extension= "442GC"
	15805	root="2.16 .840.1.113 883.4.349"
	15806	/>
	15807
	15808	<name>
	15809	FORT COLLI NS
	15810	</name>
	15811
	15812	</represen tedOrganiz ation>
	15813
	15814	</assigned Author>
	15815
	15816	</author>
	15817
	15818	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	15819	VistA -->
	15820
	15821	<!--16.11 - FACILITY LOCATION, Optional -->
	15822
	15823	<participa nt
	15824	typeCode=" LOC"
	15825	>
	15826
	15827	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	15828
	15829	<time>
	15830
	15831	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	15832
	15833	<low/>
	15834
	15835	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	15836
	15837	<high/>
	15838
	15839	</time>
	15840
	15841	<participa ntRole
	15842	classCode= "SDLOC"
	15843	>
	15844
	15845	<templateI d
	15846	root="2.16 .840.1.113 883.10.20. 22.4.32"
	15847	/>
	15848
	15849	<code
	15850	nullFlavor ="UNK"
	15851	/>
	15852
	15853	<addr
	15854	nullFlavor ="UNK"
	15855	/>
	15856
	15857	<telecom
	15858	nullFlavor ="UNK"
	15859	/>
	15860
	15861	<playingEn tity
	15862	classCode= "PLC"
	15863	>
	15864
	15865	<name>
	15866	FORT COLLI NS
	15867	</name>
	15868
	15869	</playingE ntity>
	15870
	15871	</particip antRole>
	15872
	15873	</particip ant>
	15874
	15875	<entryRela tionship
	15876	typeCode=" RSON"
	15877	>
	15878
	15879	<observati on
	15880	classCode= "OBS"
	15881	moodCode=" EVN"
	15882	>
	15883
	15884	<templateI d
	15885	root="2.16 .840.1.113 883.10.20. 22.4.19"
	15886	/>
	15887
	15888	<id
	15889	nullFlavor ="UNK"
	15890	/>
	15891
	15892	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	15893
	15894	<code
	15895	nullFlavor ="UNK"
	15896	/>
	15897
	15898	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	15899
	15900	<text>
	15901
	15902	<reference
	15903	nullFlavor ="UNK"
	15904	/>
	15905
	15906	</text>
	15907
	15908	<statusCod e
	15909	code="comp leted"
	15910	/>
	15911
	15912	<effective Time>
	15913
	15914	<low
	15915	nullFlavor ="UNK"
	15916	/>
	15917
	15918	</effectiv eTime>
	15919
	15920	<value
	15921	xsi:type=" CD"
	15922	/>
	15923
	15924	</observat ion>
	15925
	15926	</entryRel ationship>
	15927
	15928	<entryRela tionship
	15929	inversionI nd="false"
	15930	typeCode=" SUBJ"
	15931	>
	15932
	15933	<act
	15934	classCode= "ACT"
	15935	moodCode=" EVN"
	15936	>
	15937
	15938	<!--Encoun ter diagno sis act -- >
	15939
	15940	<templateI d
	15941	root="2.16 .840.1.113 883.10.20. 22.4.80"
	15942	/>
	15943
	15944	<id
	15945	nullFlavor ="UNK"
	15946	/>
	15947
	15948	<code
	15949	code="2930 8-4"
	15950	codeSystem ="2.16.840 .1.113883. 6.1"
	15951	codeSystem Name="LOIN C"
	15952	displayNam e="ENCOUNT ER DIAGNOS IS"
	15953	xsi:type=" CE"
	15954	/>
	15955
	15956	<statusCod e
	15957	code="acti ve"
	15958	/>
	15959
	15960	<effective Time
	15961	nullFlavor ="UNK"
	15962	>
	15963
	15964	</effectiv eTime>
	15965
	15966	<entryRela tionship
	15967	inversionI nd="false"
	15968	typeCode=" SUBJ"
	15969	>
	15970
	15971	<observati on
	15972	classCode= "OBS"
	15973	moodCode=" EVN"
	15974	negationIn d="false"
	15975	>
	15976
	15977	<templateI d
	15978	root="2.16 .840.1.113 883.10.20. 22.4.4"
	15979	/>
	15980
	15981	<!-- Probl em Observa tion -->
	15982
	15983	<id
	15984	nullFlavor ="UNK"
	15985	/>
	15986
	15987	<code
	15988	nullFlavor ="UNK"
	15989	>
	15990
	15991	<originalT ext>
	15992	Encounter Diagnosis Type Not A vailable
	15993	</original Text>
	15994
	15995	</code>
	15996
	15997	<statusCod e
	15998	code="comp leted"
	15999	/>
	16000
	16001	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	16002
	16003	<value
	16004	code="UNK"
	16005	codeSystem ="2.16.840 .1.113883. 6.96"
	16006	codeSystem Name="SNOM ED CT"
	16007	xsi:type=" CD"
	16008	/>
	16009
	16010	</observat ion>
	16011
	16012	</entryRel ationship>
	16013
	16014	</act>
	16015
	16016	</entryRel ationship>
	16017
	16018
	16019	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	16020
	16021	<!-- 16.09 DISCHARGE DISPOSITI ON CODE, O ptional, N ot provide d by VA
	16022	b/c da ta not yet available via VA Vi stA RPCs - ->
	16023
	16024	</encounte r>
	16025
	16026	</entry>
	16027	<entry
	16028	typeCode=" DRIV"
	16029	>
	16030
	16031	<encounter
	16032	classCode= "ENC"
	16033	moodCode=" EVN"
	16034	>
	16035
	16036	<templateI d
	16037	root="2.16 .840.1.113 883.10.20. 22.4.49"
	16038	/>
	16039
	16040	<id
	16041	nullFlavor ="NI"
	16042	/>
	16043
	16044	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	16045
	16046	<code
	16047	code="9949 9"
	16048	codeSystem ="2.16.840 .1.113883. 6.12"
	16049	codeSystem Name="CPT- 4"
	16050	displayNam e="Unliste d Evaluati on and Man agement Se rvice"
	16051	>
	16052
	16053	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	16054
	16055	<originalT ext>
	16056
	16057	<reference
	16058	value="#Hn PnoteEncou nterDescri ption1002"
	16059	/>
	16060
	16061	</original Text>
	16062
	16063	<translati on
	16064	code="3411 7-2"
	16065	codeSystem ="2.16.840 .1.113883. 6.1"
	16066	codeSystem Name="LOIN C"
	16067	displayNam e="History and Physi cal Note"
	16068	/>
	16069
	16070	</code>
	16071
	16072	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	16073
	16074	<effective Time>
	16075
	16076	<low
	16077	value="201 412051535"
	16078	/>
	16079
	16080	</effectiv eTime>
	16081
	16082	<performer >
	16083
	16084	<assignedE ntity>
	16085
	16086	<id
	16087	nullFlavor ="NA"
	16088	/>
	16089
	16090	<assignedP erson>
	16091
	16092	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	16093
	16094	<name>
	16095	FORREST,ZA CHARY H
	16096	</name>
	16097
	16098	</assigned Person>
	16099
	16100	</assigned Entity>
	16101
	16102	</performe r>
	16103
	16104	<author>
	16105
	16106	<time
	16107	nullFlavor ="NA"
	16108	/>
	16109
	16110	<assignedA uthor>
	16111
	16112	<id
	16113	nullFlavor ="NA"
	16114	/>
	16115
	16116	<represent edOrganiza tion>
	16117
	16118	<id
	16119	extension= "442"
	16120	root="2.16 .840.1.113 883.4.349"
	16121	/>
	16122
	16123	<name>
	16124	CHEYENNE V AMC
	16125	</name>
	16126
	16127	</represen tedOrganiz ation>
	16128
	16129	</assigned Author>
	16130
	16131	</author>
	16132
	16133	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	16134	VistA -->
	16135
	16136	<!--16.11 - FACILITY LOCATION, Optional -->
	16137
	16138	<participa nt
	16139	typeCode=" LOC"
	16140	>
	16141
	16142	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	16143
	16144	<time>
	16145
	16146	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	16147
	16148	<low/>
	16149
	16150	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	16151
	16152	<high/>
	16153
	16154	</time>
	16155
	16156	<participa ntRole
	16157	classCode= "SDLOC"
	16158	>
	16159
	16160	<templateI d
	16161	root="2.16 .840.1.113 883.10.20. 22.4.32"
	16162	/>
	16163
	16164	<code
	16165	nullFlavor ="UNK"
	16166	/>
	16167
	16168	<addr
	16169	nullFlavor ="UNK"
	16170	/>
	16171
	16172	<telecom
	16173	nullFlavor ="UNK"
	16174	/>
	16175
	16176	<playingEn tity
	16177	classCode= "PLC"
	16178	>
	16179
	16180	<name>
	16181	CHEYENNE V AMC
	16182	</name>
	16183
	16184	</playingE ntity>
	16185
	16186	</particip antRole>
	16187
	16188	</particip ant>
	16189
	16190	<entryRela tionship
	16191	typeCode=" RSON"
	16192	>
	16193
	16194	<observati on
	16195	classCode= "OBS"
	16196	moodCode=" EVN"
	16197	>
	16198
	16199	<templateI d
	16200	root="2.16 .840.1.113 883.10.20. 22.4.19"
	16201	/>
	16202
	16203	<id
	16204	nullFlavor ="UNK"
	16205	/>
	16206
	16207	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	16208
	16209	<code
	16210	nullFlavor ="UNK"
	16211	/>
	16212
	16213	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	16214
	16215	<text>
	16216
	16217	<reference
	16218	nullFlavor ="UNK"
	16219	/>
	16220
	16221	</text>
	16222
	16223	<statusCod e
	16224	code="comp leted"
	16225	/>
	16226
	16227	<effective Time>
	16228
	16229	<low
	16230	nullFlavor ="UNK"
	16231	/>
	16232
	16233	</effectiv eTime>
	16234
	16235	<value
	16236	xsi:type=" CD"
	16237	/>
	16238
	16239	</observat ion>
	16240
	16241	</entryRel ationship>
	16242
	16243	<entryRela tionship
	16244	inversionI nd="false"
	16245	typeCode=" SUBJ"
	16246	>
	16247
	16248	<act
	16249	classCode= "ACT"
	16250	moodCode=" EVN"
	16251	>
	16252
	16253	<!--Encoun ter diagno sis act -- >
	16254
	16255	<templateI d
	16256	root="2.16 .840.1.113 883.10.20. 22.4.80"
	16257	/>
	16258
	16259	<id
	16260	nullFlavor ="UNK"
	16261	/>
	16262
	16263	<code
	16264	code="2930 8-4"
	16265	codeSystem ="2.16.840 .1.113883. 6.1"
	16266	codeSystem Name="LOIN C"
	16267	displayNam e="ENCOUNT ER DIAGNOS IS"
	16268	xsi:type=" CE"
	16269	/>
	16270
	16271	<statusCod e
	16272	code="acti ve"
	16273	/>
	16274
	16275	<effective Time
	16276	nullFlavor ="UNK"
	16277	>
	16278
	16279	</effectiv eTime>
	16280
	16281	<entryRela tionship
	16282	inversionI nd="false"
	16283	typeCode=" SUBJ"
	16284	>
	16285
	16286	<observati on
	16287	classCode= "OBS"
	16288	moodCode=" EVN"
	16289	negationIn d="false"
	16290	>
	16291
	16292	<templateI d
	16293	root="2.16 .840.1.113 883.10.20. 22.4.4"
	16294	/>
	16295
	16296	<!-- Probl em Observa tion -->
	16297
	16298	<id
	16299	nullFlavor ="UNK"
	16300	/>
	16301
	16302	<code
	16303	nullFlavor ="UNK"
	16304	>
	16305
	16306	<originalT ext>
	16307	Encounter Diagnosis Type Not A vailable
	16308	</original Text>
	16309
	16310	</code>
	16311
	16312	<statusCod e
	16313	code="comp leted"
	16314	/>
	16315
	16316	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	16317
	16318	<value
	16319	code="UNK"
	16320	codeSystem ="2.16.840 .1.113883. 6.96"
	16321	codeSystem Name="SNOM ED CT"
	16322	xsi:type=" CD"
	16323	/>
	16324
	16325	</observat ion>
	16326
	16327	</entryRel ationship>
	16328
	16329	</act>
	16330
	16331	</entryRel ationship>
	16332
	16333
	16334	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	16335
	16336	<!-- 16.09 DISCHARGE DISPOSITI ON CODE, O ptional, N ot provide d by VA
	16337	b/c da ta not yet available via VA Vi stA RPCs - ->
	16338
	16339	</encounte r>
	16340
	16341	</entry>
	16342
	16343	<entry
	16344	typeCode=" DRIV"
	16345	>
	16346
	16347	<encounter
	16348	classCode= "ENC"
	16349	moodCode=" EVN"
	16350	>
	16351
	16352	<templateI d
	16353	root="2.16 .840.1.113 883.10.20. 22.4.49"
	16354	/>
	16355
	16356	<id
	16357	nullFlavor ="NI"
	16358	/>
	16359
	16360	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	16361
	16362	<code
	16363	code="9923 8"
	16364	codeSystem ="2.16.840 .1.113883. 6.12"
	16365	codeSystem Name="CPT- 4"
	16366	displayNam e="Hospita l discharg e day mana gement; 30 minutes o r less"
	16367	>
	16368
	16369	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	16370
	16371	<originalT ext>
	16372
	16373	<reference
	16374	value="#Di snoteEncou nterDescri ption1001"
	16375	/>
	16376
	16377	</original Text>
	16378
	16379	<translati on
	16380	code="1884 2-5"
	16381	codeSystem ="2.16.840 .1.113883. 6.1"
	16382	codeSystem Name="LOIN C"
	16383	displayNam e="Dischar ge Summari zation Not e"
	16384	/>
	16385
	16386	</code>
	16387
	16388
	16389	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	16390
	16391	<effective Time>
	16392
	16393	<low
	16394	value="201 50814"
	16395	/>
	16396
	16397	</effectiv eTime>
	16398
	16399	<performer >
	16400
	16401	<assignedE ntity>
	16402
	16403	<id
	16404	nullFlavor ="NA"
	16405	/>
	16406
	16407	<assignedP erson>
	16408
	16409	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	16410
	16411	<name>
	16412	FORREST,ZA CHARY H
	16413	</name>
	16414
	16415	</assigned Person>
	16416
	16417	</assigned Entity>
	16418
	16419	</performe r>
	16420
	16421	<author>
	16422
	16423	<time
	16424	nullFlavor ="NA"
	16425	/>
	16426
	16427	<assignedA uthor>
	16428
	16429	<id
	16430	nullFlavor ="NA"
	16431	/>
	16432
	16433	<represent edOrganiza tion>
	16434
	16435	<id
	16436	extension= "442"
	16437	root="2.16 .840.1.113 883.4.349"
	16438	/>
	16439
	16440	<name>
	16441	CHEYENNE V AMC
	16442	</name>
	16443
	16444	</represen tedOrganiz ation>
	16445
	16446	</assigned Author>
	16447
	16448	</author>
	16449
	16450	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	16451	VistA -->
	16452
	16453	<!--16.11 - FACILITY LOCATION, Optional -->
	16454
	16455	<participa nt
	16456	typeCode=" LOC"
	16457	>
	16458
	16459	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	16460
	16461	<time>
	16462
	16463	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	16464
	16465	<low/>
	16466
	16467	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	16468
	16469	<high/>
	16470
	16471	</time>
	16472
	16473	<participa ntRole
	16474	classCode= "SDLOC"
	16475	>
	16476
	16477	<playingEn tity
	16478	classCode= "PLC"
	16479	/>
	16480
	16481	</particip antRole>
	16482
	16483	</particip ant>
	16484
	16485	<entryRela tionship
	16486	typeCode=" RSON"
	16487	>
	16488
	16489	<observati on
	16490	classCode= "OBS"
	16491	moodCode=" EVN"
	16492	>
	16493
	16494	<templateI d
	16495	root="2.16 .840.1.113 883.10.20. 22.4.19"
	16496	/>
	16497
	16498	<id
	16499	nullFlavor ="UNK"
	16500	/>
	16501
	16502	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	16503
	16504	<code
	16505	nullFlavor ="UNK"
	16506	/>
	16507
	16508	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	16509
	16510	<text>
	16511
	16512	<reference
	16513	nullFlavor ="UNK"
	16514	/>
	16515
	16516	</text>
	16517
	16518	<statusCod e
	16519	code="comp leted"
	16520	/>
	16521
	16522	<value
	16523	codeSystem ="2.16.840 .1.113883. 6.96"
	16524	codeSystem Name="SNOM ED CT"
	16525	xsi:type=" CD"
	16526	/>
	16527
	16528	</observat ion>
	16529
	16530	</entryRel ationship>
	16531
	16532
	16533	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	16534
	16535
	16536
	16537	<entryRela tionship
	16538	inversionI nd="false"
	16539	typeCode=" SUBJ"
	16540	>
	16541
	16542	<act
	16543	classCode= "ACT"
	16544	moodCode=" EVN"
	16545	>
	16546
	16547	<!--Encoun ter diagno sis act -- >
	16548
	16549	<templateI d
	16550	root="2.16 .840.1.113 883.10.20. 22.4.80"
	16551	/>
	16552
	16553	<id
	16554	nullFlavor ="UNK"
	16555	/>
	16556
	16557	<code
	16558	code="2930 8-4"
	16559	codeSystem ="2.16.840 .1.113883. 6.1"
	16560	codeSystem Name="LOIN C"
	16561	displayNam e="ENCOUNT ER DIAGNOS IS"
	16562	xsi:type=" CE"
	16563	/>
	16564
	16565	<statusCod e
	16566	code="acti ve"
	16567	/>
	16568
	16569	<effective Time
	16570	nullFlavor ="UNK"
	16571	>
	16572
	16573	</effectiv eTime>
	16574
	16575	<entryRela tionship
	16576	inversionI nd="false"
	16577	typeCode=" SUBJ"
	16578	>
	16579
	16580	<observati on
	16581	classCode= "OBS"
	16582	moodCode=" EVN"
	16583	negationIn d="false"
	16584	>
	16585
	16586	<templateI d
	16587	root="2.16 .840.1.113 883.10.20. 22.4.4"
	16588	/>
	16589
	16590	<!-- Probl em Observa tion -->
	16591
	16592	<id
	16593	nullFlavor ="UNK"
	16594	/>
	16595
	16596	<code
	16597	nullFlavor ="UNK"
	16598	>
	16599
	16600	<originalT ext>
	16601	Encounter Diagnosis Type Not A vailable
	16602	</original Text>
	16603
	16604	</code>
	16605
	16606	<statusCod e
	16607	code="comp leted"
	16608	/>
	16609
	16610	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	16611
	16612	<value
	16613	code="UNK"
	16614	codeSystem ="2.16.840 .1.113883. 6.96"
	16615	codeSystem Name="SNOM ED CT"
	16616	xsi:type=" CD"
	16617	/>
	16618
	16619	</observat ion>
	16620
	16621	</entryRel ationship>
	16622
	16623	</act>
	16624
	16625	</entryRel ationship>
	16626
	16627	</encounte r>
	16628
	16629	</entry>
	16630
	16631
	16632
	16633	<entry
	16634	typeCode=" DRIV"
	16635	>
	16636
	16637	<encounter
	16638	classCode= "ENC"
	16639	moodCode=" EVN"
	16640	>
	16641
	16642	<templateI d
	16643	root="2.16 .840.1.113 883.10.20. 22.4.49"
	16644	/>
	16645
	16646	<id
	16647	nullFlavor ="NI"
	16648	/>
	16649
	16650	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	16651
	16652	<code
	16653	code="9949 9"
	16654	codeSystem ="2.16.840 .1.113883. 6.12"
	16655	codeSystem Name="CPT- 4"
	16656	displayNam e="Unliste d Evaluati on and Man agement Se rvice"
	16657	>
	16658
	16659	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	16660
	16661	<originalT ext>
	16662
	16663	<reference
	16664	value="#an NoteEncoun terDescrip tion1001"
	16665	/>
	16666
	16667	</original Text>
	16668
	16669	<translati on
	16670	code="1150 6-3"
	16671	codeSystem ="2.16.840 .1.113883. 6.1"
	16672	codeSystem Name="LOIN C"
	16673	displayNam e="Subsequ ent evalua tion note"
	16674	/>
	16675
	16676	</code>
	16677
	16678
	16679	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	16680
	16681	<effective Time>
	16682
	16683	<low
	16684	value="201 412051535"
	16685	/>
	16686
	16687	</effectiv eTime>
	16688
	16689	<performer >
	16690
	16691	<assignedE ntity>
	16692
	16693	<id
	16694	nullFlavor ="NA"
	16695	/>
	16696
	16697	<assignedP erson>
	16698
	16699	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	16700
	16701	<name>
	16702	FORREST,ZA CHARY H
	16703	</name>
	16704
	16705	</assigned Person>
	16706
	16707	</assigned Entity>
	16708
	16709	</performe r>
	16710
	16711	<author>
	16712
	16713	<time
	16714	nullFlavor ="NA"
	16715	/>
	16716
	16717	<assignedA uthor>
	16718
	16719	<id
	16720	nullFlavor ="NA"
	16721	/>
	16722
	16723	<represent edOrganiza tion>
	16724
	16725	<id
	16726	extension= "442"
	16727	root="2.16 .840.1.113 883.4.349"
	16728	/>
	16729
	16730	<name>
	16731	CHEYENNE V AMC
	16732	</name>
	16733
	16734	</represen tedOrganiz ation>
	16735
	16736	</assigned Author>
	16737
	16738	</author>
	16739
	16740	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	16741	VistA -->
	16742
	16743	<!--16.11 - FACILITY LOCATION, Optional -->
	16744
	16745	<participa nt
	16746	typeCode=" LOC"
	16747	>
	16748
	16749	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	16750
	16751	<time>
	16752
	16753	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	16754
	16755	<low/>
	16756
	16757	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	16758
	16759	<high/>
	16760
	16761	</time>
	16762
	16763	<participa ntRole
	16764	classCode= "SDLOC"
	16765	>
	16766
	16767	<playingEn tity
	16768	classCode= "PLC"
	16769	/>
	16770
	16771	</particip antRole>
	16772
	16773	</particip ant>
	16774
	16775	<entryRela tionship
	16776	typeCode=" RSON"
	16777	>
	16778
	16779	<observati on
	16780	classCode= "OBS"
	16781	moodCode=" EVN"
	16782	>
	16783
	16784	<templateI d
	16785	root="2.16 .840.1.113 883.10.20. 22.4.19"
	16786	/>
	16787
	16788	<id
	16789	nullFlavor ="UNK"
	16790	/>
	16791
	16792	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	16793
	16794	<code
	16795	nullFlavor ="UNK"
	16796	/>
	16797
	16798	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	16799
	16800	<text>
	16801
	16802	<reference
	16803	nullFlavor ="UNK"
	16804	/>
	16805
	16806	</text>
	16807
	16808	<statusCod e
	16809	code="comp leted"
	16810	/>
	16811
	16812	<value
	16813	codeSystem ="2.16.840 .1.113883. 6.96"
	16814	codeSystem Name="SNOM ED CT"
	16815	xsi:type=" CD"
	16816	/>
	16817
	16818	</observat ion>
	16819
	16820	</entryRel ationship>
	16821
	16822
	16823	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	16824
	16825
	16826
	16827	<entryRela tionship
	16828	inversionI nd="false"
	16829	typeCode=" SUBJ"
	16830	>
	16831
	16832	<act
	16833	classCode= "ACT"
	16834	moodCode=" EVN"
	16835	>
	16836
	16837	<!--Encoun ter diagno sis act -- >
	16838
	16839	<templateI d
	16840	root="2.16 .840.1.113 883.10.20. 22.4.80"
	16841	/>
	16842
	16843	<id
	16844	nullFlavor ="UNK"
	16845	/>
	16846
	16847	<code
	16848	code="2930 8-4"
	16849	codeSystem ="2.16.840 .1.113883. 6.1"
	16850	codeSystem Name="LOIN C"
	16851	displayNam e="ENCOUNT ER DIAGNOS IS"
	16852	xsi:type=" CE"
	16853	/>
	16854
	16855	<statusCod e
	16856	code="acti ve"
	16857	/>
	16858
	16859	<effective Time
	16860	nullFlavor ="UNK"
	16861	>
	16862
	16863	</effectiv eTime>
	16864
	16865	<entryRela tionship
	16866	inversionI nd="false"
	16867	typeCode=" SUBJ"
	16868	>
	16869
	16870	<observati on
	16871	classCode= "OBS"
	16872	moodCode=" EVN"
	16873	negationIn d="false"
	16874	>
	16875
	16876	<templateI d
	16877	root="2.16 .840.1.113 883.10.20. 22.4.4"
	16878	/>
	16879
	16880	<!-- Probl em Observa tion -->
	16881
	16882	<id
	16883	nullFlavor ="UNK"
	16884	/>
	16885
	16886	<code
	16887	nullFlavor ="UNK"
	16888	>
	16889
	16890	<originalT ext>
	16891	Encounter Diagnosis Type Not A vailable
	16892	</original Text>
	16893
	16894	</code>
	16895
	16896	<statusCod e
	16897	code="comp leted"
	16898	/>
	16899
	16900	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	16901
	16902	<value
	16903	code="UNK"
	16904	codeSystem ="2.16.840 .1.113883. 6.96"
	16905	codeSystem Name="SNOM ED CT"
	16906	xsi:type=" CD"
	16907	/>
	16908
	16909	</observat ion>
	16910
	16911	</entryRel ationship>
	16912
	16913	</act>
	16914
	16915	</entryRel ationship>
	16916
	16917	</encounte r>
	16918
	16919	</entry>
	16920	<entry
	16921	typeCode=" DRIV"
	16922	>
	16923
	16924	<encounter
	16925	classCode= "ENC"
	16926	moodCode=" EVN"
	16927	>
	16928
	16929	<templateI d
	16930	root="2.16 .840.1.113 883.10.20. 22.4.49"
	16931	/>
	16932
	16933	<id
	16934	nullFlavor ="NI"
	16935	/>
	16936
	16937	<!-- 16.02 ENCOUNTER TYPE. R2, CPT-4 -->
	16938
	16939	<code
	16940	code="9949 9"
	16941	codeSystem ="2.16.840 .1.113883. 6.12"
	16942	codeSystem Name="CPT- 4"
	16943	displayNam e="Unliste d Evaluati on and Man agement Se rvice"
	16944	>
	16945
	16946	<!-- 16.03 ENCOUNTER FREE TEXT TYPE. R2 -->
	16947
	16948	<originalT ext>
	16949
	16950	<reference
	16951	value="#an NoteEncoun terDescrip tion1002"
	16952	/>
	16953
	16954	</original Text>
	16955
	16956	<translati on
	16957	code="4234 8-3"
	16958	codeSystem ="2.16.840 .1.113883. 6.1"
	16959	codeSystem Name="LOIN C"
	16960	displayNam e="Advance directive s"
	16961	/>
	16962
	16963	</code>
	16964
	16965
	16966	<!-- 16.04 ENCOUNTER DATE/TIME , REQUIRED -->
	16967
	16968	<effective Time>
	16969
	16970	<low
	16971	value="201 501151136"
	16972	/>
	16973
	16974	</effectiv eTime>
	16975
	16976	<performer >
	16977
	16978	<assignedE ntity>
	16979
	16980	<id
	16981	nullFlavor ="NA"
	16982	/>
	16983
	16984	<assignedP erson>
	16985
	16986	<!-- 16.05 ENCOUNTER PROVIDER NAME, REQU IRED -->
	16987
	16988	<name>
	16989	FORREST,ZA CHARY H
	16990	</name>
	16991
	16992	</assigned Person>
	16993
	16994	</assigned Entity>
	16995
	16996	</performe r>
	16997
	16998	<author>
	16999
	17000	<time
	17001	nullFlavor ="NA"
	17002	/>
	17003
	17004	<assignedA uthor>
	17005
	17006	<id
	17007	nullFlavor ="NA"
	17008	/>
	17009
	17010	<represent edOrganiza tion>
	17011
	17012	<id
	17013	extension= "442"
	17014	root="2.16 .840.1.113 883.4.349"
	17015	/>
	17016
	17017	<name>
	17018	CHEYENNE V AMC
	17019	</name>
	17020
	17021	</represen tedOrganiz ation>
	17022
	17023	</assigned Author>
	17024
	17025	</author>
	17026
	17027	<!--16.06 - ADMISSIO N SOURCE, Optional, Not Yet Av ailable fr om VA
	17028	VistA -->
	17029
	17030	<!--16.11 - FACILITY LOCATION, Optional -->
	17031
	17032	<participa nt
	17033	typeCode=" LOC"
	17034	>
	17035
	17036	<!--16.20 - IN FACIL ITY LOCATI ON DURATIO N, Optiona l -->
	17037
	17038	<time>
	17039
	17040	<!--16.12 - ARRIVAL DATE/TIME, Optional -->
	17041
	17042	<low/>
	17043
	17044	<!-- 16.12 - DEPARTU RE DATE/TI ME, Option al -->
	17045
	17046	<high/>
	17047
	17048	</time>
	17049
	17050	<participa ntRole
	17051	classCode= "SDLOC"
	17052	>
	17053
	17054	<playingEn tity
	17055	classCode= "PLC"
	17056	/>
	17057
	17058	</particip antRole>
	17059
	17060	</particip ant>
	17061
	17062	<entryRela tionship
	17063	typeCode=" RSON"
	17064	>
	17065
	17066	<observati on
	17067	classCode= "OBS"
	17068	moodCode=" EVN"
	17069	>
	17070
	17071	<templateI d
	17072	root="2.16 .840.1.113 883.10.20. 22.4.19"
	17073	/>
	17074
	17075	<id
	17076	nullFlavor ="UNK"
	17077	/>
	17078
	17079	<!-- CCD R eason for Visit Code , REQUIRED , SNOMED C T -->
	17080
	17081	<code
	17082	nullFlavor ="UNK"
	17083	/>
	17084
	17085	<!-- 16.13 REASON FO R VISIT TE XT, Option al -->
	17086
	17087	<text>
	17088
	17089	<reference
	17090	nullFlavor ="UNK"
	17091	/>
	17092
	17093	</text>
	17094
	17095	<statusCod e
	17096	code="comp leted"
	17097	/>
	17098
	17099	<value
	17100	codeSystem ="2.16.840 .1.113883. 6.96"
	17101	codeSystem Name="SNOM ED CT"
	17102	xsi:type=" CD"
	17103	/>
	17104
	17105	</observat ion>
	17106
	17107	</entryRel ationship>
	17108
	17109
	17110	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQURIE D, SNOMED CT -->
	17111
	17112
	17113
	17114	<entryRela tionship
	17115	inversionI nd="false"
	17116	typeCode=" SUBJ"
	17117	>
	17118
	17119	<act
	17120	classCode= "ACT"
	17121	moodCode=" EVN"
	17122	>
	17123
	17124	<!--Encoun ter diagno sis act -- >
	17125
	17126	<templateI d
	17127	root="2.16 .840.1.113 883.10.20. 22.4.80"
	17128	/>
	17129
	17130	<id
	17131	nullFlavor ="UNK"
	17132	/>
	17133
	17134	<code
	17135	code="2930 8-4"
	17136	codeSystem ="2.16.840 .1.113883. 6.1"
	17137	codeSystem Name="LOIN C"
	17138	displayNam e="ENCOUNT ER DIAGNOS IS"
	17139	xsi:type=" CE"
	17140	/>
	17141
	17142	<statusCod e
	17143	code="acti ve"
	17144	/>
	17145
	17146	<effective Time
	17147	nullFlavor ="UNK"
	17148	>
	17149
	17150	</effectiv eTime>
	17151
	17152	<entryRela tionship
	17153	inversionI nd="false"
	17154	typeCode=" SUBJ"
	17155	>
	17156
	17157	<observati on
	17158	classCode= "OBS"
	17159	moodCode=" EVN"
	17160	negationIn d="false"
	17161	>
	17162
	17163	<templateI d
	17164	root="2.16 .840.1.113 883.10.20. 22.4.4"
	17165	/>
	17166
	17167	<!-- Probl em Observa tion -->
	17168
	17169	<id
	17170	nullFlavor ="UNK"
	17171	/>
	17172
	17173	<code
	17174	nullFlavor ="UNK"
	17175	>
	17176
	17177	<originalT ext>
	17178	Encounter Diagnosis Type Not A vailable
	17179	</original Text>
	17180
	17181	</code>
	17182
	17183	<statusCod e
	17184	code="comp leted"
	17185	/>
	17186
	17187	<!-- CCD E NCOUNTER D IAGNOSIS P ROBLEM COD E, REQUIRE D, SNOMED CT -->
	17188
	17189	<value
	17190	code="UNK"
	17191	codeSystem ="2.16.840 .1.113883. 6.96"
	17192	codeSystem Name="SNOM ED CT"
	17193	xsi:type=" CD"
	17194	/>
	17195
	17196	</observat ion>
	17197
	17198	</entryRel ationship>
	17199
	17200	</act>
	17201
	17202	</entryRel ationship>
	17203
	17204	</encounte r>
	17205
	17206	</entry>
	17207
	17208
	17209	</section>
	17210
	17211	</componen t>
	17212
	17213	<component >
	17214
	17215	<!-- *** ****** ****** ****** ****** ******** * RESULTS
	17216	SECTION, R EQUIRED ****** ****** ****** ****** ****** ** -->
	17217
	17218	<section>
	17219
	17220	<!-- CCD R esults Sec tion Entri es REQUIRE D -->
	17221
	17222	<templateI d
	17223	root="2.16 .840.1.113 883.10.20. 22.2.3.1"
	17224	/>
	17225
	17226	<templateI d
	17227	root="2.16 .840.1.113 883.10.20. 22.2.3"
	17228	/>
	17229
	17230	<code
	17231	code="3095 4-2"
	17232	codeSystem ="2.16.840 .1.113883. 6.1"
	17233	codeSystem Name="LOIN C"
	17234	displayNam e="Relevan t diagnost ic tests a nd/or labo ratory dat a"
	17235	/>
	17236
	17237	<title>
	17238	Results Se ction
	17239	</title>
	17240
	17241	<text>
	17242
	17243	<!-- VA Re sults Busi ness Rules for Medic al Content -->
	17244
	17245	<paragraph >
	17246	This section c ontains th e Chemistr y and Hema tology Lab Results,
	17247	Radi ology Repo rts, and P athology R eports on record wit h VA for
	17248	the patient. T he data co mes from a ll VA trea tment faci lities.
	17249
	17250	</paragrap h>
	17251
	17252	<table
	17253	ID="labRul es"
	17254	border="1"
	17255	width="100 %"
	17256	>
	17257
	17258	<tbody>
	17259
	17260	<tr>
	17261
	17262	<td>
	17263	Lab Result s
	17264	</td>
	17265
	17266	</tr>
	17267
	17268	<tr>
	17269
	17270	<td>
	17271	The includ ed Chemist ry/Hematol ogy Result s are from the last 24
	17272	months and are limit ed to the 20 most re cent sets of tests. The
	17273	data comes form all VA treatme nt facilit ies.
	17274
	17275	</td>
	17276
	17277	</tr>
	17278
	17279	</tbody>
	17280
	17281	</table>
	17282
	17283	<table
	17284	ID="labNar rative"
	17285	border="1"
	17286	width="100 %"
	17287	>
	17288
	17289	<thead>
	17290
	17291	<tr>
	17292
	17293	<th>
	17294	Date/Time
	17295	</th>
	17296
	17297	<th>
	17298	Source
	17299	</th>
	17300
	17301	<th>
	17302	Result Typ e
	17303	</th>
	17304
	17305	<th>
	17306	Result - U nit
	17307	</th>
	17308
	17309	<th>
	17310	Interpreta tion
	17311	</th>
	17312
	17313	<th>
	17314	Reference Range
	17315	</th>
	17316
	17317	<th>
	17318	Comment
	17319	</th>
	17320
	17321	</tr>
	17322
	17323	</thead>
	17324
	17325
	17326	<tbody>
	17327
	17328
	17329	<tr
	17330	ID="labTes t1001"
	17331	>
	17332
	17333	<td>
	17334	Jan 12, 20 15, 01:53 PM
	17335	</td>
	17336
	17337
	17338	<td>
	17339
	17340	<content
	17341	ID="lndSou rce1001"
	17342	>
	17343	CHEYENNE V AMC
	17344	</content>
	17345
	17346	</td>
	17347
	17348	<td>
	17349
	17350	<content
	17351	ID="lndRes ultType100 1"
	17352	>
	17353	GLUCOSE
	17354	</content>
	17355
	17356	</td>
	17357
	17358	<td/>
	17359
	17360
	17361	<td/>
	17362
	17363
	17364	<td/>
	17365
	17366
	17367	<td>
	17368
	17369	<content
	17370	ID="lndCom ment1001"
	17371	>
	17372	Specimen T ype: SERUM
	17373	Comment: ~ For Test: GLUCOSE ~T ESTING CCD A Ordering Provider: Zachary H Forrest R eport Rele ased Date/ Time: Jan 12, 2015@1 3:54
	17374	Performin g Lab: CHE YENNE VAMC
	17375	2360 E PERSHIN G BLVD CHE YENNE, WY 82001-5356
	17376
	17377	</content>
	17378
	17379	</td>
	17380
	17381	</tr>
	17382
	17383	<tr>
	17384
	17385	<td/>
	17386
	17387
	17388	<td/>
	17389
	17390
	17391	<td>
	17392
	17393	<content
	17394	ID="loincL abValues10 01"
	17395	>
	17396	GLUCOSE
	17397	</content>
	17398
	17399	</td>
	17400
	17401	<td>
	17402
	17403	<content
	17404	ID="result LabValues1 001"
	17405	>
	17406	30 mg/ dL
	17407	</content>
	17408
	17409	</td>
	17410
	17411	<td>
	17412
	17413	<content
	17414	ID="interp LabValues1 001"
	17415	>
	17416	L*
	17417	</content>
	17418
	17419	</td>
	17420
	17421	<td>
	17422
	17423	<content
	17424	ID="rangeL abValues10 01"
	17425	>
	17426	70-110
	17427	</content>
	17428
	17429	</td>
	17430
	17431	<td>
	17432
	17433	<content/>
	17434
	17435	</td>
	17436
	17437	</tr>
	17438
	17439
	17440	</tbody>
	17441	<tbody>
	17442
	17443
	17444	<tr
	17445	ID="labTes t1002"
	17446	>
	17447
	17448	<td>
	17449	Jan 12, 20 15, 01:51 PM
	17450	</td>
	17451
	17452
	17453	<td>
	17454
	17455	<content
	17456	ID="lndSou rce1002"
	17457	>
	17458	CHEYENNE V AMC
	17459	</content>
	17460
	17461	</td>
	17462
	17463	<td>
	17464
	17465	<content
	17466	ID="lndRes ultType100 2"
	17467	>
	17468	CHOLESTERO L
	17469	</content>
	17470
	17471	</td>
	17472
	17473	<td/>
	17474
	17475
	17476	<td/>
	17477
	17478
	17479	<td/>
	17480
	17481
	17482	<td>
	17483
	17484	<content
	17485	ID="lndCom ment1002"
	17486	>
	17487	Specimen T ype: SERUM
	17488	Comment: T ESTING C-C DA Orderin g Provider : Zachary H Forrest Report Rel eased Date /Time: Jan 12, 2015@ 13:53
	17489	Performin g Lab: CHE YENNE VAMC
	17490	2360 E PERSHIN G BLVD CHE YENNE, WY 82001-5356
	17491
	17492	</content>
	17493
	17494	</td>
	17495
	17496	</tr>
	17497
	17498	<tr>
	17499
	17500	<td/>
	17501
	17502
	17503	<td/>
	17504
	17505
	17506	<td>
	17507
	17508	<content
	17509	ID="loincL abValues10 02"
	17510	>
	17511	CHOLESTERO L
	17512	</content>
	17513
	17514	</td>
	17515
	17516	<td>
	17517
	17518	<content
	17519	ID="result LabValues1 002"
	17520	>
	17521	300 MG /DL
	17522	</content>
	17523
	17524	</td>
	17525
	17526	<td>
	17527
	17528	<content
	17529	ID="interp LabValues1 002"
	17530	>
	17531	H
	17532	</content>
	17533
	17534	</td>
	17535
	17536	<td>
	17537
	17538	<content
	17539	ID="rangeL abValues10 02"
	17540	>
	17541	0-200
	17542	</content>
	17543
	17544	</td>
	17545
	17546	<td>
	17547
	17548	<content/>
	17549
	17550	</td>
	17551
	17552	</tr>
	17553
	17554
	17555	</tbody>
	17556
	17557	</table>
	17558
	17559
	17560
	17561
	17562
	17563
	17564
	17565
	17566
	17567
	17568
	17569
	17570	</text>
	17571
	17572	<entry
	17573	typeCode=" DRIV"
	17574	>
	17575
	17576	<!-- CCD R esults Org anizer = V A Lab Orde r Panel , REQUIRED - ->
	17577
	17578	<organizer
	17579	classCode= "CLUSTER"
	17580	moodCode=" EVN"
	17581	>
	17582
	17583	<templateI d
	17584	root="2.16 .840.1.113 883.10.20. 22.4.1"
	17585	/>
	17586
	17587	<id
	17588	extension= "442;83434 ;3150112;4 ;1"
	17589	root="2.16 .840.1.113 883.4.349"
	17590	/>
	17591
	17592	<code
	17593	nullFlavor ="UNK"
	17594	>
	17595
	17596	<originalT ext>
	17597	GLUCOSE
	17598	</original Text>
	17599
	17600	<translati on>
	17601
	17602	<originalT ext>
	17603	GLUCOSE
	17604	</original Text>
	17605
	17606	</translat ion>
	17607
	17608	</code>
	17609
	17610	<statusCod e
	17611	code="comp leted"
	17612	/>
	17613
	17614	<effective Time>
	17615
	17616	<low
	17617	value="201 5011213533 5"
	17618	/>
	17619
	17620	</effectiv eTime>
	17621
	17622	<author>
	17623
	17624	<time
	17625	nullFlavor ="NA"
	17626	/>
	17627
	17628	<assignedA uthor>
	17629
	17630	<id
	17631	nullFlavor ="NA"
	17632	/>
	17633
	17634	<represent edOrganiza tion>
	17635
	17636	<id
	17637	extension= "442"
	17638	root="2.16 .840.1.113 883.3.1275 "
	17639	/>
	17640
	17641	<name>
	17642	CHEYENNE V AMC
	17643	</name>
	17644
	17645	</represen tedOrganiz ation>
	17646
	17647	</assigned Author>
	17648
	17649	</author>
	17650
	17651	<component >
	17652
	17653	<observati on
	17654	classCode= "OBS"
	17655	moodCode=" EVN"
	17656	>
	17657
	17658	<templateI d
	17659	root="2.16 .840.1.113 883.10.20. 22.4.2"
	17660	/>
	17661
	17662	<!-- 15.01 RESULT ID , REQUIRED -->
	17663
	17664	<id
	17665	extension= "CH;684988 6.864665;2 "
	17666	root="2.16 .840.1.113 883.4.349"
	17667	/>
	17668
	17669	<!-- 15.03 -RESULT TY PE, REQUIR ED -->
	17670
	17671	<code
	17672	code="2345 -7"
	17673	codeSystem ="2.16.840 .1.113883. 6.1"
	17674	codeSystem Name="LOIN C"
	17675	displayNam e="Glucose [Mass/vol ume] in Se rum or Pla sma"
	17676	>
	17677
	17678	<originalT ext>
	17679	GLUCOSE
	17680	</original Text>
	17681
	17682	<translati on/>
	17683
	17684	</code>
	17685
	17686
	17687	<text/>
	17688
	17689	<statusCod e
	17690	code="comp leted"
	17691	/>
	17692
	17693	<!-- 15.02 RESULT DA TE/TIME, R EQUIRED -- >
	17694
	17695	<effective Time
	17696	value="201 5011213533 5"
	17697	/>
	17698
	17699	<!-- 15.05 RESULT VA LUE, REQUI RED, xsi:t ype="PQ" - ->
	17700
	17701	<value
	17702	unit="mg/d L"
	17703	value="30"
	17704	xsi:type=" PQ"
	17705	>
	17706
	17707
	17708	</value>
	17709
	17710	<!-- 15.06 RESULT IN TERPRETATI ON, R2, -- >
	17711
	17712	<interpret ationCode>
	17713
	17714	<originalT ext>
	17715	L*
	17716	</original Text>
	17717
	17718	</interpre tationCode >
	17719
	17720	<entryRela tionship
	17721	inversionI nd="true"
	17722	typeCode=" SUBJ"
	17723	>
	17724
	17725	<act
	17726	classCode= "ACT"
	17727	moodCode=" EVN"
	17728	>
	17729
	17730	<templateI d
	17731	root="2.16 .840.1.113 883.10.20. 22.4.64"
	17732	/>
	17733
	17734	<code
	17735	code="4876 7-8"
	17736	codeSystem ="2.16.840 .1.113883. 6.1"
	17737	codeSystem Name="LOIN C"
	17738	displayNam e="Annotat ion commen t"
	17739	/>
	17740
	17741	<text>
	17742
	17743	<reference
	17744	value="#ln dComment10 01"
	17745	/>
	17746
	17747	</text>
	17748
	17749	</act>
	17750
	17751	</entryRel ationship>
	17752
	17753	<!-- CCD M ETHOD CODE , Optional , Not prov ided by VA b/c data not
	17754	yet availa ble via VA VistA RPC s -->
	17755
	17756	<!-- CCD T ARGET SITE CODE, Opt ional, Not provided by VA b/c data
	17757	not yet av ailable vi a VA VistA RPCs -->
	17758
	17759	<!-- 15.07 RESULT RE FERENCE RA NGE, R2, - ->
	17760
	17761	<reference Range>
	17762
	17763	<observati onRange>
	17764
	17765	<text>
	17766	70-110
	17767	</text>
	17768
	17769	</observat ionRange>
	17770
	17771	</referenc eRange>
	17772
	17773
	17774	</observat ion>
	17775
	17776	</componen t>
	17777
	17778	</organize r>
	17779
	17780	</entry>
	17781	<entry
	17782	typeCode=" DRIV"
	17783	>
	17784
	17785	<!-- CCD R esults Org anizer = V A Lab Orde r Panel , REQUIRED - ->
	17786
	17787	<organizer
	17788	classCode= "CLUSTER"
	17789	moodCode=" EVN"
	17790	>
	17791
	17792	<templateI d
	17793	root="2.16 .840.1.113 883.10.20. 22.4.1"
	17794	/>
	17795
	17796	<id
	17797	extension= "442;82852 ;3150112;3 ;1"
	17798	root="2.16 .840.1.113 883.4.349"
	17799	/>
	17800
	17801	<code
	17802	nullFlavor ="UNK"
	17803	>
	17804
	17805	<originalT ext>
	17806	CHOLESTERO L
	17807	</original Text>
	17808
	17809	<translati on>
	17810
	17811	<originalT ext>
	17812	CHOLESTERO L
	17813	</original Text>
	17814
	17815	</translat ion>
	17816
	17817	</code>
	17818
	17819	<statusCod e
	17820	code="comp leted"
	17821	/>
	17822
	17823	<effective Time>
	17824
	17825	<low
	17826	value="201 5011213512 4"
	17827	/>
	17828
	17829	</effectiv eTime>
	17830
	17831	<author>
	17832
	17833	<time
	17834	nullFlavor ="NA"
	17835	/>
	17836
	17837	<assignedA uthor>
	17838
	17839	<id
	17840	nullFlavor ="NA"
	17841	/>
	17842
	17843	<represent edOrganiza tion>
	17844
	17845	<id
	17846	extension= "442"
	17847	root="2.16 .840.1.113 883.3.1275 "
	17848	/>
	17849
	17850	<name>
	17851	CHEYENNE V AMC
	17852	</name>
	17853
	17854	</represen tedOrganiz ation>
	17855
	17856	</assigned Author>
	17857
	17858	</author>
	17859
	17860	<component >
	17861
	17862	<observati on
	17863	classCode= "OBS"
	17864	moodCode=" EVN"
	17865	>
	17866
	17867	<templateI d
	17868	root="2.16 .840.1.113 883.10.20. 22.4.2"
	17869	/>
	17870
	17871	<!-- 15.01 RESULT ID , REQUIRED -->
	17872
	17873	<id
	17874	extension= "CH;684988 6.864876;1 2"
	17875	root="2.16 .840.1.113 883.4.349"
	17876	/>
	17877
	17878	<!-- 15.03 -RESULT TY PE, REQUIR ED -->
	17879
	17880	<code
	17881	code="2093 -3"
	17882	codeSystem ="2.16.840 .1.113883. 6.1"
	17883	codeSystem Name="LOIN C"
	17884	displayNam e="Cholest erol [Mass /volume] i n Serum or Plasma"
	17885	>
	17886
	17887	<originalT ext>
	17888	CHOLESTERO L
	17889	</original Text>
	17890
	17891	<translati on/>
	17892
	17893	</code>
	17894
	17895
	17896	<text/>
	17897
	17898	<statusCod e
	17899	code="comp leted"
	17900	/>
	17901
	17902	<!-- 15.02 RESULT DA TE/TIME, R EQUIRED -- >
	17903
	17904	<effective Time
	17905	value="201 5011213512 4"
	17906	/>
	17907
	17908	<!-- 15.05 RESULT VA LUE, REQUI RED, xsi:t ype="PQ" - ->
	17909
	17910	<value
	17911	unit="MG/D L"
	17912	value="300 "
	17913	xsi:type=" PQ"
	17914	>
	17915
	17916
	17917	</value>
	17918
	17919	<!-- 15.06 RESULT IN TERPRETATI ON, R2, -- >
	17920
	17921	<interpret ationCode>
	17922
	17923	<originalT ext>
	17924	H
	17925	</original Text>
	17926
	17927	</interpre tationCode >
	17928
	17929	<entryRela tionship
	17930	inversionI nd="true"
	17931	typeCode=" SUBJ"
	17932	>
	17933
	17934	<act
	17935	classCode= "ACT"
	17936	moodCode=" EVN"
	17937	>
	17938
	17939	<templateI d
	17940	root="2.16 .840.1.113 883.10.20. 22.4.64"
	17941	/>
	17942
	17943	<code
	17944	code="4876 7-8"
	17945	codeSystem ="2.16.840 .1.113883. 6.1"
	17946	codeSystem Name="LOIN C"
	17947	displayNam e="Annotat ion commen t"
	17948	/>
	17949
	17950	<text>
	17951
	17952	<reference
	17953	value="#ln dComment10 02"
	17954	/>
	17955
	17956	</text>
	17957
	17958	</act>
	17959
	17960	</entryRel ationship>
	17961
	17962	<!-- CCD M ETHOD CODE , Optional , Not prov ided by VA b/c data not
	17963	yet availa ble via VA VistA RPC s -->
	17964
	17965	<!-- CCD T ARGET SITE CODE, Opt ional, Not provided by VA b/c data
	17966	not yet av ailable vi a VA VistA RPCs -->
	17967
	17968	<!-- 15.07 RESULT RE FERENCE RA NGE, R2, - ->
	17969
	17970	<reference Range>
	17971
	17972	<observati onRange>
	17973
	17974	<text>
	17975	0-200
	17976	</text>
	17977
	17978	</observat ionRange>
	17979
	17980	</referenc eRange>
	17981
	17982
	17983	</observat ion>
	17984
	17985	</componen t>
	17986
	17987	</organize r>
	17988
	17989	</entry>
	17990
	17991	</section>
	17992
	17993	</componen t>
	17994
	17995	<component >
	17996
	17997	<!-- *** ****** ****** ****** ****** ******** * IMMUNIZA TIONS
	17998	SECTION, O ptional ****** ****** ****** ****** ****** ** -->
	17999
	18000	<section>
	18001
	18002	<!-- CCD R esults Sec tion Entri es REQUIRE D -->
	18003
	18004	<templateI d
	18005	root="2.16 .840.1.113 883.10.20. 22.2.2.1"
	18006	/>
	18007
	18008	<templateI d
	18009	root="2.16 .840.1.113 883.10.20. 22.2.2"
	18010	/>
	18011
	18012	<code
	18013	code="1136 9-6"
	18014	codeSystem ="2.16.840 .1.113883. 6.1"
	18015	codeSystem Name="LOIN C"
	18016	/>
	18017
	18018	<title>
	18019	Immunizati ons Sectio n
	18020	</title>
	18021
	18022	<text>
	18023
	18024	<!-- VA Im munization Business Rules for Medical Co ntent -->
	18025
	18026	<paragraph >
	18027	This secti on contain s Immuniza tions on r ecord with VA for th e
	18028	pati ent. The d ata comes from all V A treatmen t faciliti es. A
	18029	reac tion to an immunizat ion may be reported in the all ergy
	18030	sect ion.
	18031	</paragrap h>
	18032
	18033	<table
	18034	ID="immuni zationNarr ative"
	18035	border="1"
	18036	width="100 %"
	18037	>
	18038
	18039	<thead>
	18040
	18041	<tr>
	18042
	18043	<th>
	18044	Immunizati on
	18045	</th>
	18046
	18047	<th>
	18048	Series
	18049	</th>
	18050
	18051	<th>
	18052	Date Issue d
	18053	</th>
	18054
	18055	<th>
	18056	Reaction
	18057	</th>
	18058
	18059	<th>
	18060	Comments
	18061	</th>
	18062
	18063	</tr>
	18064
	18065	</thead>
	18066
	18067	<tbody>
	18068
	18069	<tr>
	18070
	18071	<td>
	18072
	18073	<content
	18074	ID="indImm unization1 001"
	18075	>
	18076	INFLUENZA, UNSPECIFI ED FORMULA TION
	18077	</content>
	18078
	18079	</td>
	18080
	18081	<td>
	18082
	18083	<content
	18084	ID="indSer ies1001"
	18085	/>
	18086
	18087	</td>
	18088
	18089	<td>
	18090	Mar 05, 20 18
	18091	</td>
	18092
	18093
	18094	<td>
	18095
	18096	<content
	18097	ID="indRea ction1001"
	18098	/>
	18099
	18100	</td>
	18101
	18102	<td>
	18103
	18104	<content
	18105	ID="indCom ments1001"
	18106	>
	18107	Administer ed by: MEG AN DAS (NP I=11849099 54). Partn er Patient ID: 33601 62051
	18108	</content>
	18109
	18110	</td>
	18111
	18112	</tr>
	18113	<tr>
	18114
	18115	<td>
	18116
	18117	<content
	18118	ID="indImm unization1 002"
	18119	>
	18120	INFLUENZA, UNSPECIFI ED FORMULA TION
	18121	</content>
	18122
	18123	</td>
	18124
	18125	<td>
	18126
	18127	<content
	18128	ID="indSer ies1002"
	18129	/>
	18130
	18131	</td>
	18132
	18133	<td>
	18134	Jan 24, 20 17
	18135	</td>
	18136
	18137
	18138	<td>
	18139
	18140	<content
	18141	ID="indRea ction1002"
	18142	/>
	18143
	18144	</td>
	18145
	18146	<td>
	18147
	18148	<content
	18149	ID="indCom ments1002"
	18150	>
	18151	Administer ed by: pra thima madh avarao (NP I=11849099 54). Partn er Patient ID: 33601 62051
	18152	</content>
	18153
	18154	</td>
	18155
	18156	</tr>
	18157	<tr>
	18158
	18159	<td>
	18160
	18161	<content
	18162	ID="indImm unization1 003"
	18163	>
	18164	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	18165	</content>
	18166
	18167	</td>
	18168
	18169	<td>
	18170
	18171	<content
	18172	ID="indSer ies1003"
	18173	/>
	18174
	18175	</td>
	18176
	18177	<td>
	18178	Nov 30, 20 16
	18179	</td>
	18180
	18181
	18182	<td>
	18183
	18184	<content
	18185	ID="indRea ction1003"
	18186	/>
	18187
	18188	</td>
	18189
	18190	<td>
	18191
	18192	<content
	18193	ID="indCom ments1003"
	18194	>
	18195	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18196	</content>
	18197
	18198	</td>
	18199
	18200	</tr>
	18201	<tr>
	18202
	18203	<td>
	18204
	18205	<content
	18206	ID="indImm unization1 004"
	18207	>
	18208	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	18209	</content>
	18210
	18211	</td>
	18212
	18213	<td>
	18214
	18215	<content
	18216	ID="indSer ies1004"
	18217	/>
	18218
	18219	</td>
	18220
	18221	<td>
	18222	Nov 29, 20 16
	18223	</td>
	18224
	18225
	18226	<td>
	18227
	18228	<content
	18229	ID="indRea ction1004"
	18230	/>
	18231
	18232	</td>
	18233
	18234	<td>
	18235
	18236	<content
	18237	ID="indCom ments1004"
	18238	>
	18239	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18240	</content>
	18241
	18242	</td>
	18243
	18244	</tr>
	18245	<tr>
	18246
	18247	<td>
	18248
	18249	<content
	18250	ID="indImm unization1 005"
	18251	>
	18252	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	18253	</content>
	18254
	18255	</td>
	18256
	18257	<td>
	18258
	18259	<content
	18260	ID="indSer ies1005"
	18261	/>
	18262
	18263	</td>
	18264
	18265	<td>
	18266	Nov 25, 20 16
	18267	</td>
	18268
	18269
	18270	<td>
	18271
	18272	<content
	18273	ID="indRea ction1005"
	18274	/>
	18275
	18276	</td>
	18277
	18278	<td>
	18279
	18280	<content
	18281	ID="indCom ments1005"
	18282	>
	18283	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18284	</content>
	18285
	18286	</td>
	18287
	18288	</tr>
	18289	<tr>
	18290
	18291	<td>
	18292
	18293	<content
	18294	ID="indImm unization1 006"
	18295	>
	18296	PNEUMOCOCC AL CONJUGA TE PCV 13
	18297	</content>
	18298
	18299	</td>
	18300
	18301	<td>
	18302
	18303	<content
	18304	ID="indSer ies1006"
	18305	/>
	18306
	18307	</td>
	18308
	18309	<td>
	18310	Nov 25, 20 16
	18311	</td>
	18312
	18313
	18314	<td>
	18315
	18316	<content
	18317	ID="indRea ction1006"
	18318	/>
	18319
	18320	</td>
	18321
	18322	<td>
	18323
	18324	<content
	18325	ID="indCom ments1006"
	18326	>
	18327	this is a test immun ization cr eated on 3 161125.0
	18328	</content>
	18329
	18330	</td>
	18331
	18332	</tr>
	18333	<tr>
	18334
	18335	<td>
	18336
	18337	<content
	18338	ID="indImm unization1 007"
	18339	>
	18340	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	18341	</content>
	18342
	18343	</td>
	18344
	18345	<td>
	18346
	18347	<content
	18348	ID="indSer ies1007"
	18349	/>
	18350
	18351	</td>
	18352
	18353	<td>
	18354	Sep 25, 20 16
	18355	</td>
	18356
	18357
	18358	<td>
	18359
	18360	<content
	18361	ID="indRea ction1007"
	18362	/>
	18363
	18364	</td>
	18365
	18366	<td>
	18367
	18368	<content
	18369	ID="indCom ments1007"
	18370	>
	18371	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18372	</content>
	18373
	18374	</td>
	18375
	18376	</tr>
	18377	<tr>
	18378
	18379	<td>
	18380
	18381	<content
	18382	ID="indImm unization1 008"
	18383	>
	18384	PNEUMOCOCC AL CONJUGA TE PCV 13
	18385	</content>
	18386
	18387	</td>
	18388
	18389	<td>
	18390
	18391	<content
	18392	ID="indSer ies1008"
	18393	/>
	18394
	18395	</td>
	18396
	18397	<td>
	18398	Jun 01, 20 15
	18399	</td>
	18400
	18401
	18402	<td>
	18403
	18404	<content
	18405	ID="indRea ction1008"
	18406	/>
	18407
	18408	</td>
	18409
	18410	<td>
	18411
	18412	<content
	18413	ID="indCom ments1008"
	18414	>
	18415	Partner: W algreens. Administer ed by: JB1 33 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO1M OSTAFA Mfr : Kirkland s; Dosage: 2.899 oz
	18416	</content>
	18417
	18418	</td>
	18419
	18420	</tr>
	18421	<tr>
	18422
	18423	<td>
	18424
	18425	<content
	18426	ID="indImm unization1 009"
	18427	>
	18428	INFLUENZA, INJECTABL E, QUADRIV ALENT
	18429	</content>
	18430
	18431	</td>
	18432
	18433	<td>
	18434
	18435	<content
	18436	ID="indSer ies1009"
	18437	/>
	18438
	18439	</td>
	18440
	18441	<td>
	18442	Mar 07, 20 15
	18443	</td>
	18444
	18445
	18446	<td>
	18447
	18448	<content
	18449	ID="indRea ction1009"
	18450	/>
	18451
	18452	</td>
	18453
	18454	<td>
	18455
	18456	<content
	18457	ID="indCom ments1009"
	18458	>
	18459	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 59 910903086 Lot#: 1413 801 Mfr: N ovartis Ph armaceutic al Corp.
	18460	</content>
	18461
	18462	</td>
	18463
	18464	</tr>
	18465	<tr>
	18466
	18467	<td>
	18468
	18469	<content
	18470	ID="indImm unization1 010"
	18471	>
	18472	ZOSTER
	18473	</content>
	18474
	18475	</td>
	18476
	18477	<td>
	18478
	18479	<content
	18480	ID="indSer ies1010"
	18481	/>
	18482
	18483	</td>
	18484
	18485	<td>
	18486	Feb 15, 20 15
	18487	</td>
	18488
	18489
	18490	<td>
	18491
	18492	<content
	18493	ID="indRea ction1010"
	18494	/>
	18495
	18496	</td>
	18497
	18498	<td>
	18499
	18500	<content
	18501	ID="indCom ments1010"
	18502	>
	18503	Partner: W algreens. Administer ed by: BHA RATI YACHA MANENI (NP I=11849099 54). Partn er Patient ID: 33601 62051 Lot# : JOO1VGK Mfr: Kirkl and; Dosag e: 3.655 o z
	18504	</content>
	18505
	18506	</td>
	18507
	18508	</tr>
	18509	<tr>
	18510
	18511	<td>
	18512
	18513	<content
	18514	ID="indImm unization1 011"
	18515	>
	18516	INFLUENZA, INJECTABL E, QUADRIV ALENT
	18517	</content>
	18518
	18519	</td>
	18520
	18521	<td>
	18522
	18523	<content
	18524	ID="indSer ies1011"
	18525	/>
	18526
	18527	</td>
	18528
	18529	<td>
	18530	Feb 03, 20 15
	18531	</td>
	18532
	18533
	18534	<td>
	18535
	18536	<content
	18537	ID="indRea ction1011"
	18538	/>
	18539
	18540	</td>
	18541
	18542	<td>
	18543
	18544	<content
	18545	ID="indCom ments1011"
	18546	>
	18547	Partner: W algreens. Administer ed by: JB1 58 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18548	</content>
	18549
	18550	</td>
	18551
	18552	</tr>
	18553	<tr>
	18554
	18555	<td>
	18556
	18557	<content
	18558	ID="indImm unization1 012"
	18559	>
	18560	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	18561	</content>
	18562
	18563	</td>
	18564
	18565	<td>
	18566
	18567	<content
	18568	ID="indSer ies1012"
	18569	/>
	18570
	18571	</td>
	18572
	18573	<td>
	18574	Feb 02, 20 15
	18575	</td>
	18576
	18577
	18578	<td>
	18579
	18580	<content
	18581	ID="indRea ction1012"
	18582	/>
	18583
	18584	</td>
	18585
	18586	<td>
	18587
	18588	<content
	18589	ID="indCom ments1012"
	18590	>
	18591	Partner: W algreens. Administer ed by: JB1 55 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18592	</content>
	18593
	18594	</td>
	18595
	18596	</tr>
	18597	<tr>
	18598
	18599	<td>
	18600
	18601	<content
	18602	ID="indImm unization1 013"
	18603	>
	18604	INFLUENZA, LIVE, INT RANASAL, Q UADRIVALEN T
	18605	</content>
	18606
	18607	</td>
	18608
	18609	<td>
	18610
	18611	<content
	18612	ID="indSer ies1013"
	18613	/>
	18614
	18615	</td>
	18616
	18617	<td>
	18618	Feb 01, 20 15
	18619	</td>
	18620
	18621
	18622	<td>
	18623
	18624	<content
	18625	ID="indRea ction1013"
	18626	/>
	18627
	18628	</td>
	18629
	18630	<td>
	18631
	18632	<content
	18633	ID="indCom ments1013"
	18634	>
	18635	Partner: W algreens. Administer ed by: JB1 49 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18636	</content>
	18637
	18638	</td>
	18639
	18640	</tr>
	18641	<tr>
	18642
	18643	<td>
	18644
	18645	<content
	18646	ID="indImm unization1 014"
	18647	>
	18648	INFLUENZA, SEASONAL, INJECTABL E
	18649	</content>
	18650
	18651	</td>
	18652
	18653	<td>
	18654
	18655	<content
	18656	ID="indSer ies1014"
	18657	/>
	18658
	18659	</td>
	18660
	18661	<td>
	18662	Dec 08, 20 14
	18663	</td>
	18664
	18665
	18666	<td>
	18667
	18668	<content
	18669	ID="indRea ction1014"
	18670	/>
	18671
	18672	</td>
	18673
	18674	<td>
	18675
	18676	<content
	18677	ID="indCom ments1014"
	18678	>
	18679	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18680	</content>
	18681
	18682	</td>
	18683
	18684	</tr>
	18685	<tr>
	18686
	18687	<td>
	18688
	18689	<content
	18690	ID="indImm unization1 015"
	18691	>
	18692	INFLUENZA, SEASONAL, INJECTABL E
	18693	</content>
	18694
	18695	</td>
	18696
	18697	<td>
	18698
	18699	<content
	18700	ID="indSer ies1015"
	18701	/>
	18702
	18703	</td>
	18704
	18705	<td>
	18706	Dec 07, 20 14
	18707	</td>
	18708
	18709
	18710	<td>
	18711
	18712	<content
	18713	ID="indRea ction1015"
	18714	/>
	18715
	18716	</td>
	18717
	18718	<td>
	18719
	18720	<content
	18721	ID="indCom ments1015"
	18722	>
	18723	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18724	</content>
	18725
	18726	</td>
	18727
	18728	</tr>
	18729	<tr>
	18730
	18731	<td>
	18732
	18733	<content
	18734	ID="indImm unization1 016"
	18735	>
	18736	INFLUENZA, SEASONAL, INJECTABL E
	18737	</content>
	18738
	18739	</td>
	18740
	18741	<td>
	18742
	18743	<content
	18744	ID="indSer ies1016"
	18745	/>
	18746
	18747	</td>
	18748
	18749	<td>
	18750	Dec 05, 20 14
	18751	</td>
	18752
	18753
	18754	<td>
	18755
	18756	<content
	18757	ID="indRea ction1016"
	18758	/>
	18759
	18760	</td>
	18761
	18762	<td>
	18763
	18764	<content
	18765	ID="indCom ments1016"
	18766	>
	18767	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18768	</content>
	18769
	18770	</td>
	18771
	18772	</tr>
	18773	<tr>
	18774
	18775	<td>
	18776
	18777	<content
	18778	ID="indImm unization1 017"
	18779	>
	18780	INFLUENZA, SEASONAL, INJECTABL E
	18781	</content>
	18782
	18783	</td>
	18784
	18785	<td>
	18786
	18787	<content
	18788	ID="indSer ies1017"
	18789	/>
	18790
	18791	</td>
	18792
	18793	<td>
	18794	Nov 02, 20 14
	18795	</td>
	18796
	18797
	18798	<td>
	18799
	18800	<content
	18801	ID="indRea ction1017"
	18802	/>
	18803
	18804	</td>
	18805
	18806	<td>
	18807
	18808	<content
	18809	ID="indCom ments1017"
	18810	>
	18811	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	18812	</content>
	18813
	18814	</td>
	18815
	18816	</tr>
	18817	<tr>
	18818
	18819	<td>
	18820
	18821	<content
	18822	ID="indImm unization1 018"
	18823	>
	18824	INFLUENZA, SEASONAL, INJECTABL E
	18825	</content>
	18826
	18827	</td>
	18828
	18829	<td>
	18830
	18831	<content
	18832	ID="indSer ies1018"
	18833	/>
	18834
	18835	</td>
	18836
	18837	<td>
	18838	Nov 01, 20 14
	18839	</td>
	18840
	18841
	18842	<td>
	18843
	18844	<content
	18845	ID="indRea ction1018"
	18846	/>
	18847
	18848	</td>
	18849
	18850	<td>
	18851
	18852	<content
	18853	ID="indCom ments1018"
	18854	>
	18855	Partner: W algreens. Administer ed by: QUY NH PHAM (N PI=1528343 670). Part ner Patien t ID: 3360 162051 Lot #: 1413801 Mfr: Nova rtis Pharm aceutical Corp.
	18856	</content>
	18857
	18858	</td>
	18859
	18860	</tr>
	18861	<tr>
	18862
	18863	<td>
	18864
	18865	<content
	18866	ID="indImm unization1 019"
	18867	>
	18868	INFLUENZA, HIGH DOSE SEASONAL
	18869	</content>
	18870
	18871	</td>
	18872
	18873	<td>
	18874
	18875	<content
	18876	ID="indSer ies1019"
	18877	/>
	18878
	18879	</td>
	18880
	18881	<td>
	18882	Aug 19, 20 14
	18883	</td>
	18884
	18885
	18886	<td>
	18887
	18888	<content
	18889	ID="indRea ction1019"
	18890	/>
	18891
	18892	</td>
	18893
	18894	<td>
	18895
	18896	<content
	18897	ID="indCom ments1019"
	18898	>
	18899	Partner: W algreens. Administer ed by: JB1 35 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	18900	</content>
	18901
	18902	</td>
	18903
	18904	</tr>
	18905	<tr>
	18906
	18907	<td>
	18908
	18909	<content
	18910	ID="indImm unization1 020"
	18911	>
	18912	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	18913	</content>
	18914
	18915	</td>
	18916
	18917	<td>
	18918
	18919	<content
	18920	ID="indSer ies1020"
	18921	/>
	18922
	18923	</td>
	18924
	18925	<td>
	18926	Aug 01, 20 14
	18927	</td>
	18928
	18929
	18930	<td>
	18931
	18932	<content
	18933	ID="indRea ction1020"
	18934	/>
	18935
	18936	</td>
	18937
	18938	<td>
	18939
	18940	<content
	18941	ID="indCom ments1020"
	18942	>
	18943	Partner: W algreens. Administer ed by: MEG AN DAS (NP I=11849099 54). Partn er Patient ID: 33601 62051 Lot# : JOO1694 Mfr: Merck DAS
	18944	</content>
	18945
	18946	</td>
	18947
	18948	</tr>
	18949	<tr>
	18950
	18951	<td>
	18952
	18953	<content
	18954	ID="indImm unization1 021"
	18955	>
	18956	PNEUMOCOCC AL CONJUGA TE PCV 13
	18957	</content>
	18958
	18959	</td>
	18960
	18961	<td>
	18962
	18963	<content
	18964	ID="indSer ies1021"
	18965	/>
	18966
	18967	</td>
	18968
	18969	<td>
	18970	Aug 01, 20 14
	18971	</td>
	18972
	18973
	18974	<td>
	18975
	18976	<content
	18977	ID="indRea ction1021"
	18978	/>
	18979
	18980	</td>
	18981
	18982	<td>
	18983
	18984	<content
	18985	ID="indCom ments1021"
	18986	>
	18987	Partner: W algreens. Administer ed by: Chr is Stinson (NPI=1234 567890). P artner Pat ient ID: 3 360162051 Lot#: JOO1 694 Mfr: M erck
	18988	</content>
	18989
	18990	</td>
	18991
	18992	</tr>
	18993	<tr>
	18994
	18995	<td>
	18996
	18997	<content
	18998	ID="indImm unization1 022"
	18999	>
	19000	ZOSTER
	19001	</content>
	19002
	19003	</td>
	19004
	19005	<td>
	19006
	19007	<content
	19008	ID="indSer ies1022"
	19009	/>
	19010
	19011	</td>
	19012
	19013	<td>
	19014	Aug 2014
	19015	</td>
	19016
	19017
	19018	<td>
	19019
	19020	<content
	19021	ID="indRea ction1022"
	19022	/>
	19023
	19024	</td>
	19025
	19026	<td>
	19027
	19028	<content
	19029	ID="indCom ments1022"
	19030	>
	19031	Partner: W algreens. Administer ed by: JB1 21 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051
	19032	</content>
	19033
	19034	</td>
	19035
	19036	</tr>
	19037	<tr>
	19038
	19039	<td>
	19040
	19041	<content
	19042	ID="indImm unization1 023"
	19043	>
	19044	PNEUMOCOCC AL CONJUGA TE PCV 13
	19045	</content>
	19046
	19047	</td>
	19048
	19049	<td>
	19050
	19051	<content
	19052	ID="indSer ies1023"
	19053	/>
	19054
	19055	</td>
	19056
	19057	<td>
	19058	May 08, 20 14
	19059	</td>
	19060
	19061
	19062	<td>
	19063
	19064	<content
	19065	ID="indRea ction1023"
	19066	/>
	19067
	19068	</td>
	19069
	19070	<td>
	19071
	19072	<content
	19073	ID="indCom ments1023"
	19074	>
	19075	this is a test immun ization cr eated on 3 161125.0
	19076	</content>
	19077
	19078	</td>
	19079
	19080	</tr>
	19081	<tr>
	19082
	19083	<td>
	19084
	19085	<content
	19086	ID="indImm unization1 024"
	19087	>
	19088	ZOSTER
	19089	</content>
	19090
	19091	</td>
	19092
	19093	<td>
	19094
	19095	<content
	19096	ID="indSer ies1024"
	19097	/>
	19098
	19099	</td>
	19100
	19101	<td>
	19102	Apr 24, 20 14
	19103	</td>
	19104
	19105
	19106	<td>
	19107
	19108	<content
	19109	ID="indRea ction1024"
	19110	/>
	19111
	19112	</td>
	19113
	19114	<td>
	19115
	19116	<content
	19117	ID="indCom ments1024"
	19118	>
	19119	Partner: W algreens. Administer ed by: Chr is Stinson (NPI=1234 567890). P artner Pat ient ID: 3 360162051 Lot#: JOO1 694 Mfr: M erck
	19120	</content>
	19121
	19122	</td>
	19123
	19124	</tr>
	19125	<tr>
	19126
	19127	<td>
	19128
	19129	<content
	19130	ID="indImm unization1 025"
	19131	>
	19132	INFLUENZA, SEASONAL, INTRADERM AL, PRESER VATIVE FRE E
	19133	</content>
	19134
	19135	</td>
	19136
	19137	<td>
	19138
	19139	<content
	19140	ID="indSer ies1025"
	19141	/>
	19142
	19143	</td>
	19144
	19145	<td>
	19146	Aug 19, 20 13
	19147	</td>
	19148
	19149
	19150	<td>
	19151
	19152	<content
	19153	ID="indRea ction1025"
	19154	/>
	19155
	19156	</td>
	19157
	19158	<td>
	19159
	19160	<content
	19161	ID="indCom ments1025"
	19162	>
	19163	Partner: W algreens. Administer ed by: JB1 44 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	19164	</content>
	19165
	19166	</td>
	19167
	19168	</tr>
	19169	<tr>
	19170
	19171	<td>
	19172
	19173	<content
	19174	ID="indImm unization1 026"
	19175	>
	19176	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	19177	</content>
	19178
	19179	</td>
	19180
	19181	<td>
	19182
	19183	<content
	19184	ID="indSer ies1026"
	19185	/>
	19186
	19187	</td>
	19188
	19189	<td>
	19190	Aug 18, 20 13
	19191	</td>
	19192
	19193
	19194	<td>
	19195
	19196	<content
	19197	ID="indRea ction1026"
	19198	/>
	19199
	19200	</td>
	19201
	19202	<td>
	19203
	19204	<content
	19205	ID="indCom ments1026"
	19206	>
	19207	Partner: W algreens. Administer ed by: JB3 3 DASSQA ( NPI=118490 9954). Par tner Patie nt ID: 336 0162051 Lo t#: JOO169 4 Mfr: Mer ck DAS
	19208	</content>
	19209
	19210	</td>
	19211
	19212	</tr>
	19213	<tr>
	19214
	19215	<td>
	19216
	19217	<content
	19218	ID="indImm unization1 027"
	19219	>
	19220	INFLUENZA, SEASONAL, INJECTABL E
	19221	</content>
	19222
	19223	</td>
	19224
	19225	<td>
	19226
	19227	<content
	19228	ID="indSer ies1027"
	19229	/>
	19230
	19231	</td>
	19232
	19233	<td>
	19234	Jan 24, 20 12
	19235	</td>
	19236
	19237
	19238	<td>
	19239
	19240	<content
	19241	ID="indRea ction1027"
	19242	/>
	19243
	19244	</td>
	19245
	19246	<td>
	19247
	19248	<content
	19249	ID="indCom ments1027"
	19250	>
	19251	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	19252	</content>
	19253
	19254	</td>
	19255
	19256	</tr>
	19257	<tr>
	19258
	19259	<td>
	19260
	19261	<content
	19262	ID="indImm unization1 028"
	19263	>
	19264	INFLUENZA, INJECTABL E, QUADRIV ALENT, PRE SERVATIVE FREE
	19265	</content>
	19266
	19267	</td>
	19268
	19269	<td>
	19270
	19271	<content
	19272	ID="indSer ies1028"
	19273	/>
	19274
	19275	</td>
	19276
	19277	<td>
	19278	2010
	19279	</td>
	19280
	19281
	19282	<td>
	19283
	19284	<content
	19285	ID="indRea ction1028"
	19286	/>
	19287
	19288	</td>
	19289
	19290	<td>
	19291
	19292	<content
	19293	ID="indCom ments1028"
	19294	>
	19295	Partner: W algreens. Administer ed by: JB1 50 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051
	19296	</content>
	19297
	19298	</td>
	19299
	19300	</tr>
	19301	<tr>
	19302
	19303	<td>
	19304
	19305	<content
	19306	ID="indImm unization1 029"
	19307	>
	19308	ZOSTER
	19309	</content>
	19310
	19311	</td>
	19312
	19313	<td>
	19314
	19315	<content
	19316	ID="indSer ies1029"
	19317	/>
	19318
	19319	</td>
	19320
	19321	<td>
	19322	2010
	19323	</td>
	19324
	19325
	19326	<td>
	19327
	19328	<content
	19329	ID="indRea ction1029"
	19330	/>
	19331
	19332	</td>
	19333
	19334	<td>
	19335
	19336	<content
	19337	ID="indCom ments1029"
	19338	>
	19339	Partner: W algreens. Administer ed by: VK1 21 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051
	19340	</content>
	19341
	19342	</td>
	19343
	19344	</tr>
	19345	<tr>
	19346
	19347	<td>
	19348
	19349	<content
	19350	ID="indImm unization1 030"
	19351	>
	19352	INFLUENZA, INJECTABL E, MDCK, P RESERVATIV E FREE
	19353	</content>
	19354
	19355	</td>
	19356
	19357	<td>
	19358
	19359	<content
	19360	ID="indSer ies1030"
	19361	/>
	19362
	19363	</td>
	19364
	19365	<td>
	19366	Jan 24, 20 09
	19367	</td>
	19368
	19369
	19370	<td>
	19371
	19372	<content
	19373	ID="indRea ction1030"
	19374	/>
	19375
	19376	</td>
	19377
	19378	<td>
	19379
	19380	<content
	19381	ID="indCom ments1030"
	19382	>
	19383	Partner: W algreens. Administer ed by: JB1 53 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	19384	</content>
	19385
	19386	</td>
	19387
	19388	</tr>
	19389	<tr>
	19390
	19391	<td>
	19392
	19393	<content
	19394	ID="indImm unization1 031"
	19395	>
	19396	Pneumococc al (HISTOR ICAL)
	19397	</content>
	19398
	19399	</td>
	19400
	19401	<td>
	19402
	19403	<content
	19404	ID="indSer ies1031"
	19405	/>
	19406
	19407	</td>
	19408
	19409	<td>
	19410	Jan 2009
	19411	</td>
	19412
	19413
	19414	<td>
	19415
	19416	<content
	19417	ID="indRea ction1031"
	19418	/>
	19419
	19420	</td>
	19421
	19422	<td>
	19423
	19424	<content
	19425	ID="indCom ments1031"
	19426	/>
	19427
	19428	</td>
	19429
	19430	</tr>
	19431	<tr>
	19432
	19433	<td>
	19434
	19435	<content
	19436	ID="indImm unization1 032"
	19437	>
	19438	ZOSTER
	19439	</content>
	19440
	19441	</td>
	19442
	19443	<td>
	19444
	19445	<content
	19446	ID="indSer ies1032"
	19447	/>
	19448
	19449	</td>
	19450
	19451	<td>
	19452	Jun 24, 20 08
	19453	</td>
	19454
	19455
	19456	<td>
	19457
	19458	<content
	19459	ID="indRea ction1032"
	19460	/>
	19461
	19462	</td>
	19463
	19464	<td>
	19465
	19466	<content
	19467	ID="indCom ments1032"
	19468	>
	19469	Partner: W algreens. Administer ed by: JB1 21FALSE DA SSQA (NPI= 1234567890 ). Partner Patient I D: 3360162 051 Lot#: JOO1694 Mf r: Merck
	19470	</content>
	19471
	19472	</td>
	19473
	19474	</tr>
	19475	<tr>
	19476
	19477	<td>
	19478
	19479	<content
	19480	ID="indImm unization1 033"
	19481	>
	19482	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	19483	</content>
	19484
	19485	</td>
	19486
	19487	<td>
	19488
	19489	<content
	19490	ID="indSer ies1033"
	19491	/>
	19492
	19493	</td>
	19494
	19495	<td>
	19496	Jun 12, 20 08
	19497	</td>
	19498
	19499
	19500	<td>
	19501
	19502	<content
	19503	ID="indRea ction1033"
	19504	/>
	19505
	19506	</td>
	19507
	19508	<td>
	19509
	19510	<content
	19511	ID="indCom ments1033"
	19512	>
	19513	Partner: W algreens. Administer ed by: JB3 3FALSE DAS SQA (NPI=1 234567890) . Partner Patient ID : 33601620 51 Lot#: J OO1694 Mfr : Merck
	19514	</content>
	19515
	19516	</td>
	19517
	19518	</tr>
	19519	<tr>
	19520
	19521	<td>
	19522
	19523	<content
	19524	ID="indImm unization1 034"
	19525	>
	19526	INFLUENZA, UNSPECIFI ED FORMULA TION
	19527	</content>
	19528
	19529	</td>
	19530
	19531	<td>
	19532
	19533	<content
	19534	ID="indSer ies1034"
	19535	/>
	19536
	19537	</td>
	19538
	19539	<td>
	19540	Mar 05, 20 18
	19541	</td>
	19542
	19543
	19544	<td>
	19545
	19546	<content
	19547	ID="indRea ction1034"
	19548	/>
	19549
	19550	</td>
	19551
	19552	<td>
	19553
	19554	<content
	19555	ID="indCom ments1034"
	19556	>
	19557	Administer ed by: MEG AN DAS (NP I=11849099 54). Partn er Patient ID: 33601 62051
	19558	</content>
	19559
	19560	</td>
	19561
	19562	</tr>
	19563	<tr>
	19564
	19565	<td>
	19566
	19567	<content
	19568	ID="indImm unization1 035"
	19569	>
	19570	INFLUENZA, UNSPECIFI ED FORMULA TION
	19571	</content>
	19572
	19573	</td>
	19574
	19575	<td>
	19576
	19577	<content
	19578	ID="indSer ies1035"
	19579	/>
	19580
	19581	</td>
	19582
	19583	<td>
	19584	Jan 24, 20 17
	19585	</td>
	19586
	19587
	19588	<td>
	19589
	19590	<content
	19591	ID="indRea ction1035"
	19592	/>
	19593
	19594	</td>
	19595
	19596	<td>
	19597
	19598	<content
	19599	ID="indCom ments1035"
	19600	>
	19601	Administer ed by: pra thima madh avarao (NP I=11849099 54). Partn er Patient ID: 33601 62051
	19602	</content>
	19603
	19604	</td>
	19605
	19606	</tr>
	19607	<tr>
	19608
	19609	<td>
	19610
	19611	<content
	19612	ID="indImm unization1 036"
	19613	>
	19614	ADENOVIRUS TYPES 4 A ND 7
	19615	</content>
	19616
	19617	</td>
	19618
	19619	<td>
	19620
	19621	<content
	19622	ID="indSer ies1036"
	19623	/>
	19624
	19625	</td>
	19626
	19627	<td>
	19628	Dec 01, 20 16
	19629	</td>
	19630
	19631
	19632	<td>
	19633
	19634	<content
	19635	ID="indRea ction1036"
	19636	/>
	19637
	19638	</td>
	19639
	19640	<td>
	19641
	19642	<content
	19643	ID="indCom ments1036"
	19644	/>
	19645
	19646	</td>
	19647
	19648	</tr>
	19649	<tr>
	19650
	19651	<td>
	19652
	19653	<content
	19654	ID="indImm unization1 037"
	19655	>
	19656	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	19657	</content>
	19658
	19659	</td>
	19660
	19661	<td>
	19662
	19663	<content
	19664	ID="indSer ies1037"
	19665	/>
	19666
	19667	</td>
	19668
	19669	<td>
	19670	Nov 30, 20 16
	19671	</td>
	19672
	19673
	19674	<td>
	19675
	19676	<content
	19677	ID="indRea ction1037"
	19678	/>
	19679
	19680	</td>
	19681
	19682	<td>
	19683
	19684	<content
	19685	ID="indCom ments1037"
	19686	>
	19687	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	19688	</content>
	19689
	19690	</td>
	19691
	19692	</tr>
	19693	<tr>
	19694
	19695	<td>
	19696
	19697	<content
	19698	ID="indImm unization1 038"
	19699	>
	19700	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	19701	</content>
	19702
	19703	</td>
	19704
	19705	<td>
	19706
	19707	<content
	19708	ID="indSer ies1038"
	19709	/>
	19710
	19711	</td>
	19712
	19713	<td>
	19714	Nov 29, 20 16
	19715	</td>
	19716
	19717
	19718	<td>
	19719
	19720	<content
	19721	ID="indRea ction1038"
	19722	/>
	19723
	19724	</td>
	19725
	19726	<td>
	19727
	19728	<content
	19729	ID="indCom ments1038"
	19730	>
	19731	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	19732	</content>
	19733
	19734	</td>
	19735
	19736	</tr>
	19737	<tr>
	19738
	19739	<td>
	19740
	19741	<content
	19742	ID="indImm unization1 039"
	19743	>
	19744	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	19745	</content>
	19746
	19747	</td>
	19748
	19749	<td>
	19750
	19751	<content
	19752	ID="indSer ies1039"
	19753	/>
	19754
	19755	</td>
	19756
	19757	<td>
	19758	Nov 25, 20 16
	19759	</td>
	19760
	19761
	19762	<td>
	19763
	19764	<content
	19765	ID="indRea ction1039"
	19766	/>
	19767
	19768	</td>
	19769
	19770	<td>
	19771
	19772	<content
	19773	ID="indCom ments1039"
	19774	>
	19775	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	19776	</content>
	19777
	19778	</td>
	19779
	19780	</tr>
	19781	<tr>
	19782
	19783	<td>
	19784
	19785	<content
	19786	ID="indImm unization1 040"
	19787	>
	19788	PNEUMOCOCC AL CONJUGA TE PCV 13
	19789	</content>
	19790
	19791	</td>
	19792
	19793	<td>
	19794
	19795	<content
	19796	ID="indSer ies1040"
	19797	/>
	19798
	19799	</td>
	19800
	19801	<td>
	19802	Nov 25, 20 16
	19803	</td>
	19804
	19805
	19806	<td>
	19807
	19808	<content
	19809	ID="indRea ction1040"
	19810	/>
	19811
	19812	</td>
	19813
	19814	<td>
	19815
	19816	<content
	19817	ID="indCom ments1040"
	19818	>
	19819	this is a test immun ization cr eated on 3 161125.0
	19820	</content>
	19821
	19822	</td>
	19823
	19824	</tr>
	19825	<tr>
	19826
	19827	<td>
	19828
	19829	<content
	19830	ID="indImm unization1 041"
	19831	>
	19832	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	19833	</content>
	19834
	19835	</td>
	19836
	19837	<td>
	19838
	19839	<content
	19840	ID="indSer ies1041"
	19841	/>
	19842
	19843	</td>
	19844
	19845	<td>
	19846	Sep 25, 20 16
	19847	</td>
	19848
	19849
	19850	<td>
	19851
	19852	<content
	19853	ID="indRea ction1041"
	19854	/>
	19855
	19856	</td>
	19857
	19858	<td>
	19859
	19860	<content
	19861	ID="indCom ments1041"
	19862	>
	19863	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	19864	</content>
	19865
	19866	</td>
	19867
	19868	</tr>
	19869	<tr>
	19870
	19871	<td>
	19872
	19873	<content
	19874	ID="indImm unization1 042"
	19875	>
	19876	PNEUMOCOCC AL CONJUGA TE PCV 13
	19877	</content>
	19878
	19879	</td>
	19880
	19881	<td>
	19882
	19883	<content
	19884	ID="indSer ies1042"
	19885	/>
	19886
	19887	</td>
	19888
	19889	<td>
	19890	Jun 01, 20 15
	19891	</td>
	19892
	19893
	19894	<td>
	19895
	19896	<content
	19897	ID="indRea ction1042"
	19898	/>
	19899
	19900	</td>
	19901
	19902	<td>
	19903
	19904	<content
	19905	ID="indCom ments1042"
	19906	>
	19907	Partner: W algreens. Administer ed by: JB1 33 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO1M OSTAFA Mfr : Kirkland s; Dosage: 2.899 oz
	19908	</content>
	19909
	19910	</td>
	19911
	19912	</tr>
	19913	<tr>
	19914
	19915	<td>
	19916
	19917	<content
	19918	ID="indImm unization1 043"
	19919	>
	19920	INFLUENZA, INJECTABL E, QUADRIV ALENT
	19921	</content>
	19922
	19923	</td>
	19924
	19925	<td>
	19926
	19927	<content
	19928	ID="indSer ies1043"
	19929	/>
	19930
	19931	</td>
	19932
	19933	<td>
	19934	Mar 07, 20 15
	19935	</td>
	19936
	19937
	19938	<td>
	19939
	19940	<content
	19941	ID="indRea ction1043"
	19942	/>
	19943
	19944	</td>
	19945
	19946	<td>
	19947
	19948	<content
	19949	ID="indCom ments1043"
	19950	>
	19951	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 59 910903086 Lot#: 1413 801 Mfr: N ovartis Ph armaceutic al Corp.
	19952	</content>
	19953
	19954	</td>
	19955
	19956	</tr>
	19957	<tr>
	19958
	19959	<td>
	19960
	19961	<content
	19962	ID="indImm unization1 044"
	19963	>
	19964	ZOSTER
	19965	</content>
	19966
	19967	</td>
	19968
	19969	<td>
	19970
	19971	<content
	19972	ID="indSer ies1044"
	19973	/>
	19974
	19975	</td>
	19976
	19977	<td>
	19978	Feb 15, 20 15
	19979	</td>
	19980
	19981
	19982	<td>
	19983
	19984	<content
	19985	ID="indRea ction1044"
	19986	/>
	19987
	19988	</td>
	19989
	19990	<td>
	19991
	19992	<content
	19993	ID="indCom ments1044"
	19994	>
	19995	Partner: W algreens. Administer ed by: BHA RATI YACHA MANENI (NP I=11849099 54). Partn er Patient ID: 33601 62051 Lot# : JOO1VGK Mfr: Kirkl and; Dosag e: 3.655 o z
	19996	</content>
	19997
	19998	</td>
	19999
	20000	</tr>
	20001	<tr>
	20002
	20003	<td>
	20004
	20005	<content
	20006	ID="indImm unization1 045"
	20007	>
	20008	INFLUENZA, INJECTABL E, QUADRIV ALENT
	20009	</content>
	20010
	20011	</td>
	20012
	20013	<td>
	20014
	20015	<content
	20016	ID="indSer ies1045"
	20017	/>
	20018
	20019	</td>
	20020
	20021	<td>
	20022	Feb 03, 20 15
	20023	</td>
	20024
	20025
	20026	<td>
	20027
	20028	<content
	20029	ID="indRea ction1045"
	20030	/>
	20031
	20032	</td>
	20033
	20034	<td>
	20035
	20036	<content
	20037	ID="indCom ments1045"
	20038	>
	20039	Partner: W algreens. Administer ed by: JB1 58 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20040	</content>
	20041
	20042	</td>
	20043
	20044	</tr>
	20045	<tr>
	20046
	20047	<td>
	20048
	20049	<content
	20050	ID="indImm unization1 046"
	20051	>
	20052	INFLUENZA, RECOMBINA NT, INJECT ABLE, PRES ERVATIVE F REE
	20053	</content>
	20054
	20055	</td>
	20056
	20057	<td>
	20058
	20059	<content
	20060	ID="indSer ies1046"
	20061	/>
	20062
	20063	</td>
	20064
	20065	<td>
	20066	Feb 02, 20 15
	20067	</td>
	20068
	20069
	20070	<td>
	20071
	20072	<content
	20073	ID="indRea ction1046"
	20074	/>
	20075
	20076	</td>
	20077
	20078	<td>
	20079
	20080	<content
	20081	ID="indCom ments1046"
	20082	>
	20083	Partner: W algreens. Administer ed by: JB1 55 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20084	</content>
	20085
	20086	</td>
	20087
	20088	</tr>
	20089	<tr>
	20090
	20091	<td>
	20092
	20093	<content
	20094	ID="indImm unization1 047"
	20095	>
	20096	INFLUENZA, LIVE, INT RANASAL, Q UADRIVALEN T
	20097	</content>
	20098
	20099	</td>
	20100
	20101	<td>
	20102
	20103	<content
	20104	ID="indSer ies1047"
	20105	/>
	20106
	20107	</td>
	20108
	20109	<td>
	20110	Feb 01, 20 15
	20111	</td>
	20112
	20113
	20114	<td>
	20115
	20116	<content
	20117	ID="indRea ction1047"
	20118	/>
	20119
	20120	</td>
	20121
	20122	<td>
	20123
	20124	<content
	20125	ID="indCom ments1047"
	20126	>
	20127	Partner: W algreens. Administer ed by: JB1 49 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20128	</content>
	20129
	20130	</td>
	20131
	20132	</tr>
	20133	<tr>
	20134
	20135	<td>
	20136
	20137	<content
	20138	ID="indImm unization1 048"
	20139	>
	20140	INFLUENZA, SEASONAL, INJECTABL E
	20141	</content>
	20142
	20143	</td>
	20144
	20145	<td>
	20146
	20147	<content
	20148	ID="indSer ies1048"
	20149	/>
	20150
	20151	</td>
	20152
	20153	<td>
	20154	Dec 08, 20 14
	20155	</td>
	20156
	20157
	20158	<td>
	20159
	20160	<content
	20161	ID="indRea ction1048"
	20162	/>
	20163
	20164	</td>
	20165
	20166	<td>
	20167
	20168	<content
	20169	ID="indCom ments1048"
	20170	>
	20171	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20172	</content>
	20173
	20174	</td>
	20175
	20176	</tr>
	20177	<tr>
	20178
	20179	<td>
	20180
	20181	<content
	20182	ID="indImm unization1 049"
	20183	>
	20184	INFLUENZA, SEASONAL, INJECTABL E
	20185	</content>
	20186
	20187	</td>
	20188
	20189	<td>
	20190
	20191	<content
	20192	ID="indSer ies1049"
	20193	/>
	20194
	20195	</td>
	20196
	20197	<td>
	20198	Dec 07, 20 14
	20199	</td>
	20200
	20201
	20202	<td>
	20203
	20204	<content
	20205	ID="indRea ction1049"
	20206	/>
	20207
	20208	</td>
	20209
	20210	<td>
	20211
	20212	<content
	20213	ID="indCom ments1049"
	20214	>
	20215	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20216	</content>
	20217
	20218	</td>
	20219
	20220	</tr>
	20221	<tr>
	20222
	20223	<td>
	20224
	20225	<content
	20226	ID="indImm unization1 050"
	20227	>
	20228	INFLUENZA, SEASONAL, INJECTABL E
	20229	</content>
	20230
	20231	</td>
	20232
	20233	<td>
	20234
	20235	<content
	20236	ID="indSer ies1050"
	20237	/>
	20238
	20239	</td>
	20240
	20241	<td>
	20242	Dec 05, 20 14
	20243	</td>
	20244
	20245
	20246	<td>
	20247
	20248	<content
	20249	ID="indRea ction1050"
	20250	/>
	20251
	20252	</td>
	20253
	20254	<td>
	20255
	20256	<content
	20257	ID="indCom ments1050"
	20258	>
	20259	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20260	</content>
	20261
	20262	</td>
	20263
	20264	</tr>
	20265	<tr>
	20266
	20267	<td>
	20268
	20269	<content
	20270	ID="indImm unization1 051"
	20271	>
	20272	INFLUENZA, SEASONAL, INJECTABL E
	20273	</content>
	20274
	20275	</td>
	20276
	20277	<td>
	20278
	20279	<content
	20280	ID="indSer ies1051"
	20281	/>
	20282
	20283	</td>
	20284
	20285	<td>
	20286	Nov 02, 20 14
	20287	</td>
	20288
	20289
	20290	<td>
	20291
	20292	<content
	20293	ID="indRea ction1051"
	20294	/>
	20295
	20296	</td>
	20297
	20298	<td>
	20299
	20300	<content
	20301	ID="indCom ments1051"
	20302	>
	20303	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=15283 43670). Pa rtner Pati ent ID: 33 60162051 L ot#: 14138 01 Mfr: No vartis Pha rmaceutica l Corp.
	20304	</content>
	20305
	20306	</td>
	20307
	20308	</tr>
	20309	<tr>
	20310
	20311	<td>
	20312
	20313	<content
	20314	ID="indImm unization1 052"
	20315	>
	20316	INFLUENZA, SEASONAL, INJECTABL E
	20317	</content>
	20318
	20319	</td>
	20320
	20321	<td>
	20322
	20323	<content
	20324	ID="indSer ies1052"
	20325	/>
	20326
	20327	</td>
	20328
	20329	<td>
	20330	Nov 01, 20 14
	20331	</td>
	20332
	20333
	20334	<td>
	20335
	20336	<content
	20337	ID="indRea ction1052"
	20338	/>
	20339
	20340	</td>
	20341
	20342	<td>
	20343
	20344	<content
	20345	ID="indCom ments1052"
	20346	>
	20347	Partner: W algreens. Administer ed by: QUY NH PHAM (N PI=1528343 670). Part ner Patien t ID: 3360 162051 Lot #: 1413801 Mfr: Nova rtis Pharm aceutical Corp.
	20348	</content>
	20349
	20350	</td>
	20351
	20352	</tr>
	20353	<tr>
	20354
	20355	<td>
	20356
	20357	<content
	20358	ID="indImm unization1 053"
	20359	>
	20360	INFLUENZA, HIGH DOSE SEASONAL
	20361	</content>
	20362
	20363	</td>
	20364
	20365	<td>
	20366
	20367	<content
	20368	ID="indSer ies1053"
	20369	/>
	20370
	20371	</td>
	20372
	20373	<td>
	20374	Aug 19, 20 14
	20375	</td>
	20376
	20377
	20378	<td>
	20379
	20380	<content
	20381	ID="indRea ction1053"
	20382	/>
	20383
	20384	</td>
	20385
	20386	<td>
	20387
	20388	<content
	20389	ID="indCom ments1053"
	20390	>
	20391	Partner: W algreens. Administer ed by: JB1 35 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	20392	</content>
	20393
	20394	</td>
	20395
	20396	</tr>
	20397	<tr>
	20398
	20399	<td>
	20400
	20401	<content
	20402	ID="indImm unization1 054"
	20403	>
	20404	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	20405	</content>
	20406
	20407	</td>
	20408
	20409	<td>
	20410
	20411	<content
	20412	ID="indSer ies1054"
	20413	/>
	20414
	20415	</td>
	20416
	20417	<td>
	20418	Aug 01, 20 14
	20419	</td>
	20420
	20421
	20422	<td>
	20423
	20424	<content
	20425	ID="indRea ction1054"
	20426	/>
	20427
	20428	</td>
	20429
	20430	<td>
	20431
	20432	<content
	20433	ID="indCom ments1054"
	20434	>
	20435	Partner: W algreens. Administer ed by: MEG AN DAS (NP I=11849099 54). Partn er Patient ID: 33601 62051 Lot# : JOO1694 Mfr: Merck DAS
	20436	</content>
	20437
	20438	</td>
	20439
	20440	</tr>
	20441	<tr>
	20442
	20443	<td>
	20444
	20445	<content
	20446	ID="indImm unization1 055"
	20447	>
	20448	PNEUMOCOCC AL CONJUGA TE PCV 13
	20449	</content>
	20450
	20451	</td>
	20452
	20453	<td>
	20454
	20455	<content
	20456	ID="indSer ies1055"
	20457	/>
	20458
	20459	</td>
	20460
	20461	<td>
	20462	Aug 01, 20 14
	20463	</td>
	20464
	20465
	20466	<td>
	20467
	20468	<content
	20469	ID="indRea ction1055"
	20470	/>
	20471
	20472	</td>
	20473
	20474	<td>
	20475
	20476	<content
	20477	ID="indCom ments1055"
	20478	>
	20479	Partner: W algreens. Administer ed by: Chr is Stinson (NPI=1234 567890). P artner Pat ient ID: 3 360162051 Lot#: JOO1 694 Mfr: M erck
	20480	</content>
	20481
	20482	</td>
	20483
	20484	</tr>
	20485	<tr>
	20486
	20487	<td>
	20488
	20489	<content
	20490	ID="indImm unization1 056"
	20491	>
	20492	ZOSTER
	20493	</content>
	20494
	20495	</td>
	20496
	20497	<td>
	20498
	20499	<content
	20500	ID="indSer ies1056"
	20501	/>
	20502
	20503	</td>
	20504
	20505	<td>
	20506	Aug 2014
	20507	</td>
	20508
	20509
	20510	<td>
	20511
	20512	<content
	20513	ID="indRea ction1056"
	20514	/>
	20515
	20516	</td>
	20517
	20518	<td>
	20519
	20520	<content
	20521	ID="indCom ments1056"
	20522	>
	20523	Partner: W algreens. Administer ed by: JB1 21 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051
	20524	</content>
	20525
	20526	</td>
	20527
	20528	</tr>
	20529	<tr>
	20530
	20531	<td>
	20532
	20533	<content
	20534	ID="indImm unization1 057"
	20535	>
	20536	PNEUMOCOCC AL CONJUGA TE PCV 13
	20537	</content>
	20538
	20539	</td>
	20540
	20541	<td>
	20542
	20543	<content
	20544	ID="indSer ies1057"
	20545	/>
	20546
	20547	</td>
	20548
	20549	<td>
	20550	May 08, 20 14
	20551	</td>
	20552
	20553
	20554	<td>
	20555
	20556	<content
	20557	ID="indRea ction1057"
	20558	/>
	20559
	20560	</td>
	20561
	20562	<td>
	20563
	20564	<content
	20565	ID="indCom ments1057"
	20566	>
	20567	this is a test immun ization cr eated on 3 161125.0
	20568	</content>
	20569
	20570	</td>
	20571
	20572	</tr>
	20573	<tr>
	20574
	20575	<td>
	20576
	20577	<content
	20578	ID="indImm unization1 058"
	20579	>
	20580	ZOSTER
	20581	</content>
	20582
	20583	</td>
	20584
	20585	<td>
	20586
	20587	<content
	20588	ID="indSer ies1058"
	20589	/>
	20590
	20591	</td>
	20592
	20593	<td>
	20594	Apr 24, 20 14
	20595	</td>
	20596
	20597
	20598	<td>
	20599
	20600	<content
	20601	ID="indRea ction1058"
	20602	/>
	20603
	20604	</td>
	20605
	20606	<td>
	20607
	20608	<content
	20609	ID="indCom ments1058"
	20610	>
	20611	Partner: W algreens. Administer ed by: Chr is Stinson (NPI=1234 567890). P artner Pat ient ID: 3 360162051 Lot#: JOO1 694 Mfr: M erck
	20612	</content>
	20613
	20614	</td>
	20615
	20616	</tr>
	20617	<tr>
	20618
	20619	<td>
	20620
	20621	<content
	20622	ID="indImm unization1 059"
	20623	>
	20624	INFLUENZA, SEASONAL, INTRADERM AL, PRESER VATIVE FRE E
	20625	</content>
	20626
	20627	</td>
	20628
	20629	<td>
	20630
	20631	<content
	20632	ID="indSer ies1059"
	20633	/>
	20634
	20635	</td>
	20636
	20637	<td>
	20638	Aug 19, 20 13
	20639	</td>
	20640
	20641
	20642	<td>
	20643
	20644	<content
	20645	ID="indRea ction1059"
	20646	/>
	20647
	20648	</td>
	20649
	20650	<td>
	20651
	20652	<content
	20653	ID="indCom ments1059"
	20654	>
	20655	Partner: W algreens. Administer ed by: JB1 44 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	20656	</content>
	20657
	20658	</td>
	20659
	20660	</tr>
	20661	<tr>
	20662
	20663	<td>
	20664
	20665	<content
	20666	ID="indImm unization1 060"
	20667	>
	20668	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	20669	</content>
	20670
	20671	</td>
	20672
	20673	<td>
	20674
	20675	<content
	20676	ID="indSer ies1060"
	20677	/>
	20678
	20679	</td>
	20680
	20681	<td>
	20682	Aug 18, 20 13
	20683	</td>
	20684
	20685
	20686	<td>
	20687
	20688	<content
	20689	ID="indRea ction1060"
	20690	/>
	20691
	20692	</td>
	20693
	20694	<td>
	20695
	20696	<content
	20697	ID="indCom ments1060"
	20698	>
	20699	Partner: W algreens. Administer ed by: JB3 3 DASSQA ( NPI=118490 9954). Par tner Patie nt ID: 336 0162051 Lo t#: JOO169 4 Mfr: Mer ck DAS
	20700	</content>
	20701
	20702	</td>
	20703
	20704	</tr>
	20705	<tr>
	20706
	20707	<td>
	20708
	20709	<content
	20710	ID="indImm unization1 061"
	20711	>
	20712	INFLUENZA, SEASONAL, INJECTABL E
	20713	</content>
	20714
	20715	</td>
	20716
	20717	<td>
	20718
	20719	<content
	20720	ID="indSer ies1061"
	20721	/>
	20722
	20723	</td>
	20724
	20725	<td>
	20726	Jan 24, 20 12
	20727	</td>
	20728
	20729
	20730	<td>
	20731
	20732	<content
	20733	ID="indRea ction1061"
	20734	/>
	20735
	20736	</td>
	20737
	20738	<td>
	20739
	20740	<content
	20741	ID="indCom ments1061"
	20742	>
	20743	Partner: W algreens. Administer ed by: JB1 41 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	20744	</content>
	20745
	20746	</td>
	20747
	20748	</tr>
	20749	<tr>
	20750
	20751	<td>
	20752
	20753	<content
	20754	ID="indImm unization1 062"
	20755	>
	20756	INFLUENZA, INJECTABL E, QUADRIV ALENT, PRE SERVATIVE FREE
	20757	</content>
	20758
	20759	</td>
	20760
	20761	<td>
	20762
	20763	<content
	20764	ID="indSer ies1062"
	20765	/>
	20766
	20767	</td>
	20768
	20769	<td>
	20770	Jan 24, 20 10
	20771	</td>
	20772
	20773
	20774	<td>
	20775
	20776	<content
	20777	ID="indRea ction1062"
	20778	/>
	20779
	20780	</td>
	20781
	20782	<td>
	20783
	20784	<content
	20785	ID="indCom ments1062"
	20786	>
	20787	Partner: W algreens. Administer ed by: JB1 50 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	20788	</content>
	20789
	20790	</td>
	20791
	20792	</tr>
	20793	<tr>
	20794
	20795	<td>
	20796
	20797	<content
	20798	ID="indImm unization1 063"
	20799	>
	20800	ZOSTER
	20801	</content>
	20802
	20803	</td>
	20804
	20805	<td>
	20806
	20807	<content
	20808	ID="indSer ies1063"
	20809	/>
	20810
	20811	</td>
	20812
	20813	<td>
	20814	2010
	20815	</td>
	20816
	20817
	20818	<td>
	20819
	20820	<content
	20821	ID="indRea ction1063"
	20822	/>
	20823
	20824	</td>
	20825
	20826	<td>
	20827
	20828	<content
	20829	ID="indCom ments1063"
	20830	>
	20831	Partner: W algreens. Administer ed by: VK1 21 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051
	20832	</content>
	20833
	20834	</td>
	20835
	20836	</tr>
	20837	<tr>
	20838
	20839	<td>
	20840
	20841	<content
	20842	ID="indImm unization1 064"
	20843	>
	20844	INFLUENZA, INJECTABL E, MDCK, P RESERVATIV E FREE
	20845	</content>
	20846
	20847	</td>
	20848
	20849	<td>
	20850
	20851	<content
	20852	ID="indSer ies1064"
	20853	/>
	20854
	20855	</td>
	20856
	20857	<td>
	20858	Jan 24, 20 09
	20859	</td>
	20860
	20861
	20862	<td>
	20863
	20864	<content
	20865	ID="indRea ction1064"
	20866	/>
	20867
	20868	</td>
	20869
	20870	<td>
	20871
	20872	<content
	20873	ID="indCom ments1064"
	20874	>
	20875	Partner: W algreens. Administer ed by: JB1 53 DASSQA (NPI=11849 09954). Pa rtner Pati ent ID: 33 60162051 L ot#: JOO16 94 Mfr: Me rck
	20876	</content>
	20877
	20878	</td>
	20879
	20880	</tr>
	20881	<tr>
	20882
	20883	<td>
	20884
	20885	<content
	20886	ID="indImm unization1 065"
	20887	>
	20888	ZOSTER
	20889	</content>
	20890
	20891	</td>
	20892
	20893	<td>
	20894
	20895	<content
	20896	ID="indSer ies1065"
	20897	/>
	20898
	20899	</td>
	20900
	20901	<td>
	20902	Jun 24, 20 08
	20903	</td>
	20904
	20905
	20906	<td>
	20907
	20908	<content
	20909	ID="indRea ction1065"
	20910	/>
	20911
	20912	</td>
	20913
	20914	<td>
	20915
	20916	<content
	20917	ID="indCom ments1065"
	20918	>
	20919	Partner: W algreens. Administer ed by: JB1 21FALSE DA SSQA (NPI= 1234567890 ). Partner Patient I D: 3360162 051 Lot#: JOO1694 Mf r: Merck
	20920	</content>
	20921
	20922	</td>
	20923
	20924	</tr>
	20925	<tr>
	20926
	20927	<td>
	20928
	20929	<content
	20930	ID="indImm unization1 066"
	20931	>
	20932	PNEUMOCOCC AL POLYSAC CHARIDE PP V23
	20933	</content>
	20934
	20935	</td>
	20936
	20937	<td>
	20938
	20939	<content
	20940	ID="indSer ies1066"
	20941	/>
	20942
	20943	</td>
	20944
	20945	<td>
	20946	Jun 12, 20 08
	20947	</td>
	20948
	20949
	20950	<td>
	20951
	20952	<content
	20953	ID="indRea ction1066"
	20954	/>
	20955
	20956	</td>
	20957
	20958	<td>
	20959
	20960	<content
	20961	ID="indCom ments1066"
	20962	>
	20963	Partner: W algreens. Administer ed by: JB3 3FALSE DAS SQA (NPI=1 234567890) . Partner Patient ID : 33601620 51 Lot#: J OO1694 Mfr : Merck
	20964	</content>
	20965
	20966	</td>
	20967
	20968	</tr>
	20969	<tr>
	20970
	20971	<td>
	20972
	20973	<content
	20974	ID="indImm unization1 067"
	20975	>
	20976	ZOSTER(SHI NGLES) (HI STORICAL)
	20977	</content>
	20978
	20979	</td>
	20980
	20981	<td>
	20982
	20983	<content
	20984	ID="indSer ies1067"
	20985	/>
	20986
	20987	</td>
	20988
	20989	<td>
	20990	Dec 31, 19 69
	20991	</td>
	20992
	20993
	20994	<td>
	20995
	20996	<content
	20997	ID="indRea ction1067"
	20998	/>
	20999
	21000	</td>
	21001
	21002	<td>
	21003
	21004	<content
	21005	ID="indCom ments1067"
	21006	>
	21007	Administer ed by: MEG AN DINGERS (NPI=1184 909954). P artner Pat ient ID: W ALG0001
	21008	</content>
	21009
	21010	</td>
	21011
	21012	</tr>
	21013
	21014	</tbody>
	21015
	21016	</table>
	21017
	21018	</text>
	21019
	21020	<entry
	21021	typeCode=" DRIV"
	21022	>
	21023
	21024	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21025
	21026	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21027
	21028	<substance Administra tion
	21029	classCode= "SBADM"
	21030	moodCode=" EVN"
	21031	negationIn d="false"
	21032	>
	21033
	21034	<templateI d
	21035	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21036	/>
	21037
	21038	<id
	21039	nullFlavor ="NA"
	21040	/>
	21041
	21042	<text>
	21043
	21044	<reference
	21045	value="#in dComments1 001"
	21046	/>
	21047
	21048	</text>
	21049
	21050	<statusCod e
	21051	code="comp leted"
	21052	/>
	21053
	21054	<effective Time
	21055	value="201 80305"
	21056	/>
	21057
	21058	<repeatNum ber
	21059	nullFlavor ="UNK"
	21060	/>
	21061
	21062	<consumabl e>
	21063
	21064	<manufactu redProduct
	21065	classCode= "MANU"
	21066	>
	21067
	21068	<templateI d
	21069	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21070	/>
	21071
	21072	<manufactu redMateria l>
	21073
	21074	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21075
	21076	<code
	21077	code="88"
	21078	codeSystem ="2.16.840 .1.113883. 12.292"
	21079	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21080	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	21081	>
	21082
	21083	<originalT ext>
	21084
	21085	<reference
	21086	value="#in dImmunizat ion1001"
	21087	/>
	21088
	21089	</original Text>
	21090
	21091	<translati on
	21092	code="9072 4"
	21093	codeSystem ="2.16.840 .1.113883. 6.12"
	21094	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21095	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	21096	/>
	21097
	21098	</code>
	21099
	21100	</manufact uredMateri al>
	21101
	21102	</manufact uredProduc t>
	21103
	21104	</consumab le>
	21105
	21106	<performer >
	21107
	21108	<assignedE ntity>
	21109
	21110	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21111
	21112	<id
	21113	root="2.16 .840.1.113 883.4.349"
	21114	/>
	21115
	21116	<assignedP erson>
	21117
	21118	<!-- CCD P rovider Na me, REQUIR ED -->
	21119
	21120	<name/>
	21121
	21122	</assigned Person>
	21123
	21124	</assigned Entity>
	21125
	21126	</performe r>
	21127
	21128	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21129
	21130	<author>
	21131
	21132	<time
	21133	nullFlavor ="NA"
	21134	/>
	21135
	21136	<assignedA uthor>
	21137
	21138	<id
	21139	nullFlavor ="NA"
	21140	/>
	21141
	21142	<represent edOrganiza tion>
	21143
	21144	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21145	FA CILITY NBR ) -->
	21146
	21147	<id
	21148	extension= "984"
	21149	nullFlavor ="NA"
	21150	/>
	21151
	21152	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21153
	21154	<name>
	21155	DAYTSHR TE ST LAB
	21156	</name>
	21157
	21158	</represen tedOrganiz ation>
	21159
	21160	</assigned Author>
	21161
	21162	</author>
	21163
	21164
	21165	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21166	immuni zations on ly -->
	21167
	21168	</substanc eAdministr ation>
	21169
	21170	</entry>
	21171	<entry
	21172	typeCode=" DRIV"
	21173	>
	21174
	21175	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21176
	21177	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21178
	21179	<substance Administra tion
	21180	classCode= "SBADM"
	21181	moodCode=" EVN"
	21182	negationIn d="false"
	21183	>
	21184
	21185	<templateI d
	21186	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21187	/>
	21188
	21189	<id
	21190	nullFlavor ="NA"
	21191	/>
	21192
	21193	<text>
	21194
	21195	<reference
	21196	value="#in dComments1 002"
	21197	/>
	21198
	21199	</text>
	21200
	21201	<statusCod e
	21202	code="comp leted"
	21203	/>
	21204
	21205	<effective Time
	21206	value="201 70124"
	21207	/>
	21208
	21209	<repeatNum ber
	21210	nullFlavor ="UNK"
	21211	/>
	21212
	21213	<consumabl e>
	21214
	21215	<manufactu redProduct
	21216	classCode= "MANU"
	21217	>
	21218
	21219	<templateI d
	21220	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21221	/>
	21222
	21223	<manufactu redMateria l>
	21224
	21225	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21226
	21227	<code
	21228	code="88"
	21229	codeSystem ="2.16.840 .1.113883. 12.292"
	21230	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21231	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	21232	>
	21233
	21234	<originalT ext>
	21235
	21236	<reference
	21237	value="#in dImmunizat ion1002"
	21238	/>
	21239
	21240	</original Text>
	21241
	21242	<translati on
	21243	code="9072 4"
	21244	codeSystem ="2.16.840 .1.113883. 6.12"
	21245	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21246	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	21247	/>
	21248
	21249	</code>
	21250
	21251	</manufact uredMateri al>
	21252
	21253	</manufact uredProduc t>
	21254
	21255	</consumab le>
	21256
	21257	<performer >
	21258
	21259	<assignedE ntity>
	21260
	21261	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21262
	21263	<id
	21264	root="2.16 .840.1.113 883.4.349"
	21265	/>
	21266
	21267	<assignedP erson>
	21268
	21269	<!-- CCD P rovider Na me, REQUIR ED -->
	21270
	21271	<name/>
	21272
	21273	</assigned Person>
	21274
	21275	</assigned Entity>
	21276
	21277	</performe r>
	21278
	21279	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21280
	21281	<author>
	21282
	21283	<time
	21284	nullFlavor ="NA"
	21285	/>
	21286
	21287	<assignedA uthor>
	21288
	21289	<id
	21290	nullFlavor ="NA"
	21291	/>
	21292
	21293	<represent edOrganiza tion>
	21294
	21295	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21296	FA CILITY NBR ) -->
	21297
	21298	<id
	21299	extension= "984"
	21300	nullFlavor ="NA"
	21301	/>
	21302
	21303	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21304
	21305	<name>
	21306	DAYTSHR TE ST LAB
	21307	</name>
	21308
	21309	</represen tedOrganiz ation>
	21310
	21311	</assigned Author>
	21312
	21313	</author>
	21314
	21315
	21316	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21317	immuni zations on ly -->
	21318
	21319	</substanc eAdministr ation>
	21320
	21321	</entry>
	21322	<entry
	21323	typeCode=" DRIV"
	21324	>
	21325
	21326	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21327
	21328	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21329
	21330	<substance Administra tion
	21331	classCode= "SBADM"
	21332	moodCode=" EVN"
	21333	negationIn d="false"
	21334	>
	21335
	21336	<templateI d
	21337	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21338	/>
	21339
	21340	<id
	21341	nullFlavor ="NA"
	21342	/>
	21343
	21344	<text>
	21345
	21346	<reference
	21347	value="#in dComments1 003"
	21348	/>
	21349
	21350	</text>
	21351
	21352	<statusCod e
	21353	code="comp leted"
	21354	/>
	21355
	21356	<effective Time
	21357	value="201 61130"
	21358	/>
	21359
	21360	<repeatNum ber
	21361	nullFlavor ="UNK"
	21362	/>
	21363
	21364	<consumabl e>
	21365
	21366	<manufactu redProduct
	21367	classCode= "MANU"
	21368	>
	21369
	21370	<templateI d
	21371	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21372	/>
	21373
	21374	<manufactu redMateria l>
	21375
	21376	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21377
	21378	<code
	21379	code="155"
	21380	codeSystem ="2.16.840 .1.113883. 12.292"
	21381	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21382	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21383	>
	21384
	21385	<originalT ext>
	21386
	21387	<reference
	21388	value="#in dImmunizat ion1003"
	21389	/>
	21390
	21391	</original Text>
	21392
	21393	<translati on
	21394	code="9067 3"
	21395	codeSystem ="2.16.840 .1.113883. 6.12"
	21396	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21397	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21398	/>
	21399
	21400	</code>
	21401
	21402	</manufact uredMateri al>
	21403
	21404	</manufact uredProduc t>
	21405
	21406	</consumab le>
	21407
	21408	<performer >
	21409
	21410	<assignedE ntity>
	21411
	21412	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21413
	21414	<id
	21415	root="2.16 .840.1.113 883.4.349"
	21416	/>
	21417
	21418	<assignedP erson>
	21419
	21420	<!-- CCD P rovider Na me, REQUIR ED -->
	21421
	21422	<name/>
	21423
	21424	</assigned Person>
	21425
	21426	</assigned Entity>
	21427
	21428	</performe r>
	21429
	21430	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21431
	21432	<author>
	21433
	21434	<time
	21435	nullFlavor ="NA"
	21436	/>
	21437
	21438	<assignedA uthor>
	21439
	21440	<id
	21441	nullFlavor ="NA"
	21442	/>
	21443
	21444	<represent edOrganiza tion>
	21445
	21446	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21447	FA CILITY NBR ) -->
	21448
	21449	<id
	21450	extension= "984"
	21451	nullFlavor ="NA"
	21452	/>
	21453
	21454	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21455
	21456	<name>
	21457	DAYTSHR TE ST LAB
	21458	</name>
	21459
	21460	</represen tedOrganiz ation>
	21461
	21462	</assigned Author>
	21463
	21464	</author>
	21465
	21466
	21467	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21468	immuni zations on ly -->
	21469
	21470	</substanc eAdministr ation>
	21471
	21472	</entry>
	21473	<entry
	21474	typeCode=" DRIV"
	21475	>
	21476
	21477	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21478
	21479	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21480
	21481	<substance Administra tion
	21482	classCode= "SBADM"
	21483	moodCode=" EVN"
	21484	negationIn d="false"
	21485	>
	21486
	21487	<templateI d
	21488	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21489	/>
	21490
	21491	<id
	21492	nullFlavor ="NA"
	21493	/>
	21494
	21495	<text>
	21496
	21497	<reference
	21498	value="#in dComments1 004"
	21499	/>
	21500
	21501	</text>
	21502
	21503	<statusCod e
	21504	code="comp leted"
	21505	/>
	21506
	21507	<effective Time
	21508	value="201 61129"
	21509	/>
	21510
	21511	<repeatNum ber
	21512	nullFlavor ="UNK"
	21513	/>
	21514
	21515	<consumabl e>
	21516
	21517	<manufactu redProduct
	21518	classCode= "MANU"
	21519	>
	21520
	21521	<templateI d
	21522	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21523	/>
	21524
	21525	<manufactu redMateria l>
	21526
	21527	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21528
	21529	<code
	21530	code="155"
	21531	codeSystem ="2.16.840 .1.113883. 12.292"
	21532	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21533	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21534	>
	21535
	21536	<originalT ext>
	21537
	21538	<reference
	21539	value="#in dImmunizat ion1004"
	21540	/>
	21541
	21542	</original Text>
	21543
	21544	<translati on
	21545	code="9067 3"
	21546	codeSystem ="2.16.840 .1.113883. 6.12"
	21547	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21548	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21549	/>
	21550
	21551	</code>
	21552
	21553	</manufact uredMateri al>
	21554
	21555	</manufact uredProduc t>
	21556
	21557	</consumab le>
	21558
	21559	<performer >
	21560
	21561	<assignedE ntity>
	21562
	21563	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21564
	21565	<id
	21566	root="2.16 .840.1.113 883.4.349"
	21567	/>
	21568
	21569	<assignedP erson>
	21570
	21571	<!-- CCD P rovider Na me, REQUIR ED -->
	21572
	21573	<name/>
	21574
	21575	</assigned Person>
	21576
	21577	</assigned Entity>
	21578
	21579	</performe r>
	21580
	21581	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21582
	21583	<author>
	21584
	21585	<time
	21586	nullFlavor ="NA"
	21587	/>
	21588
	21589	<assignedA uthor>
	21590
	21591	<id
	21592	nullFlavor ="NA"
	21593	/>
	21594
	21595	<represent edOrganiza tion>
	21596
	21597	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21598	FA CILITY NBR ) -->
	21599
	21600	<id
	21601	extension= "984"
	21602	nullFlavor ="NA"
	21603	/>
	21604
	21605	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21606
	21607	<name>
	21608	DAYTSHR TE ST LAB
	21609	</name>
	21610
	21611	</represen tedOrganiz ation>
	21612
	21613	</assigned Author>
	21614
	21615	</author>
	21616
	21617
	21618	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21619	immuni zations on ly -->
	21620
	21621	</substanc eAdministr ation>
	21622
	21623	</entry>
	21624	<entry
	21625	typeCode=" DRIV"
	21626	>
	21627
	21628	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21629
	21630	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21631
	21632	<substance Administra tion
	21633	classCode= "SBADM"
	21634	moodCode=" EVN"
	21635	negationIn d="false"
	21636	>
	21637
	21638	<templateI d
	21639	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21640	/>
	21641
	21642	<id
	21643	nullFlavor ="NA"
	21644	/>
	21645
	21646	<text>
	21647
	21648	<reference
	21649	value="#in dComments1 005"
	21650	/>
	21651
	21652	</text>
	21653
	21654	<statusCod e
	21655	code="comp leted"
	21656	/>
	21657
	21658	<effective Time
	21659	value="201 61125"
	21660	/>
	21661
	21662	<repeatNum ber
	21663	nullFlavor ="UNK"
	21664	/>
	21665
	21666	<consumabl e>
	21667
	21668	<manufactu redProduct
	21669	classCode= "MANU"
	21670	>
	21671
	21672	<templateI d
	21673	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21674	/>
	21675
	21676	<manufactu redMateria l>
	21677
	21678	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21679
	21680	<code
	21681	code="155"
	21682	codeSystem ="2.16.840 .1.113883. 12.292"
	21683	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21684	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21685	>
	21686
	21687	<originalT ext>
	21688
	21689	<reference
	21690	value="#in dImmunizat ion1005"
	21691	/>
	21692
	21693	</original Text>
	21694
	21695	<translati on
	21696	code="9067 3"
	21697	codeSystem ="2.16.840 .1.113883. 6.12"
	21698	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21699	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21700	/>
	21701
	21702	</code>
	21703
	21704	</manufact uredMateri al>
	21705
	21706	</manufact uredProduc t>
	21707
	21708	</consumab le>
	21709
	21710	<performer >
	21711
	21712	<assignedE ntity>
	21713
	21714	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21715
	21716	<id
	21717	root="2.16 .840.1.113 883.4.349"
	21718	/>
	21719
	21720	<assignedP erson>
	21721
	21722	<!-- CCD P rovider Na me, REQUIR ED -->
	21723
	21724	<name/>
	21725
	21726	</assigned Person>
	21727
	21728	</assigned Entity>
	21729
	21730	</performe r>
	21731
	21732	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21733
	21734	<author>
	21735
	21736	<time
	21737	nullFlavor ="NA"
	21738	/>
	21739
	21740	<assignedA uthor>
	21741
	21742	<id
	21743	nullFlavor ="NA"
	21744	/>
	21745
	21746	<represent edOrganiza tion>
	21747
	21748	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21749	FA CILITY NBR ) -->
	21750
	21751	<id
	21752	extension= "984"
	21753	nullFlavor ="NA"
	21754	/>
	21755
	21756	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21757
	21758	<name>
	21759	DAYTSHR TE ST LAB
	21760	</name>
	21761
	21762	</represen tedOrganiz ation>
	21763
	21764	</assigned Author>
	21765
	21766	</author>
	21767
	21768
	21769	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21770	immuni zations on ly -->
	21771
	21772	</substanc eAdministr ation>
	21773
	21774	</entry>
	21775	<entry
	21776	typeCode=" DRIV"
	21777	>
	21778
	21779	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21780
	21781	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21782
	21783	<substance Administra tion
	21784	classCode= "SBADM"
	21785	moodCode=" EVN"
	21786	negationIn d="false"
	21787	>
	21788
	21789	<templateI d
	21790	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21791	/>
	21792
	21793	<id
	21794	nullFlavor ="NA"
	21795	/>
	21796
	21797	<text>
	21798
	21799	<reference
	21800	value="#in dComments1 006"
	21801	/>
	21802
	21803	</text>
	21804
	21805	<statusCod e
	21806	code="comp leted"
	21807	/>
	21808
	21809	<effective Time
	21810	value="201 61125"
	21811	/>
	21812
	21813	<repeatNum ber
	21814	nullFlavor ="UNK"
	21815	/>
	21816
	21817	<consumabl e>
	21818
	21819	<manufactu redProduct
	21820	classCode= "MANU"
	21821	>
	21822
	21823	<templateI d
	21824	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21825	/>
	21826
	21827	<manufactu redMateria l>
	21828
	21829	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21830
	21831	<code
	21832	code="133"
	21833	codeSystem ="2.16.840 .1.113883. 12.292"
	21834	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21835	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	21836	>
	21837
	21838	<originalT ext>
	21839
	21840	<reference
	21841	value="#in dImmunizat ion1006"
	21842	/>
	21843
	21844	</original Text>
	21845
	21846	<translati on
	21847	code="9067 0"
	21848	codeSystem ="2.16.840 .1.113883. 6.12"
	21849	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	21850	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	21851	/>
	21852
	21853	</code>
	21854
	21855	</manufact uredMateri al>
	21856
	21857	</manufact uredProduc t>
	21858
	21859	</consumab le>
	21860
	21861	<performer >
	21862
	21863	<assignedE ntity>
	21864
	21865	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	21866
	21867	<id
	21868	root="2.16 .840.1.113 883.4.349"
	21869	/>
	21870
	21871	<assignedP erson>
	21872
	21873	<!-- CCD P rovider Na me, REQUIR ED -->
	21874
	21875	<name/>
	21876
	21877	</assigned Person>
	21878
	21879	</assigned Entity>
	21880
	21881	</performe r>
	21882
	21883	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	21884
	21885	<author>
	21886
	21887	<time
	21888	nullFlavor ="NA"
	21889	/>
	21890
	21891	<assignedA uthor>
	21892
	21893	<id
	21894	nullFlavor ="NA"
	21895	/>
	21896
	21897	<represent edOrganiza tion>
	21898
	21899	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	21900	FA CILITY NBR ) -->
	21901
	21902	<id
	21903	extension= "984"
	21904	nullFlavor ="NA"
	21905	/>
	21906
	21907	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	21908
	21909	<name>
	21910	DAYTSHR TE ST LAB
	21911	</name>
	21912
	21913	</represen tedOrganiz ation>
	21914
	21915	</assigned Author>
	21916
	21917	</author>
	21918
	21919
	21920	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	21921	immuni zations on ly -->
	21922
	21923	</substanc eAdministr ation>
	21924
	21925	</entry>
	21926	<entry
	21927	typeCode=" DRIV"
	21928	>
	21929
	21930	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	21931
	21932	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	21933
	21934	<substance Administra tion
	21935	classCode= "SBADM"
	21936	moodCode=" EVN"
	21937	negationIn d="false"
	21938	>
	21939
	21940	<templateI d
	21941	root="2.16 .840.1.113 883.10.20. 22.4.52"
	21942	/>
	21943
	21944	<id
	21945	nullFlavor ="NA"
	21946	/>
	21947
	21948	<text>
	21949
	21950	<reference
	21951	value="#in dComments1 007"
	21952	/>
	21953
	21954	</text>
	21955
	21956	<statusCod e
	21957	code="comp leted"
	21958	/>
	21959
	21960	<effective Time
	21961	value="201 60925"
	21962	/>
	21963
	21964	<repeatNum ber
	21965	nullFlavor ="UNK"
	21966	/>
	21967
	21968	<consumabl e>
	21969
	21970	<manufactu redProduct
	21971	classCode= "MANU"
	21972	>
	21973
	21974	<templateI d
	21975	root="2.16 .840.1.113 883.10.20. 22.4.54"
	21976	/>
	21977
	21978	<manufactu redMateria l>
	21979
	21980	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	21981
	21982	<code
	21983	code="155"
	21984	codeSystem ="2.16.840 .1.113883. 12.292"
	21985	codeSystem Name="Vacc ine Admini stered (CV X code)"
	21986	displayNam e="FLU VAC C RIV3 NO PRESERV"
	21987	>
	21988
	21989	<originalT ext>
	21990
	21991	<reference
	21992	value="#in dImmunizat ion1007"
	21993	/>
	21994
	21995	</original Text>
	21996
	21997	<translati on
	21998	code="9067 3"
	21999	codeSystem ="2.16.840 .1.113883. 6.12"
	22000	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22001	displayNam e="FLU VAC C RIV3 NO PRESERV"
	22002	/>
	22003
	22004	</code>
	22005
	22006	</manufact uredMateri al>
	22007
	22008	</manufact uredProduc t>
	22009
	22010	</consumab le>
	22011
	22012	<performer >
	22013
	22014	<assignedE ntity>
	22015
	22016	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22017
	22018	<id
	22019	root="2.16 .840.1.113 883.4.349"
	22020	/>
	22021
	22022	<assignedP erson>
	22023
	22024	<!-- CCD P rovider Na me, REQUIR ED -->
	22025
	22026	<name/>
	22027
	22028	</assigned Person>
	22029
	22030	</assigned Entity>
	22031
	22032	</performe r>
	22033
	22034	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22035
	22036	<author>
	22037
	22038	<time
	22039	nullFlavor ="NA"
	22040	/>
	22041
	22042	<assignedA uthor>
	22043
	22044	<id
	22045	nullFlavor ="NA"
	22046	/>
	22047
	22048	<represent edOrganiza tion>
	22049
	22050	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22051	FA CILITY NBR ) -->
	22052
	22053	<id
	22054	extension= "984"
	22055	nullFlavor ="NA"
	22056	/>
	22057
	22058	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22059
	22060	<name>
	22061	DAYTSHR TE ST LAB
	22062	</name>
	22063
	22064	</represen tedOrganiz ation>
	22065
	22066	</assigned Author>
	22067
	22068	</author>
	22069
	22070
	22071	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22072	immuni zations on ly -->
	22073
	22074	</substanc eAdministr ation>
	22075
	22076	</entry>
	22077	<entry
	22078	typeCode=" DRIV"
	22079	>
	22080
	22081	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22082
	22083	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22084
	22085	<substance Administra tion
	22086	classCode= "SBADM"
	22087	moodCode=" EVN"
	22088	negationIn d="false"
	22089	>
	22090
	22091	<templateI d
	22092	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22093	/>
	22094
	22095	<id
	22096	nullFlavor ="NA"
	22097	/>
	22098
	22099	<text>
	22100
	22101	<reference
	22102	value="#in dComments1 008"
	22103	/>
	22104
	22105	</text>
	22106
	22107	<statusCod e
	22108	code="comp leted"
	22109	/>
	22110
	22111	<effective Time
	22112	value="201 50601"
	22113	/>
	22114
	22115	<repeatNum ber
	22116	nullFlavor ="UNK"
	22117	/>
	22118
	22119	<consumabl e>
	22120
	22121	<manufactu redProduct
	22122	classCode= "MANU"
	22123	>
	22124
	22125	<templateI d
	22126	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22127	/>
	22128
	22129	<manufactu redMateria l>
	22130
	22131	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22132
	22133	<code
	22134	code="133"
	22135	codeSystem ="2.16.840 .1.113883. 12.292"
	22136	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22137	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	22138	>
	22139
	22140	<originalT ext>
	22141
	22142	<reference
	22143	value="#in dImmunizat ion1008"
	22144	/>
	22145
	22146	</original Text>
	22147
	22148	<translati on
	22149	code="9067 0"
	22150	codeSystem ="2.16.840 .1.113883. 6.12"
	22151	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22152	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	22153	/>
	22154
	22155	</code>
	22156
	22157	</manufact uredMateri al>
	22158
	22159	</manufact uredProduc t>
	22160
	22161	</consumab le>
	22162
	22163	<performer >
	22164
	22165	<assignedE ntity>
	22166
	22167	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22168
	22169	<id
	22170	root="2.16 .840.1.113 883.4.349"
	22171	/>
	22172
	22173	<assignedP erson>
	22174
	22175	<!-- CCD P rovider Na me, REQUIR ED -->
	22176
	22177	<name/>
	22178
	22179	</assigned Person>
	22180
	22181	</assigned Entity>
	22182
	22183	</performe r>
	22184
	22185	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22186
	22187	<author>
	22188
	22189	<time
	22190	nullFlavor ="NA"
	22191	/>
	22192
	22193	<assignedA uthor>
	22194
	22195	<id
	22196	nullFlavor ="NA"
	22197	/>
	22198
	22199	<represent edOrganiza tion>
	22200
	22201	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22202	FA CILITY NBR ) -->
	22203
	22204	<id
	22205	extension= "984"
	22206	nullFlavor ="NA"
	22207	/>
	22208
	22209	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22210
	22211	<name>
	22212	DAYTSHR TE ST LAB
	22213	</name>
	22214
	22215	</represen tedOrganiz ation>
	22216
	22217	</assigned Author>
	22218
	22219	</author>
	22220
	22221
	22222	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22223	immuni zations on ly -->
	22224
	22225	</substanc eAdministr ation>
	22226
	22227	</entry>
	22228	<entry
	22229	typeCode=" DRIV"
	22230	>
	22231
	22232	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22233
	22234	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22235
	22236	<substance Administra tion
	22237	classCode= "SBADM"
	22238	moodCode=" EVN"
	22239	negationIn d="false"
	22240	>
	22241
	22242	<templateI d
	22243	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22244	/>
	22245
	22246	<id
	22247	nullFlavor ="NA"
	22248	/>
	22249
	22250	<text>
	22251
	22252	<reference
	22253	value="#in dComments1 009"
	22254	/>
	22255
	22256	</text>
	22257
	22258	<statusCod e
	22259	code="comp leted"
	22260	/>
	22261
	22262	<effective Time
	22263	value="201 50307"
	22264	/>
	22265
	22266	<repeatNum ber
	22267	nullFlavor ="UNK"
	22268	/>
	22269
	22270	<consumabl e>
	22271
	22272	<manufactu redProduct
	22273	classCode= "MANU"
	22274	>
	22275
	22276	<templateI d
	22277	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22278	/>
	22279
	22280	<manufactu redMateria l>
	22281
	22282	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22283
	22284	<code
	22285	code="158"
	22286	codeSystem ="2.16.840 .1.113883. 12.292"
	22287	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22288	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	22289	>
	22290
	22291	<originalT ext>
	22292
	22293	<reference
	22294	value="#in dImmunizat ion1009"
	22295	/>
	22296
	22297	</original Text>
	22298
	22299	<translati on
	22300	code="9068 8"
	22301	codeSystem ="2.16.840 .1.113883. 6.12"
	22302	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22303	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	22304	/>
	22305
	22306	</code>
	22307
	22308	</manufact uredMateri al>
	22309
	22310	</manufact uredProduc t>
	22311
	22312	</consumab le>
	22313
	22314	<performer >
	22315
	22316	<assignedE ntity>
	22317
	22318	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22319
	22320	<id
	22321	root="2.16 .840.1.113 883.4.349"
	22322	/>
	22323
	22324	<assignedP erson>
	22325
	22326	<!-- CCD P rovider Na me, REQUIR ED -->
	22327
	22328	<name/>
	22329
	22330	</assigned Person>
	22331
	22332	</assigned Entity>
	22333
	22334	</performe r>
	22335
	22336	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22337
	22338	<author>
	22339
	22340	<time
	22341	nullFlavor ="NA"
	22342	/>
	22343
	22344	<assignedA uthor>
	22345
	22346	<id
	22347	nullFlavor ="NA"
	22348	/>
	22349
	22350	<represent edOrganiza tion>
	22351
	22352	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22353	FA CILITY NBR ) -->
	22354
	22355	<id
	22356	extension= "984"
	22357	nullFlavor ="NA"
	22358	/>
	22359
	22360	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22361
	22362	<name>
	22363	DAYTSHR TE ST LAB
	22364	</name>
	22365
	22366	</represen tedOrganiz ation>
	22367
	22368	</assigned Author>
	22369
	22370	</author>
	22371
	22372
	22373	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22374	immuni zations on ly -->
	22375
	22376	</substanc eAdministr ation>
	22377
	22378	</entry>
	22379	<entry
	22380	typeCode=" DRIV"
	22381	>
	22382
	22383	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22384
	22385	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22386
	22387	<substance Administra tion
	22388	classCode= "SBADM"
	22389	moodCode=" EVN"
	22390	negationIn d="false"
	22391	>
	22392
	22393	<templateI d
	22394	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22395	/>
	22396
	22397	<id
	22398	nullFlavor ="NA"
	22399	/>
	22400
	22401	<text>
	22402
	22403	<reference
	22404	value="#in dComments1 010"
	22405	/>
	22406
	22407	</text>
	22408
	22409	<statusCod e
	22410	code="comp leted"
	22411	/>
	22412
	22413	<effective Time
	22414	value="201 50215"
	22415	/>
	22416
	22417	<repeatNum ber
	22418	nullFlavor ="UNK"
	22419	/>
	22420
	22421	<consumabl e>
	22422
	22423	<manufactu redProduct
	22424	classCode= "MANU"
	22425	>
	22426
	22427	<templateI d
	22428	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22429	/>
	22430
	22431	<manufactu redMateria l>
	22432
	22433	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22434
	22435	<code
	22436	code="121"
	22437	codeSystem ="2.16.840 .1.113883. 12.292"
	22438	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22439	displayNam e="ZOSTER VACC SC"
	22440	>
	22441
	22442	<originalT ext>
	22443
	22444	<reference
	22445	value="#in dImmunizat ion1010"
	22446	/>
	22447
	22448	</original Text>
	22449
	22450	<translati on
	22451	code="9073 6"
	22452	codeSystem ="2.16.840 .1.113883. 6.12"
	22453	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22454	displayNam e="ZOSTER VACC SC"
	22455	/>
	22456
	22457	</code>
	22458
	22459	</manufact uredMateri al>
	22460
	22461	</manufact uredProduc t>
	22462
	22463	</consumab le>
	22464
	22465	<performer >
	22466
	22467	<assignedE ntity>
	22468
	22469	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22470
	22471	<id
	22472	root="2.16 .840.1.113 883.4.349"
	22473	/>
	22474
	22475	<assignedP erson>
	22476
	22477	<!-- CCD P rovider Na me, REQUIR ED -->
	22478
	22479	<name/>
	22480
	22481	</assigned Person>
	22482
	22483	</assigned Entity>
	22484
	22485	</performe r>
	22486
	22487	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22488
	22489	<author>
	22490
	22491	<time
	22492	nullFlavor ="NA"
	22493	/>
	22494
	22495	<assignedA uthor>
	22496
	22497	<id
	22498	nullFlavor ="NA"
	22499	/>
	22500
	22501	<represent edOrganiza tion>
	22502
	22503	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22504	FA CILITY NBR ) -->
	22505
	22506	<id
	22507	extension= "984"
	22508	nullFlavor ="NA"
	22509	/>
	22510
	22511	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22512
	22513	<name>
	22514	DAYTSHR TE ST LAB
	22515	</name>
	22516
	22517	</represen tedOrganiz ation>
	22518
	22519	</assigned Author>
	22520
	22521	</author>
	22522
	22523
	22524	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22525	immuni zations on ly -->
	22526
	22527	</substanc eAdministr ation>
	22528
	22529	</entry>
	22530	<entry
	22531	typeCode=" DRIV"
	22532	>
	22533
	22534	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22535
	22536	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22537
	22538	<substance Administra tion
	22539	classCode= "SBADM"
	22540	moodCode=" EVN"
	22541	negationIn d="false"
	22542	>
	22543
	22544	<templateI d
	22545	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22546	/>
	22547
	22548	<id
	22549	nullFlavor ="NA"
	22550	/>
	22551
	22552	<text>
	22553
	22554	<reference
	22555	value="#in dComments1 011"
	22556	/>
	22557
	22558	</text>
	22559
	22560	<statusCod e
	22561	code="comp leted"
	22562	/>
	22563
	22564	<effective Time
	22565	value="201 50203"
	22566	/>
	22567
	22568	<repeatNum ber
	22569	nullFlavor ="UNK"
	22570	/>
	22571
	22572	<consumabl e>
	22573
	22574	<manufactu redProduct
	22575	classCode= "MANU"
	22576	>
	22577
	22578	<templateI d
	22579	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22580	/>
	22581
	22582	<manufactu redMateria l>
	22583
	22584	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22585
	22586	<code
	22587	code="158"
	22588	codeSystem ="2.16.840 .1.113883. 12.292"
	22589	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22590	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	22591	>
	22592
	22593	<originalT ext>
	22594
	22595	<reference
	22596	value="#in dImmunizat ion1011"
	22597	/>
	22598
	22599	</original Text>
	22600
	22601	<translati on
	22602	code="9068 8"
	22603	codeSystem ="2.16.840 .1.113883. 6.12"
	22604	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22605	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	22606	/>
	22607
	22608	</code>
	22609
	22610	</manufact uredMateri al>
	22611
	22612	</manufact uredProduc t>
	22613
	22614	</consumab le>
	22615
	22616	<performer >
	22617
	22618	<assignedE ntity>
	22619
	22620	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22621
	22622	<id
	22623	root="2.16 .840.1.113 883.4.349"
	22624	/>
	22625
	22626	<assignedP erson>
	22627
	22628	<!-- CCD P rovider Na me, REQUIR ED -->
	22629
	22630	<name/>
	22631
	22632	</assigned Person>
	22633
	22634	</assigned Entity>
	22635
	22636	</performe r>
	22637
	22638	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22639
	22640	<author>
	22641
	22642	<time
	22643	nullFlavor ="NA"
	22644	/>
	22645
	22646	<assignedA uthor>
	22647
	22648	<id
	22649	nullFlavor ="NA"
	22650	/>
	22651
	22652	<represent edOrganiza tion>
	22653
	22654	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22655	FA CILITY NBR ) -->
	22656
	22657	<id
	22658	extension= "984"
	22659	nullFlavor ="NA"
	22660	/>
	22661
	22662	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22663
	22664	<name>
	22665	DAYTSHR TE ST LAB
	22666	</name>
	22667
	22668	</represen tedOrganiz ation>
	22669
	22670	</assigned Author>
	22671
	22672	</author>
	22673
	22674
	22675	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22676	immuni zations on ly -->
	22677
	22678	</substanc eAdministr ation>
	22679
	22680	</entry>
	22681	<entry
	22682	typeCode=" DRIV"
	22683	>
	22684
	22685	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22686
	22687	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22688
	22689	<substance Administra tion
	22690	classCode= "SBADM"
	22691	moodCode=" EVN"
	22692	negationIn d="false"
	22693	>
	22694
	22695	<templateI d
	22696	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22697	/>
	22698
	22699	<id
	22700	nullFlavor ="NA"
	22701	/>
	22702
	22703	<text>
	22704
	22705	<reference
	22706	value="#in dComments1 012"
	22707	/>
	22708
	22709	</text>
	22710
	22711	<statusCod e
	22712	code="comp leted"
	22713	/>
	22714
	22715	<effective Time
	22716	value="201 50202"
	22717	/>
	22718
	22719	<repeatNum ber
	22720	nullFlavor ="UNK"
	22721	/>
	22722
	22723	<consumabl e>
	22724
	22725	<manufactu redProduct
	22726	classCode= "MANU"
	22727	>
	22728
	22729	<templateI d
	22730	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22731	/>
	22732
	22733	<manufactu redMateria l>
	22734
	22735	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22736
	22737	<code
	22738	code="155"
	22739	codeSystem ="2.16.840 .1.113883. 12.292"
	22740	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22741	displayNam e="FLU VAC C RIV3 NO PRESERV"
	22742	>
	22743
	22744	<originalT ext>
	22745
	22746	<reference
	22747	value="#in dImmunizat ion1012"
	22748	/>
	22749
	22750	</original Text>
	22751
	22752	<translati on
	22753	code="9067 3"
	22754	codeSystem ="2.16.840 .1.113883. 6.12"
	22755	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22756	displayNam e="FLU VAC C RIV3 NO PRESERV"
	22757	/>
	22758
	22759	</code>
	22760
	22761	</manufact uredMateri al>
	22762
	22763	</manufact uredProduc t>
	22764
	22765	</consumab le>
	22766
	22767	<performer >
	22768
	22769	<assignedE ntity>
	22770
	22771	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22772
	22773	<id
	22774	root="2.16 .840.1.113 883.4.349"
	22775	/>
	22776
	22777	<assignedP erson>
	22778
	22779	<!-- CCD P rovider Na me, REQUIR ED -->
	22780
	22781	<name/>
	22782
	22783	</assigned Person>
	22784
	22785	</assigned Entity>
	22786
	22787	</performe r>
	22788
	22789	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22790
	22791	<author>
	22792
	22793	<time
	22794	nullFlavor ="NA"
	22795	/>
	22796
	22797	<assignedA uthor>
	22798
	22799	<id
	22800	nullFlavor ="NA"
	22801	/>
	22802
	22803	<represent edOrganiza tion>
	22804
	22805	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22806	FA CILITY NBR ) -->
	22807
	22808	<id
	22809	extension= "984"
	22810	nullFlavor ="NA"
	22811	/>
	22812
	22813	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22814
	22815	<name>
	22816	DAYTSHR TE ST LAB
	22817	</name>
	22818
	22819	</represen tedOrganiz ation>
	22820
	22821	</assigned Author>
	22822
	22823	</author>
	22824
	22825
	22826	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22827	immuni zations on ly -->
	22828
	22829	</substanc eAdministr ation>
	22830
	22831	</entry>
	22832	<entry
	22833	typeCode=" DRIV"
	22834	>
	22835
	22836	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22837
	22838	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22839
	22840	<substance Administra tion
	22841	classCode= "SBADM"
	22842	moodCode=" EVN"
	22843	negationIn d="false"
	22844	>
	22845
	22846	<templateI d
	22847	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22848	/>
	22849
	22850	<id
	22851	nullFlavor ="NA"
	22852	/>
	22853
	22854	<text>
	22855
	22856	<reference
	22857	value="#in dComments1 013"
	22858	/>
	22859
	22860	</text>
	22861
	22862	<statusCod e
	22863	code="comp leted"
	22864	/>
	22865
	22866	<effective Time
	22867	value="201 50201"
	22868	/>
	22869
	22870	<repeatNum ber
	22871	nullFlavor ="UNK"
	22872	/>
	22873
	22874	<consumabl e>
	22875
	22876	<manufactu redProduct
	22877	classCode= "MANU"
	22878	>
	22879
	22880	<templateI d
	22881	root="2.16 .840.1.113 883.10.20. 22.4.54"
	22882	/>
	22883
	22884	<manufactu redMateria l>
	22885
	22886	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	22887
	22888	<code
	22889	code="149"
	22890	codeSystem ="2.16.840 .1.113883. 12.292"
	22891	codeSystem Name="Vacc ine Admini stered (CV X code)"
	22892	displayNam e="FLU VAC CINE 4 VAL ENT NASAL"
	22893	>
	22894
	22895	<originalT ext>
	22896
	22897	<reference
	22898	value="#in dImmunizat ion1013"
	22899	/>
	22900
	22901	</original Text>
	22902
	22903	<translati on
	22904	code="9067 2"
	22905	codeSystem ="2.16.840 .1.113883. 6.12"
	22906	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	22907	displayNam e="FLU VAC CINE 4 VAL ENT NASAL"
	22908	/>
	22909
	22910	</code>
	22911
	22912	</manufact uredMateri al>
	22913
	22914	</manufact uredProduc t>
	22915
	22916	</consumab le>
	22917
	22918	<performer >
	22919
	22920	<assignedE ntity>
	22921
	22922	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	22923
	22924	<id
	22925	root="2.16 .840.1.113 883.4.349"
	22926	/>
	22927
	22928	<assignedP erson>
	22929
	22930	<!-- CCD P rovider Na me, REQUIR ED -->
	22931
	22932	<name/>
	22933
	22934	</assigned Person>
	22935
	22936	</assigned Entity>
	22937
	22938	</performe r>
	22939
	22940	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	22941
	22942	<author>
	22943
	22944	<time
	22945	nullFlavor ="NA"
	22946	/>
	22947
	22948	<assignedA uthor>
	22949
	22950	<id
	22951	nullFlavor ="NA"
	22952	/>
	22953
	22954	<represent edOrganiza tion>
	22955
	22956	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	22957	FA CILITY NBR ) -->
	22958
	22959	<id
	22960	extension= "984"
	22961	nullFlavor ="NA"
	22962	/>
	22963
	22964	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	22965
	22966	<name>
	22967	DAYTSHR TE ST LAB
	22968	</name>
	22969
	22970	</represen tedOrganiz ation>
	22971
	22972	</assigned Author>
	22973
	22974	</author>
	22975
	22976
	22977	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	22978	immuni zations on ly -->
	22979
	22980	</substanc eAdministr ation>
	22981
	22982	</entry>
	22983	<entry
	22984	typeCode=" DRIV"
	22985	>
	22986
	22987	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	22988
	22989	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	22990
	22991	<substance Administra tion
	22992	classCode= "SBADM"
	22993	moodCode=" EVN"
	22994	negationIn d="false"
	22995	>
	22996
	22997	<templateI d
	22998	root="2.16 .840.1.113 883.10.20. 22.4.52"
	22999	/>
	23000
	23001	<id
	23002	nullFlavor ="NA"
	23003	/>
	23004
	23005	<text>
	23006
	23007	<reference
	23008	value="#in dComments1 014"
	23009	/>
	23010
	23011	</text>
	23012
	23013	<statusCod e
	23014	code="comp leted"
	23015	/>
	23016
	23017	<effective Time
	23018	value="201 41208"
	23019	/>
	23020
	23021	<repeatNum ber
	23022	nullFlavor ="UNK"
	23023	/>
	23024
	23025	<consumabl e>
	23026
	23027	<manufactu redProduct
	23028	classCode= "MANU"
	23029	>
	23030
	23031	<templateI d
	23032	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23033	/>
	23034
	23035	<manufactu redMateria l>
	23036
	23037	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23038
	23039	<code
	23040	code="141"
	23041	codeSystem ="2.16.840 .1.113883. 12.292"
	23042	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23043	>
	23044
	23045	<originalT ext>
	23046
	23047	<reference
	23048	value="#in dImmunizat ion1014"
	23049	/>
	23050
	23051	</original Text>
	23052
	23053
	23054	</code>
	23055
	23056	</manufact uredMateri al>
	23057
	23058	</manufact uredProduc t>
	23059
	23060	</consumab le>
	23061
	23062	<performer >
	23063
	23064	<assignedE ntity>
	23065
	23066	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23067
	23068	<id
	23069	root="2.16 .840.1.113 883.4.349"
	23070	/>
	23071
	23072	<assignedP erson>
	23073
	23074	<!-- CCD P rovider Na me, REQUIR ED -->
	23075
	23076	<name/>
	23077
	23078	</assigned Person>
	23079
	23080	</assigned Entity>
	23081
	23082	</performe r>
	23083
	23084	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23085
	23086	<author>
	23087
	23088	<time
	23089	nullFlavor ="NA"
	23090	/>
	23091
	23092	<assignedA uthor>
	23093
	23094	<id
	23095	nullFlavor ="NA"
	23096	/>
	23097
	23098	<represent edOrganiza tion>
	23099
	23100	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23101	FA CILITY NBR ) -->
	23102
	23103	<id
	23104	extension= "984"
	23105	nullFlavor ="NA"
	23106	/>
	23107
	23108	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23109
	23110	<name>
	23111	DAYTSHR TE ST LAB
	23112	</name>
	23113
	23114	</represen tedOrganiz ation>
	23115
	23116	</assigned Author>
	23117
	23118	</author>
	23119
	23120
	23121	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23122	immuni zations on ly -->
	23123
	23124	</substanc eAdministr ation>
	23125
	23126	</entry>
	23127	<entry
	23128	typeCode=" DRIV"
	23129	>
	23130
	23131	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23132
	23133	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23134
	23135	<substance Administra tion
	23136	classCode= "SBADM"
	23137	moodCode=" EVN"
	23138	negationIn d="false"
	23139	>
	23140
	23141	<templateI d
	23142	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23143	/>
	23144
	23145	<id
	23146	nullFlavor ="NA"
	23147	/>
	23148
	23149	<text>
	23150
	23151	<reference
	23152	value="#in dComments1 015"
	23153	/>
	23154
	23155	</text>
	23156
	23157	<statusCod e
	23158	code="comp leted"
	23159	/>
	23160
	23161	<effective Time
	23162	value="201 41207"
	23163	/>
	23164
	23165	<repeatNum ber
	23166	nullFlavor ="UNK"
	23167	/>
	23168
	23169	<consumabl e>
	23170
	23171	<manufactu redProduct
	23172	classCode= "MANU"
	23173	>
	23174
	23175	<templateI d
	23176	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23177	/>
	23178
	23179	<manufactu redMateria l>
	23180
	23181	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23182
	23183	<code
	23184	code="141"
	23185	codeSystem ="2.16.840 .1.113883. 12.292"
	23186	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23187	>
	23188
	23189	<originalT ext>
	23190
	23191	<reference
	23192	value="#in dImmunizat ion1015"
	23193	/>
	23194
	23195	</original Text>
	23196
	23197
	23198	</code>
	23199
	23200	</manufact uredMateri al>
	23201
	23202	</manufact uredProduc t>
	23203
	23204	</consumab le>
	23205
	23206	<performer >
	23207
	23208	<assignedE ntity>
	23209
	23210	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23211
	23212	<id
	23213	root="2.16 .840.1.113 883.4.349"
	23214	/>
	23215
	23216	<assignedP erson>
	23217
	23218	<!-- CCD P rovider Na me, REQUIR ED -->
	23219
	23220	<name/>
	23221
	23222	</assigned Person>
	23223
	23224	</assigned Entity>
	23225
	23226	</performe r>
	23227
	23228	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23229
	23230	<author>
	23231
	23232	<time
	23233	nullFlavor ="NA"
	23234	/>
	23235
	23236	<assignedA uthor>
	23237
	23238	<id
	23239	nullFlavor ="NA"
	23240	/>
	23241
	23242	<represent edOrganiza tion>
	23243
	23244	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23245	FA CILITY NBR ) -->
	23246
	23247	<id
	23248	extension= "984"
	23249	nullFlavor ="NA"
	23250	/>
	23251
	23252	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23253
	23254	<name>
	23255	DAYTSHR TE ST LAB
	23256	</name>
	23257
	23258	</represen tedOrganiz ation>
	23259
	23260	</assigned Author>
	23261
	23262	</author>
	23263
	23264
	23265	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23266	immuni zations on ly -->
	23267
	23268	</substanc eAdministr ation>
	23269
	23270	</entry>
	23271	<entry
	23272	typeCode=" DRIV"
	23273	>
	23274
	23275	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23276
	23277	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23278
	23279	<substance Administra tion
	23280	classCode= "SBADM"
	23281	moodCode=" EVN"
	23282	negationIn d="false"
	23283	>
	23284
	23285	<templateI d
	23286	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23287	/>
	23288
	23289	<id
	23290	nullFlavor ="NA"
	23291	/>
	23292
	23293	<text>
	23294
	23295	<reference
	23296	value="#in dComments1 016"
	23297	/>
	23298
	23299	</text>
	23300
	23301	<statusCod e
	23302	code="comp leted"
	23303	/>
	23304
	23305	<effective Time
	23306	value="201 41205"
	23307	/>
	23308
	23309	<repeatNum ber
	23310	nullFlavor ="UNK"
	23311	/>
	23312
	23313	<consumabl e>
	23314
	23315	<manufactu redProduct
	23316	classCode= "MANU"
	23317	>
	23318
	23319	<templateI d
	23320	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23321	/>
	23322
	23323	<manufactu redMateria l>
	23324
	23325	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23326
	23327	<code
	23328	code="141"
	23329	codeSystem ="2.16.840 .1.113883. 12.292"
	23330	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23331	>
	23332
	23333	<originalT ext>
	23334
	23335	<reference
	23336	value="#in dImmunizat ion1016"
	23337	/>
	23338
	23339	</original Text>
	23340
	23341
	23342	</code>
	23343
	23344	</manufact uredMateri al>
	23345
	23346	</manufact uredProduc t>
	23347
	23348	</consumab le>
	23349
	23350	<performer >
	23351
	23352	<assignedE ntity>
	23353
	23354	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23355
	23356	<id
	23357	root="2.16 .840.1.113 883.4.349"
	23358	/>
	23359
	23360	<assignedP erson>
	23361
	23362	<!-- CCD P rovider Na me, REQUIR ED -->
	23363
	23364	<name/>
	23365
	23366	</assigned Person>
	23367
	23368	</assigned Entity>
	23369
	23370	</performe r>
	23371
	23372	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23373
	23374	<author>
	23375
	23376	<time
	23377	nullFlavor ="NA"
	23378	/>
	23379
	23380	<assignedA uthor>
	23381
	23382	<id
	23383	nullFlavor ="NA"
	23384	/>
	23385
	23386	<represent edOrganiza tion>
	23387
	23388	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23389	FA CILITY NBR ) -->
	23390
	23391	<id
	23392	extension= "984"
	23393	nullFlavor ="NA"
	23394	/>
	23395
	23396	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23397
	23398	<name>
	23399	DAYTSHR TE ST LAB
	23400	</name>
	23401
	23402	</represen tedOrganiz ation>
	23403
	23404	</assigned Author>
	23405
	23406	</author>
	23407
	23408
	23409	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23410	immuni zations on ly -->
	23411
	23412	</substanc eAdministr ation>
	23413
	23414	</entry>
	23415	<entry
	23416	typeCode=" DRIV"
	23417	>
	23418
	23419	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23420
	23421	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23422
	23423	<substance Administra tion
	23424	classCode= "SBADM"
	23425	moodCode=" EVN"
	23426	negationIn d="false"
	23427	>
	23428
	23429	<templateI d
	23430	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23431	/>
	23432
	23433	<id
	23434	nullFlavor ="NA"
	23435	/>
	23436
	23437	<text>
	23438
	23439	<reference
	23440	value="#in dComments1 017"
	23441	/>
	23442
	23443	</text>
	23444
	23445	<statusCod e
	23446	code="comp leted"
	23447	/>
	23448
	23449	<effective Time
	23450	value="201 41102"
	23451	/>
	23452
	23453	<repeatNum ber
	23454	nullFlavor ="UNK"
	23455	/>
	23456
	23457	<consumabl e>
	23458
	23459	<manufactu redProduct
	23460	classCode= "MANU"
	23461	>
	23462
	23463	<templateI d
	23464	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23465	/>
	23466
	23467	<manufactu redMateria l>
	23468
	23469	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23470
	23471	<code
	23472	code="141"
	23473	codeSystem ="2.16.840 .1.113883. 12.292"
	23474	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23475	>
	23476
	23477	<originalT ext>
	23478
	23479	<reference
	23480	value="#in dImmunizat ion1017"
	23481	/>
	23482
	23483	</original Text>
	23484
	23485
	23486	</code>
	23487
	23488	</manufact uredMateri al>
	23489
	23490	</manufact uredProduc t>
	23491
	23492	</consumab le>
	23493
	23494	<performer >
	23495
	23496	<assignedE ntity>
	23497
	23498	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23499
	23500	<id
	23501	root="2.16 .840.1.113 883.4.349"
	23502	/>
	23503
	23504	<assignedP erson>
	23505
	23506	<!-- CCD P rovider Na me, REQUIR ED -->
	23507
	23508	<name/>
	23509
	23510	</assigned Person>
	23511
	23512	</assigned Entity>
	23513
	23514	</performe r>
	23515
	23516	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23517
	23518	<author>
	23519
	23520	<time
	23521	nullFlavor ="NA"
	23522	/>
	23523
	23524	<assignedA uthor>
	23525
	23526	<id
	23527	nullFlavor ="NA"
	23528	/>
	23529
	23530	<represent edOrganiza tion>
	23531
	23532	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23533	FA CILITY NBR ) -->
	23534
	23535	<id
	23536	extension= "984"
	23537	nullFlavor ="NA"
	23538	/>
	23539
	23540	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23541
	23542	<name>
	23543	DAYTSHR TE ST LAB
	23544	</name>
	23545
	23546	</represen tedOrganiz ation>
	23547
	23548	</assigned Author>
	23549
	23550	</author>
	23551
	23552
	23553	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23554	immuni zations on ly -->
	23555
	23556	</substanc eAdministr ation>
	23557
	23558	</entry>
	23559	<entry
	23560	typeCode=" DRIV"
	23561	>
	23562
	23563	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23564
	23565	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23566
	23567	<substance Administra tion
	23568	classCode= "SBADM"
	23569	moodCode=" EVN"
	23570	negationIn d="false"
	23571	>
	23572
	23573	<templateI d
	23574	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23575	/>
	23576
	23577	<id
	23578	nullFlavor ="NA"
	23579	/>
	23580
	23581	<text>
	23582
	23583	<reference
	23584	value="#in dComments1 018"
	23585	/>
	23586
	23587	</text>
	23588
	23589	<statusCod e
	23590	code="comp leted"
	23591	/>
	23592
	23593	<effective Time
	23594	value="201 41101"
	23595	/>
	23596
	23597	<repeatNum ber
	23598	nullFlavor ="UNK"
	23599	/>
	23600
	23601	<consumabl e>
	23602
	23603	<manufactu redProduct
	23604	classCode= "MANU"
	23605	>
	23606
	23607	<templateI d
	23608	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23609	/>
	23610
	23611	<manufactu redMateria l>
	23612
	23613	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23614
	23615	<code
	23616	code="141"
	23617	codeSystem ="2.16.840 .1.113883. 12.292"
	23618	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23619	>
	23620
	23621	<originalT ext>
	23622
	23623	<reference
	23624	value="#in dImmunizat ion1018"
	23625	/>
	23626
	23627	</original Text>
	23628
	23629
	23630	</code>
	23631
	23632	</manufact uredMateri al>
	23633
	23634	</manufact uredProduc t>
	23635
	23636	</consumab le>
	23637
	23638	<performer >
	23639
	23640	<assignedE ntity>
	23641
	23642	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23643
	23644	<id
	23645	root="2.16 .840.1.113 883.4.349"
	23646	/>
	23647
	23648	<assignedP erson>
	23649
	23650	<!-- CCD P rovider Na me, REQUIR ED -->
	23651
	23652	<name/>
	23653
	23654	</assigned Person>
	23655
	23656	</assigned Entity>
	23657
	23658	</performe r>
	23659
	23660	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23661
	23662	<author>
	23663
	23664	<time
	23665	nullFlavor ="NA"
	23666	/>
	23667
	23668	<assignedA uthor>
	23669
	23670	<id
	23671	nullFlavor ="NA"
	23672	/>
	23673
	23674	<represent edOrganiza tion>
	23675
	23676	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23677	FA CILITY NBR ) -->
	23678
	23679	<id
	23680	extension= "984"
	23681	nullFlavor ="NA"
	23682	/>
	23683
	23684	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23685
	23686	<name>
	23687	DAYTSHR TE ST LAB
	23688	</name>
	23689
	23690	</represen tedOrganiz ation>
	23691
	23692	</assigned Author>
	23693
	23694	</author>
	23695
	23696
	23697	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23698	immuni zations on ly -->
	23699
	23700	</substanc eAdministr ation>
	23701
	23702	</entry>
	23703	<entry
	23704	typeCode=" DRIV"
	23705	>
	23706
	23707	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23708
	23709	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23710
	23711	<substance Administra tion
	23712	classCode= "SBADM"
	23713	moodCode=" EVN"
	23714	negationIn d="false"
	23715	>
	23716
	23717	<templateI d
	23718	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23719	/>
	23720
	23721	<id
	23722	nullFlavor ="NA"
	23723	/>
	23724
	23725	<text>
	23726
	23727	<reference
	23728	value="#in dComments1 019"
	23729	/>
	23730
	23731	</text>
	23732
	23733	<statusCod e
	23734	code="comp leted"
	23735	/>
	23736
	23737	<effective Time
	23738	value="201 40819"
	23739	/>
	23740
	23741	<repeatNum ber
	23742	nullFlavor ="UNK"
	23743	/>
	23744
	23745	<consumabl e>
	23746
	23747	<manufactu redProduct
	23748	classCode= "MANU"
	23749	>
	23750
	23751	<templateI d
	23752	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23753	/>
	23754
	23755	<manufactu redMateria l>
	23756
	23757	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23758
	23759	<code
	23760	code="135"
	23761	codeSystem ="2.16.840 .1.113883. 12.292"
	23762	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23763	displayNam e="FLU VAC C PRSV FRE E INC ANTI G"
	23764	>
	23765
	23766	<originalT ext>
	23767
	23768	<reference
	23769	value="#in dImmunizat ion1019"
	23770	/>
	23771
	23772	</original Text>
	23773
	23774	<translati on
	23775	code="9066 2"
	23776	codeSystem ="2.16.840 .1.113883. 6.12"
	23777	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	23778	displayNam e="FLU VAC C PRSV FRE E INC ANTI G"
	23779	/>
	23780
	23781	</code>
	23782
	23783	</manufact uredMateri al>
	23784
	23785	</manufact uredProduc t>
	23786
	23787	</consumab le>
	23788
	23789	<performer >
	23790
	23791	<assignedE ntity>
	23792
	23793	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23794
	23795	<id
	23796	root="2.16 .840.1.113 883.4.349"
	23797	/>
	23798
	23799	<assignedP erson>
	23800
	23801	<!-- CCD P rovider Na me, REQUIR ED -->
	23802
	23803	<name/>
	23804
	23805	</assigned Person>
	23806
	23807	</assigned Entity>
	23808
	23809	</performe r>
	23810
	23811	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23812
	23813	<author>
	23814
	23815	<time
	23816	nullFlavor ="NA"
	23817	/>
	23818
	23819	<assignedA uthor>
	23820
	23821	<id
	23822	nullFlavor ="NA"
	23823	/>
	23824
	23825	<represent edOrganiza tion>
	23826
	23827	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23828	FA CILITY NBR ) -->
	23829
	23830	<id
	23831	extension= "984"
	23832	nullFlavor ="NA"
	23833	/>
	23834
	23835	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23836
	23837	<name>
	23838	DAYTSHR TE ST LAB
	23839	</name>
	23840
	23841	</represen tedOrganiz ation>
	23842
	23843	</assigned Author>
	23844
	23845	</author>
	23846
	23847
	23848	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	23849	immuni zations on ly -->
	23850
	23851	</substanc eAdministr ation>
	23852
	23853	</entry>
	23854	<entry
	23855	typeCode=" DRIV"
	23856	>
	23857
	23858	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	23859
	23860	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	23861
	23862	<substance Administra tion
	23863	classCode= "SBADM"
	23864	moodCode=" EVN"
	23865	negationIn d="false"
	23866	>
	23867
	23868	<templateI d
	23869	root="2.16 .840.1.113 883.10.20. 22.4.52"
	23870	/>
	23871
	23872	<id
	23873	nullFlavor ="NA"
	23874	/>
	23875
	23876	<text>
	23877
	23878	<reference
	23879	value="#in dComments1 020"
	23880	/>
	23881
	23882	</text>
	23883
	23884	<statusCod e
	23885	code="comp leted"
	23886	/>
	23887
	23888	<effective Time
	23889	value="201 40801"
	23890	/>
	23891
	23892	<repeatNum ber
	23893	nullFlavor ="UNK"
	23894	/>
	23895
	23896	<consumabl e>
	23897
	23898	<manufactu redProduct
	23899	classCode= "MANU"
	23900	>
	23901
	23902	<templateI d
	23903	root="2.16 .840.1.113 883.10.20. 22.4.54"
	23904	/>
	23905
	23906	<manufactu redMateria l>
	23907
	23908	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	23909
	23910	<code
	23911	code="33"
	23912	codeSystem ="2.16.840 .1.113883. 12.292"
	23913	codeSystem Name="Vacc ine Admini stered (CV X code)"
	23914	displayNam e="PNEUMOC OCCAL VACC INE"
	23915	>
	23916
	23917	<originalT ext>
	23918
	23919	<reference
	23920	value="#in dImmunizat ion1020"
	23921	/>
	23922
	23923	</original Text>
	23924
	23925	<translati on
	23926	code="9073 2"
	23927	codeSystem ="2.16.840 .1.113883. 6.12"
	23928	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	23929	displayNam e="PNEUMOC OCCAL VACC INE"
	23930	/>
	23931
	23932	</code>
	23933
	23934	</manufact uredMateri al>
	23935
	23936	</manufact uredProduc t>
	23937
	23938	</consumab le>
	23939
	23940	<performer >
	23941
	23942	<assignedE ntity>
	23943
	23944	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	23945
	23946	<id
	23947	root="2.16 .840.1.113 883.4.349"
	23948	/>
	23949
	23950	<assignedP erson>
	23951
	23952	<!-- CCD P rovider Na me, REQUIR ED -->
	23953
	23954	<name/>
	23955
	23956	</assigned Person>
	23957
	23958	</assigned Entity>
	23959
	23960	</performe r>
	23961
	23962	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	23963
	23964	<author>
	23965
	23966	<time
	23967	nullFlavor ="NA"
	23968	/>
	23969
	23970	<assignedA uthor>
	23971
	23972	<id
	23973	nullFlavor ="NA"
	23974	/>
	23975
	23976	<represent edOrganiza tion>
	23977
	23978	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	23979	FA CILITY NBR ) -->
	23980
	23981	<id
	23982	extension= "984"
	23983	nullFlavor ="NA"
	23984	/>
	23985
	23986	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	23987
	23988	<name>
	23989	DAYTSHR TE ST LAB
	23990	</name>
	23991
	23992	</represen tedOrganiz ation>
	23993
	23994	</assigned Author>
	23995
	23996	</author>
	23997
	23998
	23999	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24000	immuni zations on ly -->
	24001
	24002	</substanc eAdministr ation>
	24003
	24004	</entry>
	24005	<entry
	24006	typeCode=" DRIV"
	24007	>
	24008
	24009	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24010
	24011	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24012
	24013	<substance Administra tion
	24014	classCode= "SBADM"
	24015	moodCode=" EVN"
	24016	negationIn d="false"
	24017	>
	24018
	24019	<templateI d
	24020	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24021	/>
	24022
	24023	<id
	24024	nullFlavor ="NA"
	24025	/>
	24026
	24027	<text>
	24028
	24029	<reference
	24030	value="#in dComments1 021"
	24031	/>
	24032
	24033	</text>
	24034
	24035	<statusCod e
	24036	code="comp leted"
	24037	/>
	24038
	24039	<effective Time
	24040	value="201 40801"
	24041	/>
	24042
	24043	<repeatNum ber
	24044	nullFlavor ="UNK"
	24045	/>
	24046
	24047	<consumabl e>
	24048
	24049	<manufactu redProduct
	24050	classCode= "MANU"
	24051	>
	24052
	24053	<templateI d
	24054	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24055	/>
	24056
	24057	<manufactu redMateria l>
	24058
	24059	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24060
	24061	<code
	24062	code="133"
	24063	codeSystem ="2.16.840 .1.113883. 12.292"
	24064	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24065	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	24066	>
	24067
	24068	<originalT ext>
	24069
	24070	<reference
	24071	value="#in dImmunizat ion1021"
	24072	/>
	24073
	24074	</original Text>
	24075
	24076	<translati on
	24077	code="9067 0"
	24078	codeSystem ="2.16.840 .1.113883. 6.12"
	24079	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24080	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	24081	/>
	24082
	24083	</code>
	24084
	24085	</manufact uredMateri al>
	24086
	24087	</manufact uredProduc t>
	24088
	24089	</consumab le>
	24090
	24091	<performer >
	24092
	24093	<assignedE ntity>
	24094
	24095	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24096
	24097	<id
	24098	root="2.16 .840.1.113 883.4.349"
	24099	/>
	24100
	24101	<assignedP erson>
	24102
	24103	<!-- CCD P rovider Na me, REQUIR ED -->
	24104
	24105	<name/>
	24106
	24107	</assigned Person>
	24108
	24109	</assigned Entity>
	24110
	24111	</performe r>
	24112
	24113	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24114
	24115	<author>
	24116
	24117	<time
	24118	nullFlavor ="NA"
	24119	/>
	24120
	24121	<assignedA uthor>
	24122
	24123	<id
	24124	nullFlavor ="NA"
	24125	/>
	24126
	24127	<represent edOrganiza tion>
	24128
	24129	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24130	FA CILITY NBR ) -->
	24131
	24132	<id
	24133	extension= "984"
	24134	nullFlavor ="NA"
	24135	/>
	24136
	24137	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24138
	24139	<name>
	24140	DAYTSHR TE ST LAB
	24141	</name>
	24142
	24143	</represen tedOrganiz ation>
	24144
	24145	</assigned Author>
	24146
	24147	</author>
	24148
	24149
	24150	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24151	immuni zations on ly -->
	24152
	24153	</substanc eAdministr ation>
	24154
	24155	</entry>
	24156	<entry
	24157	typeCode=" DRIV"
	24158	>
	24159
	24160	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24161
	24162	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24163
	24164	<substance Administra tion
	24165	classCode= "SBADM"
	24166	moodCode=" EVN"
	24167	negationIn d="false"
	24168	>
	24169
	24170	<templateI d
	24171	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24172	/>
	24173
	24174	<id
	24175	nullFlavor ="NA"
	24176	/>
	24177
	24178	<text>
	24179
	24180	<reference
	24181	value="#in dComments1 022"
	24182	/>
	24183
	24184	</text>
	24185
	24186	<statusCod e
	24187	code="comp leted"
	24188	/>
	24189
	24190	<effective Time
	24191	value="201 408"
	24192	/>
	24193
	24194	<repeatNum ber
	24195	nullFlavor ="UNK"
	24196	/>
	24197
	24198	<consumabl e>
	24199
	24200	<manufactu redProduct
	24201	classCode= "MANU"
	24202	>
	24203
	24204	<templateI d
	24205	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24206	/>
	24207
	24208	<manufactu redMateria l>
	24209
	24210	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24211
	24212	<code
	24213	code="121"
	24214	codeSystem ="2.16.840 .1.113883. 12.292"
	24215	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24216	displayNam e="ZOSTER VACC SC"
	24217	>
	24218
	24219	<originalT ext>
	24220
	24221	<reference
	24222	value="#in dImmunizat ion1022"
	24223	/>
	24224
	24225	</original Text>
	24226
	24227	<translati on
	24228	code="9073 6"
	24229	codeSystem ="2.16.840 .1.113883. 6.12"
	24230	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24231	displayNam e="ZOSTER VACC SC"
	24232	/>
	24233
	24234	</code>
	24235
	24236	</manufact uredMateri al>
	24237
	24238	</manufact uredProduc t>
	24239
	24240	</consumab le>
	24241
	24242	<performer >
	24243
	24244	<assignedE ntity>
	24245
	24246	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24247
	24248	<id
	24249	root="2.16 .840.1.113 883.4.349"
	24250	/>
	24251
	24252	<assignedP erson>
	24253
	24254	<!-- CCD P rovider Na me, REQUIR ED -->
	24255
	24256	<name/>
	24257
	24258	</assigned Person>
	24259
	24260	</assigned Entity>
	24261
	24262	</performe r>
	24263
	24264	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24265
	24266	<author>
	24267
	24268	<time
	24269	nullFlavor ="NA"
	24270	/>
	24271
	24272	<assignedA uthor>
	24273
	24274	<id
	24275	nullFlavor ="NA"
	24276	/>
	24277
	24278	<represent edOrganiza tion>
	24279
	24280	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24281	FA CILITY NBR ) -->
	24282
	24283	<id
	24284	extension= "984"
	24285	nullFlavor ="NA"
	24286	/>
	24287
	24288	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24289
	24290	<name>
	24291	DAYTSHR TE ST LAB
	24292	</name>
	24293
	24294	</represen tedOrganiz ation>
	24295
	24296	</assigned Author>
	24297
	24298	</author>
	24299
	24300
	24301	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24302	immuni zations on ly -->
	24303
	24304	</substanc eAdministr ation>
	24305
	24306	</entry>
	24307	<entry
	24308	typeCode=" DRIV"
	24309	>
	24310
	24311	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24312
	24313	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24314
	24315	<substance Administra tion
	24316	classCode= "SBADM"
	24317	moodCode=" EVN"
	24318	negationIn d="false"
	24319	>
	24320
	24321	<templateI d
	24322	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24323	/>
	24324
	24325	<id
	24326	nullFlavor ="NA"
	24327	/>
	24328
	24329	<text>
	24330
	24331	<reference
	24332	value="#in dComments1 023"
	24333	/>
	24334
	24335	</text>
	24336
	24337	<statusCod e
	24338	code="comp leted"
	24339	/>
	24340
	24341	<effective Time
	24342	value="201 40508"
	24343	/>
	24344
	24345	<repeatNum ber
	24346	nullFlavor ="UNK"
	24347	/>
	24348
	24349	<consumabl e>
	24350
	24351	<manufactu redProduct
	24352	classCode= "MANU"
	24353	>
	24354
	24355	<templateI d
	24356	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24357	/>
	24358
	24359	<manufactu redMateria l>
	24360
	24361	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24362
	24363	<code
	24364	code="133"
	24365	codeSystem ="2.16.840 .1.113883. 12.292"
	24366	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24367	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	24368	>
	24369
	24370	<originalT ext>
	24371
	24372	<reference
	24373	value="#in dImmunizat ion1023"
	24374	/>
	24375
	24376	</original Text>
	24377
	24378	<translati on
	24379	code="9067 0"
	24380	codeSystem ="2.16.840 .1.113883. 6.12"
	24381	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24382	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	24383	/>
	24384
	24385	</code>
	24386
	24387	</manufact uredMateri al>
	24388
	24389	</manufact uredProduc t>
	24390
	24391	</consumab le>
	24392
	24393	<performer >
	24394
	24395	<assignedE ntity>
	24396
	24397	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24398
	24399	<id
	24400	root="2.16 .840.1.113 883.4.349"
	24401	/>
	24402
	24403	<assignedP erson>
	24404
	24405	<!-- CCD P rovider Na me, REQUIR ED -->
	24406
	24407	<name/>
	24408
	24409	</assigned Person>
	24410
	24411	</assigned Entity>
	24412
	24413	</performe r>
	24414
	24415	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24416
	24417	<author>
	24418
	24419	<time
	24420	nullFlavor ="NA"
	24421	/>
	24422
	24423	<assignedA uthor>
	24424
	24425	<id
	24426	nullFlavor ="NA"
	24427	/>
	24428
	24429	<represent edOrganiza tion>
	24430
	24431	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24432	FA CILITY NBR ) -->
	24433
	24434	<id
	24435	extension= "984"
	24436	nullFlavor ="NA"
	24437	/>
	24438
	24439	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24440
	24441	<name>
	24442	DAYTSHR TE ST LAB
	24443	</name>
	24444
	24445	</represen tedOrganiz ation>
	24446
	24447	</assigned Author>
	24448
	24449	</author>
	24450
	24451
	24452	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24453	immuni zations on ly -->
	24454
	24455	</substanc eAdministr ation>
	24456
	24457	</entry>
	24458	<entry
	24459	typeCode=" DRIV"
	24460	>
	24461
	24462	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24463
	24464	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24465
	24466	<substance Administra tion
	24467	classCode= "SBADM"
	24468	moodCode=" EVN"
	24469	negationIn d="false"
	24470	>
	24471
	24472	<templateI d
	24473	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24474	/>
	24475
	24476	<id
	24477	nullFlavor ="NA"
	24478	/>
	24479
	24480	<text>
	24481
	24482	<reference
	24483	value="#in dComments1 024"
	24484	/>
	24485
	24486	</text>
	24487
	24488	<statusCod e
	24489	code="comp leted"
	24490	/>
	24491
	24492	<effective Time
	24493	value="201 40424"
	24494	/>
	24495
	24496	<repeatNum ber
	24497	nullFlavor ="UNK"
	24498	/>
	24499
	24500	<consumabl e>
	24501
	24502	<manufactu redProduct
	24503	classCode= "MANU"
	24504	>
	24505
	24506	<templateI d
	24507	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24508	/>
	24509
	24510	<manufactu redMateria l>
	24511
	24512	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24513
	24514	<code
	24515	code="121"
	24516	codeSystem ="2.16.840 .1.113883. 12.292"
	24517	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24518	displayNam e="ZOSTER VACC SC"
	24519	>
	24520
	24521	<originalT ext>
	24522
	24523	<reference
	24524	value="#in dImmunizat ion1024"
	24525	/>
	24526
	24527	</original Text>
	24528
	24529	<translati on
	24530	code="9073 6"
	24531	codeSystem ="2.16.840 .1.113883. 6.12"
	24532	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24533	displayNam e="ZOSTER VACC SC"
	24534	/>
	24535
	24536	</code>
	24537
	24538	</manufact uredMateri al>
	24539
	24540	</manufact uredProduc t>
	24541
	24542	</consumab le>
	24543
	24544	<performer >
	24545
	24546	<assignedE ntity>
	24547
	24548	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24549
	24550	<id
	24551	root="2.16 .840.1.113 883.4.349"
	24552	/>
	24553
	24554	<assignedP erson>
	24555
	24556	<!-- CCD P rovider Na me, REQUIR ED -->
	24557
	24558	<name/>
	24559
	24560	</assigned Person>
	24561
	24562	</assigned Entity>
	24563
	24564	</performe r>
	24565
	24566	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24567
	24568	<author>
	24569
	24570	<time
	24571	nullFlavor ="NA"
	24572	/>
	24573
	24574	<assignedA uthor>
	24575
	24576	<id
	24577	nullFlavor ="NA"
	24578	/>
	24579
	24580	<represent edOrganiza tion>
	24581
	24582	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24583	FA CILITY NBR ) -->
	24584
	24585	<id
	24586	extension= "984"
	24587	nullFlavor ="NA"
	24588	/>
	24589
	24590	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24591
	24592	<name>
	24593	DAYTSHR TE ST LAB
	24594	</name>
	24595
	24596	</represen tedOrganiz ation>
	24597
	24598	</assigned Author>
	24599
	24600	</author>
	24601
	24602
	24603	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24604	immuni zations on ly -->
	24605
	24606	</substanc eAdministr ation>
	24607
	24608	</entry>
	24609	<entry
	24610	typeCode=" DRIV"
	24611	>
	24612
	24613	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24614
	24615	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24616
	24617	<substance Administra tion
	24618	classCode= "SBADM"
	24619	moodCode=" EVN"
	24620	negationIn d="false"
	24621	>
	24622
	24623	<templateI d
	24624	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24625	/>
	24626
	24627	<id
	24628	nullFlavor ="NA"
	24629	/>
	24630
	24631	<text>
	24632
	24633	<reference
	24634	value="#in dComments1 025"
	24635	/>
	24636
	24637	</text>
	24638
	24639	<statusCod e
	24640	code="comp leted"
	24641	/>
	24642
	24643	<effective Time
	24644	value="201 30819"
	24645	/>
	24646
	24647	<repeatNum ber
	24648	nullFlavor ="UNK"
	24649	/>
	24650
	24651	<consumabl e>
	24652
	24653	<manufactu redProduct
	24654	classCode= "MANU"
	24655	>
	24656
	24657	<templateI d
	24658	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24659	/>
	24660
	24661	<manufactu redMateria l>
	24662
	24663	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24664
	24665	<code
	24666	code="144"
	24667	codeSystem ="2.16.840 .1.113883. 12.292"
	24668	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24669	displayNam e="FLU VAC C IIV3 NO PRESERV ID "
	24670	>
	24671
	24672	<originalT ext>
	24673
	24674	<reference
	24675	value="#in dImmunizat ion1025"
	24676	/>
	24677
	24678	</original Text>
	24679
	24680	<translati on
	24681	code="9065 4"
	24682	codeSystem ="2.16.840 .1.113883. 6.12"
	24683	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24684	displayNam e="FLU VAC C IIV3 NO PRESERV ID "
	24685	/>
	24686
	24687	</code>
	24688
	24689	</manufact uredMateri al>
	24690
	24691	</manufact uredProduc t>
	24692
	24693	</consumab le>
	24694
	24695	<performer >
	24696
	24697	<assignedE ntity>
	24698
	24699	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24700
	24701	<id
	24702	root="2.16 .840.1.113 883.4.349"
	24703	/>
	24704
	24705	<assignedP erson>
	24706
	24707	<!-- CCD P rovider Na me, REQUIR ED -->
	24708
	24709	<name/>
	24710
	24711	</assigned Person>
	24712
	24713	</assigned Entity>
	24714
	24715	</performe r>
	24716
	24717	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24718
	24719	<author>
	24720
	24721	<time
	24722	nullFlavor ="NA"
	24723	/>
	24724
	24725	<assignedA uthor>
	24726
	24727	<id
	24728	nullFlavor ="NA"
	24729	/>
	24730
	24731	<represent edOrganiza tion>
	24732
	24733	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24734	FA CILITY NBR ) -->
	24735
	24736	<id
	24737	extension= "984"
	24738	nullFlavor ="NA"
	24739	/>
	24740
	24741	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24742
	24743	<name>
	24744	DAYTSHR TE ST LAB
	24745	</name>
	24746
	24747	</represen tedOrganiz ation>
	24748
	24749	</assigned Author>
	24750
	24751	</author>
	24752
	24753
	24754	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24755	immuni zations on ly -->
	24756
	24757	</substanc eAdministr ation>
	24758
	24759	</entry>
	24760	<entry
	24761	typeCode=" DRIV"
	24762	>
	24763
	24764	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24765
	24766	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24767
	24768	<substance Administra tion
	24769	classCode= "SBADM"
	24770	moodCode=" EVN"
	24771	negationIn d="false"
	24772	>
	24773
	24774	<templateI d
	24775	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24776	/>
	24777
	24778	<id
	24779	nullFlavor ="NA"
	24780	/>
	24781
	24782	<text>
	24783
	24784	<reference
	24785	value="#in dComments1 026"
	24786	/>
	24787
	24788	</text>
	24789
	24790	<statusCod e
	24791	code="comp leted"
	24792	/>
	24793
	24794	<effective Time
	24795	value="201 30818"
	24796	/>
	24797
	24798	<repeatNum ber
	24799	nullFlavor ="UNK"
	24800	/>
	24801
	24802	<consumabl e>
	24803
	24804	<manufactu redProduct
	24805	classCode= "MANU"
	24806	>
	24807
	24808	<templateI d
	24809	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24810	/>
	24811
	24812	<manufactu redMateria l>
	24813
	24814	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24815
	24816	<code
	24817	code="33"
	24818	codeSystem ="2.16.840 .1.113883. 12.292"
	24819	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24820	displayNam e="PNEUMOC OCCAL VACC INE"
	24821	>
	24822
	24823	<originalT ext>
	24824
	24825	<reference
	24826	value="#in dImmunizat ion1026"
	24827	/>
	24828
	24829	</original Text>
	24830
	24831	<translati on
	24832	code="9073 2"
	24833	codeSystem ="2.16.840 .1.113883. 6.12"
	24834	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	24835	displayNam e="PNEUMOC OCCAL VACC INE"
	24836	/>
	24837
	24838	</code>
	24839
	24840	</manufact uredMateri al>
	24841
	24842	</manufact uredProduc t>
	24843
	24844	</consumab le>
	24845
	24846	<performer >
	24847
	24848	<assignedE ntity>
	24849
	24850	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24851
	24852	<id
	24853	root="2.16 .840.1.113 883.4.349"
	24854	/>
	24855
	24856	<assignedP erson>
	24857
	24858	<!-- CCD P rovider Na me, REQUIR ED -->
	24859
	24860	<name/>
	24861
	24862	</assigned Person>
	24863
	24864	</assigned Entity>
	24865
	24866	</performe r>
	24867
	24868	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	24869
	24870	<author>
	24871
	24872	<time
	24873	nullFlavor ="NA"
	24874	/>
	24875
	24876	<assignedA uthor>
	24877
	24878	<id
	24879	nullFlavor ="NA"
	24880	/>
	24881
	24882	<represent edOrganiza tion>
	24883
	24884	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	24885	FA CILITY NBR ) -->
	24886
	24887	<id
	24888	extension= "984"
	24889	nullFlavor ="NA"
	24890	/>
	24891
	24892	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	24893
	24894	<name>
	24895	DAYTSHR TE ST LAB
	24896	</name>
	24897
	24898	</represen tedOrganiz ation>
	24899
	24900	</assigned Author>
	24901
	24902	</author>
	24903
	24904
	24905	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	24906	immuni zations on ly -->
	24907
	24908	</substanc eAdministr ation>
	24909
	24910	</entry>
	24911	<entry
	24912	typeCode=" DRIV"
	24913	>
	24914
	24915	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	24916
	24917	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	24918
	24919	<substance Administra tion
	24920	classCode= "SBADM"
	24921	moodCode=" EVN"
	24922	negationIn d="false"
	24923	>
	24924
	24925	<templateI d
	24926	root="2.16 .840.1.113 883.10.20. 22.4.52"
	24927	/>
	24928
	24929	<id
	24930	nullFlavor ="NA"
	24931	/>
	24932
	24933	<text>
	24934
	24935	<reference
	24936	value="#in dComments1 027"
	24937	/>
	24938
	24939	</text>
	24940
	24941	<statusCod e
	24942	code="comp leted"
	24943	/>
	24944
	24945	<effective Time
	24946	value="201 20124"
	24947	/>
	24948
	24949	<repeatNum ber
	24950	nullFlavor ="UNK"
	24951	/>
	24952
	24953	<consumabl e>
	24954
	24955	<manufactu redProduct
	24956	classCode= "MANU"
	24957	>
	24958
	24959	<templateI d
	24960	root="2.16 .840.1.113 883.10.20. 22.4.54"
	24961	/>
	24962
	24963	<manufactu redMateria l>
	24964
	24965	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	24966
	24967	<code
	24968	code="141"
	24969	codeSystem ="2.16.840 .1.113883. 12.292"
	24970	codeSystem Name="Vacc ine Admini stered (CV X code)"
	24971	>
	24972
	24973	<originalT ext>
	24974
	24975	<reference
	24976	value="#in dImmunizat ion1027"
	24977	/>
	24978
	24979	</original Text>
	24980
	24981
	24982	</code>
	24983
	24984	</manufact uredMateri al>
	24985
	24986	</manufact uredProduc t>
	24987
	24988	</consumab le>
	24989
	24990	<performer >
	24991
	24992	<assignedE ntity>
	24993
	24994	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	24995
	24996	<id
	24997	root="2.16 .840.1.113 883.4.349"
	24998	/>
	24999
	25000	<assignedP erson>
	25001
	25002	<!-- CCD P rovider Na me, REQUIR ED -->
	25003
	25004	<name/>
	25005
	25006	</assigned Person>
	25007
	25008	</assigned Entity>
	25009
	25010	</performe r>
	25011
	25012	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25013
	25014	<author>
	25015
	25016	<time
	25017	nullFlavor ="NA"
	25018	/>
	25019
	25020	<assignedA uthor>
	25021
	25022	<id
	25023	nullFlavor ="NA"
	25024	/>
	25025
	25026	<represent edOrganiza tion>
	25027
	25028	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25029	FA CILITY NBR ) -->
	25030
	25031	<id
	25032	extension= "984"
	25033	nullFlavor ="NA"
	25034	/>
	25035
	25036	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25037
	25038	<name>
	25039	DAYTSHR TE ST LAB
	25040	</name>
	25041
	25042	</represen tedOrganiz ation>
	25043
	25044	</assigned Author>
	25045
	25046	</author>
	25047
	25048
	25049	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25050	immuni zations on ly -->
	25051
	25052	</substanc eAdministr ation>
	25053
	25054	</entry>
	25055	<entry
	25056	typeCode=" DRIV"
	25057	>
	25058
	25059	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25060
	25061	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25062
	25063	<substance Administra tion
	25064	classCode= "SBADM"
	25065	moodCode=" EVN"
	25066	negationIn d="false"
	25067	>
	25068
	25069	<templateI d
	25070	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25071	/>
	25072
	25073	<id
	25074	nullFlavor ="NA"
	25075	/>
	25076
	25077	<text>
	25078
	25079	<reference
	25080	value="#in dComments1 028"
	25081	/>
	25082
	25083	</text>
	25084
	25085	<statusCod e
	25086	code="comp leted"
	25087	/>
	25088
	25089	<effective Time
	25090	value="201 0"
	25091	/>
	25092
	25093	<repeatNum ber
	25094	nullFlavor ="UNK"
	25095	/>
	25096
	25097	<consumabl e>
	25098
	25099	<manufactu redProduct
	25100	classCode= "MANU"
	25101	>
	25102
	25103	<templateI d
	25104	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25105	/>
	25106
	25107	<manufactu redMateria l>
	25108
	25109	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25110
	25111	<code
	25112	code="150"
	25113	codeSystem ="2.16.840 .1.113883. 12.292"
	25114	codeSystem Name="Vacc ine Admini stered (CV X code)"
	25115	>
	25116
	25117	<originalT ext>
	25118
	25119	<reference
	25120	value="#in dImmunizat ion1028"
	25121	/>
	25122
	25123	</original Text>
	25124
	25125
	25126	</code>
	25127
	25128	</manufact uredMateri al>
	25129
	25130	</manufact uredProduc t>
	25131
	25132	</consumab le>
	25133
	25134	<performer >
	25135
	25136	<assignedE ntity>
	25137
	25138	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25139
	25140	<id
	25141	root="2.16 .840.1.113 883.4.349"
	25142	/>
	25143
	25144	<assignedP erson>
	25145
	25146	<!-- CCD P rovider Na me, REQUIR ED -->
	25147
	25148	<name/>
	25149
	25150	</assigned Person>
	25151
	25152	</assigned Entity>
	25153
	25154	</performe r>
	25155
	25156	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25157
	25158	<author>
	25159
	25160	<time
	25161	nullFlavor ="NA"
	25162	/>
	25163
	25164	<assignedA uthor>
	25165
	25166	<id
	25167	nullFlavor ="NA"
	25168	/>
	25169
	25170	<represent edOrganiza tion>
	25171
	25172	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25173	FA CILITY NBR ) -->
	25174
	25175	<id
	25176	extension= "984"
	25177	nullFlavor ="NA"
	25178	/>
	25179
	25180	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25181
	25182	<name>
	25183	DAYTSHR TE ST LAB
	25184	</name>
	25185
	25186	</represen tedOrganiz ation>
	25187
	25188	</assigned Author>
	25189
	25190	</author>
	25191
	25192
	25193	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25194	immuni zations on ly -->
	25195
	25196	</substanc eAdministr ation>
	25197
	25198	</entry>
	25199	<entry
	25200	typeCode=" DRIV"
	25201	>
	25202
	25203	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25204
	25205	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25206
	25207	<substance Administra tion
	25208	classCode= "SBADM"
	25209	moodCode=" EVN"
	25210	negationIn d="false"
	25211	>
	25212
	25213	<templateI d
	25214	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25215	/>
	25216
	25217	<id
	25218	nullFlavor ="NA"
	25219	/>
	25220
	25221	<text>
	25222
	25223	<reference
	25224	value="#in dComments1 029"
	25225	/>
	25226
	25227	</text>
	25228
	25229	<statusCod e
	25230	code="comp leted"
	25231	/>
	25232
	25233	<effective Time
	25234	value="201 0"
	25235	/>
	25236
	25237	<repeatNum ber
	25238	nullFlavor ="UNK"
	25239	/>
	25240
	25241	<consumabl e>
	25242
	25243	<manufactu redProduct
	25244	classCode= "MANU"
	25245	>
	25246
	25247	<templateI d
	25248	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25249	/>
	25250
	25251	<manufactu redMateria l>
	25252
	25253	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25254
	25255	<code
	25256	code="121"
	25257	codeSystem ="2.16.840 .1.113883. 12.292"
	25258	codeSystem Name="Vacc ine Admini stered (CV X code)"
	25259	displayNam e="ZOSTER VACC SC"
	25260	>
	25261
	25262	<originalT ext>
	25263
	25264	<reference
	25265	value="#in dImmunizat ion1029"
	25266	/>
	25267
	25268	</original Text>
	25269
	25270	<translati on
	25271	code="9073 6"
	25272	codeSystem ="2.16.840 .1.113883. 6.12"
	25273	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	25274	displayNam e="ZOSTER VACC SC"
	25275	/>
	25276
	25277	</code>
	25278
	25279	</manufact uredMateri al>
	25280
	25281	</manufact uredProduc t>
	25282
	25283	</consumab le>
	25284
	25285	<performer >
	25286
	25287	<assignedE ntity>
	25288
	25289	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25290
	25291	<id
	25292	root="2.16 .840.1.113 883.4.349"
	25293	/>
	25294
	25295	<assignedP erson>
	25296
	25297	<!-- CCD P rovider Na me, REQUIR ED -->
	25298
	25299	<name/>
	25300
	25301	</assigned Person>
	25302
	25303	</assigned Entity>
	25304
	25305	</performe r>
	25306
	25307	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25308
	25309	<author>
	25310
	25311	<time
	25312	nullFlavor ="NA"
	25313	/>
	25314
	25315	<assignedA uthor>
	25316
	25317	<id
	25318	nullFlavor ="NA"
	25319	/>
	25320
	25321	<represent edOrganiza tion>
	25322
	25323	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25324	FA CILITY NBR ) -->
	25325
	25326	<id
	25327	extension= "984"
	25328	nullFlavor ="NA"
	25329	/>
	25330
	25331	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25332
	25333	<name>
	25334	DAYTSHR TE ST LAB
	25335	</name>
	25336
	25337	</represen tedOrganiz ation>
	25338
	25339	</assigned Author>
	25340
	25341	</author>
	25342
	25343
	25344	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25345	immuni zations on ly -->
	25346
	25347	</substanc eAdministr ation>
	25348
	25349	</entry>
	25350	<entry
	25351	typeCode=" DRIV"
	25352	>
	25353
	25354	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25355
	25356	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25357
	25358	<substance Administra tion
	25359	classCode= "SBADM"
	25360	moodCode=" EVN"
	25361	negationIn d="false"
	25362	>
	25363
	25364	<templateI d
	25365	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25366	/>
	25367
	25368	<id
	25369	nullFlavor ="NA"
	25370	/>
	25371
	25372	<text>
	25373
	25374	<reference
	25375	value="#in dComments1 030"
	25376	/>
	25377
	25378	</text>
	25379
	25380	<statusCod e
	25381	code="comp leted"
	25382	/>
	25383
	25384	<effective Time
	25385	value="200 90124"
	25386	/>
	25387
	25388	<repeatNum ber
	25389	nullFlavor ="UNK"
	25390	/>
	25391
	25392	<consumabl e>
	25393
	25394	<manufactu redProduct
	25395	classCode= "MANU"
	25396	>
	25397
	25398	<templateI d
	25399	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25400	/>
	25401
	25402	<manufactu redMateria l>
	25403
	25404	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25405
	25406	<code
	25407	code="153"
	25408	codeSystem ="2.16.840 .1.113883. 12.292"
	25409	codeSystem Name="Vacc ine Admini stered (CV X code)"
	25410	displayNam e="FLU VAC C CELL CUL T PRSV FRE E"
	25411	>
	25412
	25413	<originalT ext>
	25414
	25415	<reference
	25416	value="#in dImmunizat ion1030"
	25417	/>
	25418
	25419	</original Text>
	25420
	25421	<translati on
	25422	code="9066 1"
	25423	codeSystem ="2.16.840 .1.113883. 6.12"
	25424	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	25425	displayNam e="FLU VAC C CELL CUL T PRSV FRE E"
	25426	/>
	25427
	25428	</code>
	25429
	25430	</manufact uredMateri al>
	25431
	25432	</manufact uredProduc t>
	25433
	25434	</consumab le>
	25435
	25436	<performer >
	25437
	25438	<assignedE ntity>
	25439
	25440	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25441
	25442	<id
	25443	root="2.16 .840.1.113 883.4.349"
	25444	/>
	25445
	25446	<assignedP erson>
	25447
	25448	<!-- CCD P rovider Na me, REQUIR ED -->
	25449
	25450	<name/>
	25451
	25452	</assigned Person>
	25453
	25454	</assigned Entity>
	25455
	25456	</performe r>
	25457
	25458	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25459
	25460	<author>
	25461
	25462	<time
	25463	nullFlavor ="NA"
	25464	/>
	25465
	25466	<assignedA uthor>
	25467
	25468	<id
	25469	nullFlavor ="NA"
	25470	/>
	25471
	25472	<represent edOrganiza tion>
	25473
	25474	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25475	FA CILITY NBR ) -->
	25476
	25477	<id
	25478	extension= "984"
	25479	nullFlavor ="NA"
	25480	/>
	25481
	25482	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25483
	25484	<name>
	25485	DAYTSHR TE ST LAB
	25486	</name>
	25487
	25488	</represen tedOrganiz ation>
	25489
	25490	</assigned Author>
	25491
	25492	</author>
	25493
	25494
	25495	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25496	immuni zations on ly -->
	25497
	25498	</substanc eAdministr ation>
	25499
	25500	</entry>
	25501	<entry
	25502	typeCode=" DRIV"
	25503	>
	25504
	25505	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25506
	25507	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25508
	25509	<substance Administra tion
	25510	classCode= "SBADM"
	25511	moodCode=" EVN"
	25512	negationIn d="false"
	25513	>
	25514
	25515	<templateI d
	25516	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25517	/>
	25518
	25519	<id
	25520	nullFlavor ="NA"
	25521	/>
	25522
	25523	<text>
	25524
	25525	<reference
	25526	value="#in dComments1 031"
	25527	/>
	25528
	25529	</text>
	25530
	25531	<statusCod e
	25532	code="comp leted"
	25533	/>
	25534
	25535	<effective Time
	25536	value="200 901"
	25537	/>
	25538
	25539	<repeatNum ber
	25540	nullFlavor ="UNK"
	25541	/>
	25542
	25543	<consumabl e>
	25544
	25545	<manufactu redProduct
	25546	classCode= "MANU"
	25547	>
	25548
	25549	<templateI d
	25550	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25551	/>
	25552
	25553	<manufactu redMateria l>
	25554
	25555	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25556
	25557	<code
	25558	nullFlavor ="UNK"
	25559	>
	25560
	25561	<originalT ext>
	25562
	25563	<reference
	25564	value="#in dImmunizat ion1031"
	25565	/>
	25566
	25567	</original Text>
	25568
	25569
	25570	</code>
	25571
	25572	</manufact uredMateri al>
	25573
	25574	</manufact uredProduc t>
	25575
	25576	</consumab le>
	25577
	25578	<performer >
	25579
	25580	<assignedE ntity>
	25581
	25582	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25583
	25584	<id
	25585	root="2.16 .840.1.113 883.4.349"
	25586	/>
	25587
	25588	<assignedP erson>
	25589
	25590	<!-- CCD P rovider Na me, REQUIR ED -->
	25591
	25592	<name/>
	25593
	25594	</assigned Person>
	25595
	25596	</assigned Entity>
	25597
	25598	</performe r>
	25599
	25600	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25601
	25602	<author>
	25603
	25604	<time
	25605	nullFlavor ="NA"
	25606	/>
	25607
	25608	<assignedA uthor>
	25609
	25610	<id
	25611	nullFlavor ="NA"
	25612	/>
	25613
	25614	<represent edOrganiza tion>
	25615
	25616	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25617	FA CILITY NBR ) -->
	25618
	25619	<id
	25620	extension= "984"
	25621	nullFlavor ="NA"
	25622	/>
	25623
	25624	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25625
	25626	<name>
	25627	DAYTSHR TE ST LAB
	25628	</name>
	25629
	25630	</represen tedOrganiz ation>
	25631
	25632	</assigned Author>
	25633
	25634	</author>
	25635
	25636
	25637	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25638	immuni zations on ly -->
	25639
	25640	</substanc eAdministr ation>
	25641
	25642	</entry>
	25643	<entry
	25644	typeCode=" DRIV"
	25645	>
	25646
	25647	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25648
	25649	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25650
	25651	<substance Administra tion
	25652	classCode= "SBADM"
	25653	moodCode=" EVN"
	25654	negationIn d="false"
	25655	>
	25656
	25657	<templateI d
	25658	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25659	/>
	25660
	25661	<id
	25662	nullFlavor ="NA"
	25663	/>
	25664
	25665	<text>
	25666
	25667	<reference
	25668	value="#in dComments1 032"
	25669	/>
	25670
	25671	</text>
	25672
	25673	<statusCod e
	25674	code="comp leted"
	25675	/>
	25676
	25677	<effective Time
	25678	value="200 80624"
	25679	/>
	25680
	25681	<repeatNum ber
	25682	nullFlavor ="UNK"
	25683	/>
	25684
	25685	<consumabl e>
	25686
	25687	<manufactu redProduct
	25688	classCode= "MANU"
	25689	>
	25690
	25691	<templateI d
	25692	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25693	/>
	25694
	25695	<manufactu redMateria l>
	25696
	25697	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25698
	25699	<code
	25700	code="121"
	25701	codeSystem ="2.16.840 .1.113883. 12.292"
	25702	codeSystem Name="Vacc ine Admini stered (CV X code)"
	25703	displayNam e="ZOSTER VACC SC"
	25704	>
	25705
	25706	<originalT ext>
	25707
	25708	<reference
	25709	value="#in dImmunizat ion1032"
	25710	/>
	25711
	25712	</original Text>
	25713
	25714	<translati on
	25715	code="9073 6"
	25716	codeSystem ="2.16.840 .1.113883. 6.12"
	25717	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	25718	displayNam e="ZOSTER VACC SC"
	25719	/>
	25720
	25721	</code>
	25722
	25723	</manufact uredMateri al>
	25724
	25725	</manufact uredProduc t>
	25726
	25727	</consumab le>
	25728
	25729	<performer >
	25730
	25731	<assignedE ntity>
	25732
	25733	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25734
	25735	<id
	25736	root="2.16 .840.1.113 883.4.349"
	25737	/>
	25738
	25739	<assignedP erson>
	25740
	25741	<!-- CCD P rovider Na me, REQUIR ED -->
	25742
	25743	<name/>
	25744
	25745	</assigned Person>
	25746
	25747	</assigned Entity>
	25748
	25749	</performe r>
	25750
	25751	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25752
	25753	<author>
	25754
	25755	<time
	25756	nullFlavor ="NA"
	25757	/>
	25758
	25759	<assignedA uthor>
	25760
	25761	<id
	25762	nullFlavor ="NA"
	25763	/>
	25764
	25765	<represent edOrganiza tion>
	25766
	25767	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25768	FA CILITY NBR ) -->
	25769
	25770	<id
	25771	extension= "984"
	25772	nullFlavor ="NA"
	25773	/>
	25774
	25775	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25776
	25777	<name>
	25778	DAYTSHR TE ST LAB
	25779	</name>
	25780
	25781	</represen tedOrganiz ation>
	25782
	25783	</assigned Author>
	25784
	25785	</author>
	25786
	25787
	25788	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25789	immuni zations on ly -->
	25790
	25791	</substanc eAdministr ation>
	25792
	25793	</entry>
	25794	<entry
	25795	typeCode=" DRIV"
	25796	>
	25797
	25798	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25799
	25800	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25801
	25802	<substance Administra tion
	25803	classCode= "SBADM"
	25804	moodCode=" EVN"
	25805	negationIn d="false"
	25806	>
	25807
	25808	<templateI d
	25809	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25810	/>
	25811
	25812	<id
	25813	nullFlavor ="NA"
	25814	/>
	25815
	25816	<text>
	25817
	25818	<reference
	25819	value="#in dComments1 033"
	25820	/>
	25821
	25822	</text>
	25823
	25824	<statusCod e
	25825	code="comp leted"
	25826	/>
	25827
	25828	<effective Time
	25829	value="200 80612"
	25830	/>
	25831
	25832	<repeatNum ber
	25833	nullFlavor ="UNK"
	25834	/>
	25835
	25836	<consumabl e>
	25837
	25838	<manufactu redProduct
	25839	classCode= "MANU"
	25840	>
	25841
	25842	<templateI d
	25843	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25844	/>
	25845
	25846	<manufactu redMateria l>
	25847
	25848	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	25849
	25850	<code
	25851	code="33"
	25852	codeSystem ="2.16.840 .1.113883. 12.292"
	25853	codeSystem Name="Vacc ine Admini stered (CV X code)"
	25854	displayNam e="PNEUMOC OCCAL VACC INE"
	25855	>
	25856
	25857	<originalT ext>
	25858
	25859	<reference
	25860	value="#in dImmunizat ion1033"
	25861	/>
	25862
	25863	</original Text>
	25864
	25865	<translati on
	25866	code="9073 2"
	25867	codeSystem ="2.16.840 .1.113883. 6.12"
	25868	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	25869	displayNam e="PNEUMOC OCCAL VACC INE"
	25870	/>
	25871
	25872	</code>
	25873
	25874	</manufact uredMateri al>
	25875
	25876	</manufact uredProduc t>
	25877
	25878	</consumab le>
	25879
	25880	<performer >
	25881
	25882	<assignedE ntity>
	25883
	25884	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	25885
	25886	<id
	25887	root="2.16 .840.1.113 883.4.349"
	25888	/>
	25889
	25890	<assignedP erson>
	25891
	25892	<!-- CCD P rovider Na me, REQUIR ED -->
	25893
	25894	<name/>
	25895
	25896	</assigned Person>
	25897
	25898	</assigned Entity>
	25899
	25900	</performe r>
	25901
	25902	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	25903
	25904	<author>
	25905
	25906	<time
	25907	nullFlavor ="NA"
	25908	/>
	25909
	25910	<assignedA uthor>
	25911
	25912	<id
	25913	nullFlavor ="NA"
	25914	/>
	25915
	25916	<represent edOrganiza tion>
	25917
	25918	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	25919	FA CILITY NBR ) -->
	25920
	25921	<id
	25922	extension= "984"
	25923	nullFlavor ="NA"
	25924	/>
	25925
	25926	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	25927
	25928	<name>
	25929	DAYTSHR TE ST LAB
	25930	</name>
	25931
	25932	</represen tedOrganiz ation>
	25933
	25934	</assigned Author>
	25935
	25936	</author>
	25937
	25938
	25939	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	25940	immuni zations on ly -->
	25941
	25942	</substanc eAdministr ation>
	25943
	25944	</entry>
	25945	<entry
	25946	typeCode=" DRIV"
	25947	>
	25948
	25949	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	25950
	25951	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	25952
	25953	<substance Administra tion
	25954	classCode= "SBADM"
	25955	moodCode=" EVN"
	25956	negationIn d="false"
	25957	>
	25958
	25959	<templateI d
	25960	root="2.16 .840.1.113 883.10.20. 22.4.52"
	25961	/>
	25962
	25963	<id
	25964	nullFlavor ="NA"
	25965	/>
	25966
	25967	<text>
	25968
	25969	<reference
	25970	value="#in dComments1 034"
	25971	/>
	25972
	25973	</text>
	25974
	25975	<statusCod e
	25976	code="comp leted"
	25977	/>
	25978
	25979	<effective Time
	25980	value="201 80305"
	25981	/>
	25982
	25983	<repeatNum ber
	25984	nullFlavor ="UNK"
	25985	/>
	25986
	25987	<consumabl e>
	25988
	25989	<manufactu redProduct
	25990	classCode= "MANU"
	25991	>
	25992
	25993	<templateI d
	25994	root="2.16 .840.1.113 883.10.20. 22.4.54"
	25995	/>
	25996
	25997	<manufactu redMateria l>
	25998
	25999	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26000
	26001	<code
	26002	code="88"
	26003	codeSystem ="2.16.840 .1.113883. 12.292"
	26004	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26005	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	26006	>
	26007
	26008	<originalT ext>
	26009
	26010	<reference
	26011	value="#in dImmunizat ion1034"
	26012	/>
	26013
	26014	</original Text>
	26015
	26016	<translati on
	26017	code="9072 4"
	26018	codeSystem ="2.16.840 .1.113883. 6.12"
	26019	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26020	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	26021	/>
	26022
	26023	</code>
	26024
	26025	</manufact uredMateri al>
	26026
	26027	</manufact uredProduc t>
	26028
	26029	</consumab le>
	26030
	26031	<performer >
	26032
	26033	<assignedE ntity>
	26034
	26035	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26036
	26037	<id
	26038	root="2.16 .840.1.113 883.4.349"
	26039	/>
	26040
	26041	<assignedP erson>
	26042
	26043	<!-- CCD P rovider Na me, REQUIR ED -->
	26044
	26045	<name/>
	26046
	26047	</assigned Person>
	26048
	26049	</assigned Entity>
	26050
	26051	</performe r>
	26052
	26053	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26054
	26055	<author>
	26056
	26057	<time
	26058	nullFlavor ="NA"
	26059	/>
	26060
	26061	<assignedA uthor>
	26062
	26063	<id
	26064	nullFlavor ="NA"
	26065	/>
	26066
	26067	<represent edOrganiza tion>
	26068
	26069	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26070	FA CILITY NBR ) -->
	26071
	26072	<id
	26073	extension= "983"
	26074	nullFlavor ="NA"
	26075	/>
	26076
	26077	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26078
	26079	<name>
	26080	CHYSHR TES T LAB
	26081	</name>
	26082
	26083	</represen tedOrganiz ation>
	26084
	26085	</assigned Author>
	26086
	26087	</author>
	26088
	26089
	26090	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26091	immuni zations on ly -->
	26092
	26093	</substanc eAdministr ation>
	26094
	26095	</entry>
	26096	<entry
	26097	typeCode=" DRIV"
	26098	>
	26099
	26100	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26101
	26102	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26103
	26104	<substance Administra tion
	26105	classCode= "SBADM"
	26106	moodCode=" EVN"
	26107	negationIn d="false"
	26108	>
	26109
	26110	<templateI d
	26111	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26112	/>
	26113
	26114	<id
	26115	nullFlavor ="NA"
	26116	/>
	26117
	26118	<text>
	26119
	26120	<reference
	26121	value="#in dComments1 035"
	26122	/>
	26123
	26124	</text>
	26125
	26126	<statusCod e
	26127	code="comp leted"
	26128	/>
	26129
	26130	<effective Time
	26131	value="201 70124"
	26132	/>
	26133
	26134	<repeatNum ber
	26135	nullFlavor ="UNK"
	26136	/>
	26137
	26138	<consumabl e>
	26139
	26140	<manufactu redProduct
	26141	classCode= "MANU"
	26142	>
	26143
	26144	<templateI d
	26145	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26146	/>
	26147
	26148	<manufactu redMateria l>
	26149
	26150	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26151
	26152	<code
	26153	code="88"
	26154	codeSystem ="2.16.840 .1.113883. 12.292"
	26155	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26156	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	26157	>
	26158
	26159	<originalT ext>
	26160
	26161	<reference
	26162	value="#in dImmunizat ion1035"
	26163	/>
	26164
	26165	</original Text>
	26166
	26167	<translati on
	26168	code="9072 4"
	26169	codeSystem ="2.16.840 .1.113883. 6.12"
	26170	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26171	displayNam e="INFLUEN ZA IMMUNIZ ATION"
	26172	/>
	26173
	26174	</code>
	26175
	26176	</manufact uredMateri al>
	26177
	26178	</manufact uredProduc t>
	26179
	26180	</consumab le>
	26181
	26182	<performer >
	26183
	26184	<assignedE ntity>
	26185
	26186	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26187
	26188	<id
	26189	root="2.16 .840.1.113 883.4.349"
	26190	/>
	26191
	26192	<assignedP erson>
	26193
	26194	<!-- CCD P rovider Na me, REQUIR ED -->
	26195
	26196	<name/>
	26197
	26198	</assigned Person>
	26199
	26200	</assigned Entity>
	26201
	26202	</performe r>
	26203
	26204	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26205
	26206	<author>
	26207
	26208	<time
	26209	nullFlavor ="NA"
	26210	/>
	26211
	26212	<assignedA uthor>
	26213
	26214	<id
	26215	nullFlavor ="NA"
	26216	/>
	26217
	26218	<represent edOrganiza tion>
	26219
	26220	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26221	FA CILITY NBR ) -->
	26222
	26223	<id
	26224	extension= "983"
	26225	nullFlavor ="NA"
	26226	/>
	26227
	26228	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26229
	26230	<name>
	26231	CHYSHR TES T LAB
	26232	</name>
	26233
	26234	</represen tedOrganiz ation>
	26235
	26236	</assigned Author>
	26237
	26238	</author>
	26239
	26240
	26241	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26242	immuni zations on ly -->
	26243
	26244	</substanc eAdministr ation>
	26245
	26246	</entry>
	26247	<entry
	26248	typeCode=" DRIV"
	26249	>
	26250
	26251	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26252
	26253	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26254
	26255	<substance Administra tion
	26256	classCode= "SBADM"
	26257	moodCode=" EVN"
	26258	negationIn d="false"
	26259	>
	26260
	26261	<templateI d
	26262	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26263	/>
	26264
	26265	<id
	26266	nullFlavor ="NA"
	26267	/>
	26268
	26269	<text>
	26270
	26271	<reference
	26272	value="#in dComments1 036"
	26273	/>
	26274
	26275	</text>
	26276
	26277	<statusCod e
	26278	code="comp leted"
	26279	/>
	26280
	26281	<effective Time
	26282	value="201 61201"
	26283	/>
	26284
	26285	<repeatNum ber
	26286	nullFlavor ="UNK"
	26287	/>
	26288
	26289	<consumabl e>
	26290
	26291	<manufactu redProduct
	26292	classCode= "MANU"
	26293	>
	26294
	26295	<templateI d
	26296	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26297	/>
	26298
	26299	<manufactu redMateria l>
	26300
	26301	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26302
	26303	<code
	26304	code="143"
	26305	codeSystem ="2.16.840 .1.113883. 12.292"
	26306	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26307	>
	26308
	26309	<originalT ext>
	26310
	26311	<reference
	26312	value="#in dImmunizat ion1036"
	26313	/>
	26314
	26315	</original Text>
	26316
	26317
	26318	</code>
	26319
	26320	</manufact uredMateri al>
	26321
	26322	</manufact uredProduc t>
	26323
	26324	</consumab le>
	26325
	26326	<performer >
	26327
	26328	<assignedE ntity>
	26329
	26330	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26331
	26332	<id
	26333	root="2.16 .840.1.113 883.4.349"
	26334	/>
	26335
	26336	<assignedP erson>
	26337
	26338	<!-- CCD P rovider Na me, REQUIR ED -->
	26339
	26340	<name/>
	26341
	26342	</assigned Person>
	26343
	26344	</assigned Entity>
	26345
	26346	</performe r>
	26347
	26348	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26349
	26350	<author>
	26351
	26352	<time
	26353	nullFlavor ="NA"
	26354	/>
	26355
	26356	<assignedA uthor>
	26357
	26358	<id
	26359	nullFlavor ="NA"
	26360	/>
	26361
	26362	<represent edOrganiza tion>
	26363
	26364	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26365	FA CILITY NBR ) -->
	26366
	26367	<id
	26368	extension= "442"
	26369	nullFlavor ="NA"
	26370	/>
	26371
	26372	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26373
	26374	<name>
	26375	CHEYENNE V AMC
	26376	</name>
	26377
	26378	</represen tedOrganiz ation>
	26379
	26380	</assigned Author>
	26381
	26382	</author>
	26383
	26384
	26385	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26386	immuni zations on ly -->
	26387
	26388	</substanc eAdministr ation>
	26389
	26390	</entry>
	26391	<entry
	26392	typeCode=" DRIV"
	26393	>
	26394
	26395	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26396
	26397	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26398
	26399	<substance Administra tion
	26400	classCode= "SBADM"
	26401	moodCode=" EVN"
	26402	negationIn d="false"
	26403	>
	26404
	26405	<templateI d
	26406	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26407	/>
	26408
	26409	<id
	26410	nullFlavor ="NA"
	26411	/>
	26412
	26413	<text>
	26414
	26415	<reference
	26416	value="#in dComments1 037"
	26417	/>
	26418
	26419	</text>
	26420
	26421	<statusCod e
	26422	code="comp leted"
	26423	/>
	26424
	26425	<effective Time
	26426	value="201 61130"
	26427	/>
	26428
	26429	<repeatNum ber
	26430	nullFlavor ="UNK"
	26431	/>
	26432
	26433	<consumabl e>
	26434
	26435	<manufactu redProduct
	26436	classCode= "MANU"
	26437	>
	26438
	26439	<templateI d
	26440	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26441	/>
	26442
	26443	<manufactu redMateria l>
	26444
	26445	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26446
	26447	<code
	26448	code="155"
	26449	codeSystem ="2.16.840 .1.113883. 12.292"
	26450	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26451	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26452	>
	26453
	26454	<originalT ext>
	26455
	26456	<reference
	26457	value="#in dImmunizat ion1037"
	26458	/>
	26459
	26460	</original Text>
	26461
	26462	<translati on
	26463	code="9067 3"
	26464	codeSystem ="2.16.840 .1.113883. 6.12"
	26465	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26466	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26467	/>
	26468
	26469	</code>
	26470
	26471	</manufact uredMateri al>
	26472
	26473	</manufact uredProduc t>
	26474
	26475	</consumab le>
	26476
	26477	<performer >
	26478
	26479	<assignedE ntity>
	26480
	26481	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26482
	26483	<id
	26484	root="2.16 .840.1.113 883.4.349"
	26485	/>
	26486
	26487	<assignedP erson>
	26488
	26489	<!-- CCD P rovider Na me, REQUIR ED -->
	26490
	26491	<name/>
	26492
	26493	</assigned Person>
	26494
	26495	</assigned Entity>
	26496
	26497	</performe r>
	26498
	26499	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26500
	26501	<author>
	26502
	26503	<time
	26504	nullFlavor ="NA"
	26505	/>
	26506
	26507	<assignedA uthor>
	26508
	26509	<id
	26510	nullFlavor ="NA"
	26511	/>
	26512
	26513	<represent edOrganiza tion>
	26514
	26515	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26516	FA CILITY NBR ) -->
	26517
	26518	<id
	26519	extension= "983"
	26520	nullFlavor ="NA"
	26521	/>
	26522
	26523	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26524
	26525	<name>
	26526	CHYSHR TES T LAB
	26527	</name>
	26528
	26529	</represen tedOrganiz ation>
	26530
	26531	</assigned Author>
	26532
	26533	</author>
	26534
	26535
	26536	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26537	immuni zations on ly -->
	26538
	26539	</substanc eAdministr ation>
	26540
	26541	</entry>
	26542	<entry
	26543	typeCode=" DRIV"
	26544	>
	26545
	26546	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26547
	26548	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26549
	26550	<substance Administra tion
	26551	classCode= "SBADM"
	26552	moodCode=" EVN"
	26553	negationIn d="false"
	26554	>
	26555
	26556	<templateI d
	26557	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26558	/>
	26559
	26560	<id
	26561	nullFlavor ="NA"
	26562	/>
	26563
	26564	<text>
	26565
	26566	<reference
	26567	value="#in dComments1 038"
	26568	/>
	26569
	26570	</text>
	26571
	26572	<statusCod e
	26573	code="comp leted"
	26574	/>
	26575
	26576	<effective Time
	26577	value="201 61129"
	26578	/>
	26579
	26580	<repeatNum ber
	26581	nullFlavor ="UNK"
	26582	/>
	26583
	26584	<consumabl e>
	26585
	26586	<manufactu redProduct
	26587	classCode= "MANU"
	26588	>
	26589
	26590	<templateI d
	26591	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26592	/>
	26593
	26594	<manufactu redMateria l>
	26595
	26596	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26597
	26598	<code
	26599	code="155"
	26600	codeSystem ="2.16.840 .1.113883. 12.292"
	26601	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26602	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26603	>
	26604
	26605	<originalT ext>
	26606
	26607	<reference
	26608	value="#in dImmunizat ion1038"
	26609	/>
	26610
	26611	</original Text>
	26612
	26613	<translati on
	26614	code="9067 3"
	26615	codeSystem ="2.16.840 .1.113883. 6.12"
	26616	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26617	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26618	/>
	26619
	26620	</code>
	26621
	26622	</manufact uredMateri al>
	26623
	26624	</manufact uredProduc t>
	26625
	26626	</consumab le>
	26627
	26628	<performer >
	26629
	26630	<assignedE ntity>
	26631
	26632	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26633
	26634	<id
	26635	root="2.16 .840.1.113 883.4.349"
	26636	/>
	26637
	26638	<assignedP erson>
	26639
	26640	<!-- CCD P rovider Na me, REQUIR ED -->
	26641
	26642	<name/>
	26643
	26644	</assigned Person>
	26645
	26646	</assigned Entity>
	26647
	26648	</performe r>
	26649
	26650	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26651
	26652	<author>
	26653
	26654	<time
	26655	nullFlavor ="NA"
	26656	/>
	26657
	26658	<assignedA uthor>
	26659
	26660	<id
	26661	nullFlavor ="NA"
	26662	/>
	26663
	26664	<represent edOrganiza tion>
	26665
	26666	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26667	FA CILITY NBR ) -->
	26668
	26669	<id
	26670	extension= "983"
	26671	nullFlavor ="NA"
	26672	/>
	26673
	26674	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26675
	26676	<name>
	26677	CHYSHR TES T LAB
	26678	</name>
	26679
	26680	</represen tedOrganiz ation>
	26681
	26682	</assigned Author>
	26683
	26684	</author>
	26685
	26686
	26687	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26688	immuni zations on ly -->
	26689
	26690	</substanc eAdministr ation>
	26691
	26692	</entry>
	26693	<entry
	26694	typeCode=" DRIV"
	26695	>
	26696
	26697	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26698
	26699	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26700
	26701	<substance Administra tion
	26702	classCode= "SBADM"
	26703	moodCode=" EVN"
	26704	negationIn d="false"
	26705	>
	26706
	26707	<templateI d
	26708	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26709	/>
	26710
	26711	<id
	26712	nullFlavor ="NA"
	26713	/>
	26714
	26715	<text>
	26716
	26717	<reference
	26718	value="#in dComments1 039"
	26719	/>
	26720
	26721	</text>
	26722
	26723	<statusCod e
	26724	code="comp leted"
	26725	/>
	26726
	26727	<effective Time
	26728	value="201 61125"
	26729	/>
	26730
	26731	<repeatNum ber
	26732	nullFlavor ="UNK"
	26733	/>
	26734
	26735	<consumabl e>
	26736
	26737	<manufactu redProduct
	26738	classCode= "MANU"
	26739	>
	26740
	26741	<templateI d
	26742	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26743	/>
	26744
	26745	<manufactu redMateria l>
	26746
	26747	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26748
	26749	<code
	26750	code="155"
	26751	codeSystem ="2.16.840 .1.113883. 12.292"
	26752	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26753	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26754	>
	26755
	26756	<originalT ext>
	26757
	26758	<reference
	26759	value="#in dImmunizat ion1039"
	26760	/>
	26761
	26762	</original Text>
	26763
	26764	<translati on
	26765	code="9067 3"
	26766	codeSystem ="2.16.840 .1.113883. 6.12"
	26767	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26768	displayNam e="FLU VAC C RIV3 NO PRESERV"
	26769	/>
	26770
	26771	</code>
	26772
	26773	</manufact uredMateri al>
	26774
	26775	</manufact uredProduc t>
	26776
	26777	</consumab le>
	26778
	26779	<performer >
	26780
	26781	<assignedE ntity>
	26782
	26783	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26784
	26785	<id
	26786	root="2.16 .840.1.113 883.4.349"
	26787	/>
	26788
	26789	<assignedP erson>
	26790
	26791	<!-- CCD P rovider Na me, REQUIR ED -->
	26792
	26793	<name/>
	26794
	26795	</assigned Person>
	26796
	26797	</assigned Entity>
	26798
	26799	</performe r>
	26800
	26801	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26802
	26803	<author>
	26804
	26805	<time
	26806	nullFlavor ="NA"
	26807	/>
	26808
	26809	<assignedA uthor>
	26810
	26811	<id
	26812	nullFlavor ="NA"
	26813	/>
	26814
	26815	<represent edOrganiza tion>
	26816
	26817	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26818	FA CILITY NBR ) -->
	26819
	26820	<id
	26821	extension= "983"
	26822	nullFlavor ="NA"
	26823	/>
	26824
	26825	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26826
	26827	<name>
	26828	CHYSHR TES T LAB
	26829	</name>
	26830
	26831	</represen tedOrganiz ation>
	26832
	26833	</assigned Author>
	26834
	26835	</author>
	26836
	26837
	26838	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26839	immuni zations on ly -->
	26840
	26841	</substanc eAdministr ation>
	26842
	26843	</entry>
	26844	<entry
	26845	typeCode=" DRIV"
	26846	>
	26847
	26848	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	26849
	26850	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	26851
	26852	<substance Administra tion
	26853	classCode= "SBADM"
	26854	moodCode=" EVN"
	26855	negationIn d="false"
	26856	>
	26857
	26858	<templateI d
	26859	root="2.16 .840.1.113 883.10.20. 22.4.52"
	26860	/>
	26861
	26862	<id
	26863	nullFlavor ="NA"
	26864	/>
	26865
	26866	<text>
	26867
	26868	<reference
	26869	value="#in dComments1 040"
	26870	/>
	26871
	26872	</text>
	26873
	26874	<statusCod e
	26875	code="comp leted"
	26876	/>
	26877
	26878	<effective Time
	26879	value="201 61125"
	26880	/>
	26881
	26882	<repeatNum ber
	26883	nullFlavor ="UNK"
	26884	/>
	26885
	26886	<consumabl e>
	26887
	26888	<manufactu redProduct
	26889	classCode= "MANU"
	26890	>
	26891
	26892	<templateI d
	26893	root="2.16 .840.1.113 883.10.20. 22.4.54"
	26894	/>
	26895
	26896	<manufactu redMateria l>
	26897
	26898	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	26899
	26900	<code
	26901	code="133"
	26902	codeSystem ="2.16.840 .1.113883. 12.292"
	26903	codeSystem Name="Vacc ine Admini stered (CV X code)"
	26904	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	26905	>
	26906
	26907	<originalT ext>
	26908
	26909	<reference
	26910	value="#in dImmunizat ion1040"
	26911	/>
	26912
	26913	</original Text>
	26914
	26915	<translati on
	26916	code="9067 0"
	26917	codeSystem ="2.16.840 .1.113883. 6.12"
	26918	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	26919	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	26920	/>
	26921
	26922	</code>
	26923
	26924	</manufact uredMateri al>
	26925
	26926	</manufact uredProduc t>
	26927
	26928	</consumab le>
	26929
	26930	<performer >
	26931
	26932	<assignedE ntity>
	26933
	26934	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	26935
	26936	<id
	26937	root="2.16 .840.1.113 883.4.349"
	26938	/>
	26939
	26940	<assignedP erson>
	26941
	26942	<!-- CCD P rovider Na me, REQUIR ED -->
	26943
	26944	<name/>
	26945
	26946	</assigned Person>
	26947
	26948	</assigned Entity>
	26949
	26950	</performe r>
	26951
	26952	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	26953
	26954	<author>
	26955
	26956	<time
	26957	nullFlavor ="NA"
	26958	/>
	26959
	26960	<assignedA uthor>
	26961
	26962	<id
	26963	nullFlavor ="NA"
	26964	/>
	26965
	26966	<represent edOrganiza tion>
	26967
	26968	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	26969	FA CILITY NBR ) -->
	26970
	26971	<id
	26972	extension= "983"
	26973	nullFlavor ="NA"
	26974	/>
	26975
	26976	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	26977
	26978	<name>
	26979	CHYSHR TES T LAB
	26980	</name>
	26981
	26982	</represen tedOrganiz ation>
	26983
	26984	</assigned Author>
	26985
	26986	</author>
	26987
	26988
	26989	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	26990	immuni zations on ly -->
	26991
	26992	</substanc eAdministr ation>
	26993
	26994	</entry>
	26995	<entry
	26996	typeCode=" DRIV"
	26997	>
	26998
	26999	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27000
	27001	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27002
	27003	<substance Administra tion
	27004	classCode= "SBADM"
	27005	moodCode=" EVN"
	27006	negationIn d="false"
	27007	>
	27008
	27009	<templateI d
	27010	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27011	/>
	27012
	27013	<id
	27014	nullFlavor ="NA"
	27015	/>
	27016
	27017	<text>
	27018
	27019	<reference
	27020	value="#in dComments1 041"
	27021	/>
	27022
	27023	</text>
	27024
	27025	<statusCod e
	27026	code="comp leted"
	27027	/>
	27028
	27029	<effective Time
	27030	value="201 60925"
	27031	/>
	27032
	27033	<repeatNum ber
	27034	nullFlavor ="UNK"
	27035	/>
	27036
	27037	<consumabl e>
	27038
	27039	<manufactu redProduct
	27040	classCode= "MANU"
	27041	>
	27042
	27043	<templateI d
	27044	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27045	/>
	27046
	27047	<manufactu redMateria l>
	27048
	27049	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27050
	27051	<code
	27052	code="155"
	27053	codeSystem ="2.16.840 .1.113883. 12.292"
	27054	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27055	displayNam e="FLU VAC C RIV3 NO PRESERV"
	27056	>
	27057
	27058	<originalT ext>
	27059
	27060	<reference
	27061	value="#in dImmunizat ion1041"
	27062	/>
	27063
	27064	</original Text>
	27065
	27066	<translati on
	27067	code="9067 3"
	27068	codeSystem ="2.16.840 .1.113883. 6.12"
	27069	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27070	displayNam e="FLU VAC C RIV3 NO PRESERV"
	27071	/>
	27072
	27073	</code>
	27074
	27075	</manufact uredMateri al>
	27076
	27077	</manufact uredProduc t>
	27078
	27079	</consumab le>
	27080
	27081	<performer >
	27082
	27083	<assignedE ntity>
	27084
	27085	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27086
	27087	<id
	27088	root="2.16 .840.1.113 883.4.349"
	27089	/>
	27090
	27091	<assignedP erson>
	27092
	27093	<!-- CCD P rovider Na me, REQUIR ED -->
	27094
	27095	<name/>
	27096
	27097	</assigned Person>
	27098
	27099	</assigned Entity>
	27100
	27101	</performe r>
	27102
	27103	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27104
	27105	<author>
	27106
	27107	<time
	27108	nullFlavor ="NA"
	27109	/>
	27110
	27111	<assignedA uthor>
	27112
	27113	<id
	27114	nullFlavor ="NA"
	27115	/>
	27116
	27117	<represent edOrganiza tion>
	27118
	27119	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27120	FA CILITY NBR ) -->
	27121
	27122	<id
	27123	extension= "983"
	27124	nullFlavor ="NA"
	27125	/>
	27126
	27127	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27128
	27129	<name>
	27130	CHYSHR TES T LAB
	27131	</name>
	27132
	27133	</represen tedOrganiz ation>
	27134
	27135	</assigned Author>
	27136
	27137	</author>
	27138
	27139
	27140	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27141	immuni zations on ly -->
	27142
	27143	</substanc eAdministr ation>
	27144
	27145	</entry>
	27146	<entry
	27147	typeCode=" DRIV"
	27148	>
	27149
	27150	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27151
	27152	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27153
	27154	<substance Administra tion
	27155	classCode= "SBADM"
	27156	moodCode=" EVN"
	27157	negationIn d="false"
	27158	>
	27159
	27160	<templateI d
	27161	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27162	/>
	27163
	27164	<id
	27165	nullFlavor ="NA"
	27166	/>
	27167
	27168	<text>
	27169
	27170	<reference
	27171	value="#in dComments1 042"
	27172	/>
	27173
	27174	</text>
	27175
	27176	<statusCod e
	27177	code="comp leted"
	27178	/>
	27179
	27180	<effective Time
	27181	value="201 50601"
	27182	/>
	27183
	27184	<repeatNum ber
	27185	nullFlavor ="UNK"
	27186	/>
	27187
	27188	<consumabl e>
	27189
	27190	<manufactu redProduct
	27191	classCode= "MANU"
	27192	>
	27193
	27194	<templateI d
	27195	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27196	/>
	27197
	27198	<manufactu redMateria l>
	27199
	27200	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27201
	27202	<code
	27203	code="133"
	27204	codeSystem ="2.16.840 .1.113883. 12.292"
	27205	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27206	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	27207	>
	27208
	27209	<originalT ext>
	27210
	27211	<reference
	27212	value="#in dImmunizat ion1042"
	27213	/>
	27214
	27215	</original Text>
	27216
	27217	<translati on
	27218	code="9067 0"
	27219	codeSystem ="2.16.840 .1.113883. 6.12"
	27220	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27221	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	27222	/>
	27223
	27224	</code>
	27225
	27226	</manufact uredMateri al>
	27227
	27228	</manufact uredProduc t>
	27229
	27230	</consumab le>
	27231
	27232	<performer >
	27233
	27234	<assignedE ntity>
	27235
	27236	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27237
	27238	<id
	27239	root="2.16 .840.1.113 883.4.349"
	27240	/>
	27241
	27242	<assignedP erson>
	27243
	27244	<!-- CCD P rovider Na me, REQUIR ED -->
	27245
	27246	<name/>
	27247
	27248	</assigned Person>
	27249
	27250	</assigned Entity>
	27251
	27252	</performe r>
	27253
	27254	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27255
	27256	<author>
	27257
	27258	<time
	27259	nullFlavor ="NA"
	27260	/>
	27261
	27262	<assignedA uthor>
	27263
	27264	<id
	27265	nullFlavor ="NA"
	27266	/>
	27267
	27268	<represent edOrganiza tion>
	27269
	27270	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27271	FA CILITY NBR ) -->
	27272
	27273	<id
	27274	extension= "983"
	27275	nullFlavor ="NA"
	27276	/>
	27277
	27278	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27279
	27280	<name>
	27281	CHYSHR TES T LAB
	27282	</name>
	27283
	27284	</represen tedOrganiz ation>
	27285
	27286	</assigned Author>
	27287
	27288	</author>
	27289
	27290
	27291	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27292	immuni zations on ly -->
	27293
	27294	</substanc eAdministr ation>
	27295
	27296	</entry>
	27297	<entry
	27298	typeCode=" DRIV"
	27299	>
	27300
	27301	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27302
	27303	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27304
	27305	<substance Administra tion
	27306	classCode= "SBADM"
	27307	moodCode=" EVN"
	27308	negationIn d="false"
	27309	>
	27310
	27311	<templateI d
	27312	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27313	/>
	27314
	27315	<id
	27316	nullFlavor ="NA"
	27317	/>
	27318
	27319	<text>
	27320
	27321	<reference
	27322	value="#in dComments1 043"
	27323	/>
	27324
	27325	</text>
	27326
	27327	<statusCod e
	27328	code="comp leted"
	27329	/>
	27330
	27331	<effective Time
	27332	value="201 50307"
	27333	/>
	27334
	27335	<repeatNum ber
	27336	nullFlavor ="UNK"
	27337	/>
	27338
	27339	<consumabl e>
	27340
	27341	<manufactu redProduct
	27342	classCode= "MANU"
	27343	>
	27344
	27345	<templateI d
	27346	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27347	/>
	27348
	27349	<manufactu redMateria l>
	27350
	27351	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27352
	27353	<code
	27354	code="158"
	27355	codeSystem ="2.16.840 .1.113883. 12.292"
	27356	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27357	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	27358	>
	27359
	27360	<originalT ext>
	27361
	27362	<reference
	27363	value="#in dImmunizat ion1043"
	27364	/>
	27365
	27366	</original Text>
	27367
	27368	<translati on
	27369	code="9068 8"
	27370	codeSystem ="2.16.840 .1.113883. 6.12"
	27371	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27372	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	27373	/>
	27374
	27375	</code>
	27376
	27377	</manufact uredMateri al>
	27378
	27379	</manufact uredProduc t>
	27380
	27381	</consumab le>
	27382
	27383	<performer >
	27384
	27385	<assignedE ntity>
	27386
	27387	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27388
	27389	<id
	27390	root="2.16 .840.1.113 883.4.349"
	27391	/>
	27392
	27393	<assignedP erson>
	27394
	27395	<!-- CCD P rovider Na me, REQUIR ED -->
	27396
	27397	<name/>
	27398
	27399	</assigned Person>
	27400
	27401	</assigned Entity>
	27402
	27403	</performe r>
	27404
	27405	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27406
	27407	<author>
	27408
	27409	<time
	27410	nullFlavor ="NA"
	27411	/>
	27412
	27413	<assignedA uthor>
	27414
	27415	<id
	27416	nullFlavor ="NA"
	27417	/>
	27418
	27419	<represent edOrganiza tion>
	27420
	27421	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27422	FA CILITY NBR ) -->
	27423
	27424	<id
	27425	extension= "983"
	27426	nullFlavor ="NA"
	27427	/>
	27428
	27429	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27430
	27431	<name>
	27432	CHYSHR TES T LAB
	27433	</name>
	27434
	27435	</represen tedOrganiz ation>
	27436
	27437	</assigned Author>
	27438
	27439	</author>
	27440
	27441
	27442	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27443	immuni zations on ly -->
	27444
	27445	</substanc eAdministr ation>
	27446
	27447	</entry>
	27448	<entry
	27449	typeCode=" DRIV"
	27450	>
	27451
	27452	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27453
	27454	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27455
	27456	<substance Administra tion
	27457	classCode= "SBADM"
	27458	moodCode=" EVN"
	27459	negationIn d="false"
	27460	>
	27461
	27462	<templateI d
	27463	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27464	/>
	27465
	27466	<id
	27467	nullFlavor ="NA"
	27468	/>
	27469
	27470	<text>
	27471
	27472	<reference
	27473	value="#in dComments1 044"
	27474	/>
	27475
	27476	</text>
	27477
	27478	<statusCod e
	27479	code="comp leted"
	27480	/>
	27481
	27482	<effective Time
	27483	value="201 50215"
	27484	/>
	27485
	27486	<repeatNum ber
	27487	nullFlavor ="UNK"
	27488	/>
	27489
	27490	<consumabl e>
	27491
	27492	<manufactu redProduct
	27493	classCode= "MANU"
	27494	>
	27495
	27496	<templateI d
	27497	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27498	/>
	27499
	27500	<manufactu redMateria l>
	27501
	27502	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27503
	27504	<code
	27505	code="121"
	27506	codeSystem ="2.16.840 .1.113883. 12.292"
	27507	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27508	displayNam e="ZOSTER VACC SC"
	27509	>
	27510
	27511	<originalT ext>
	27512
	27513	<reference
	27514	value="#in dImmunizat ion1044"
	27515	/>
	27516
	27517	</original Text>
	27518
	27519	<translati on
	27520	code="9073 6"
	27521	codeSystem ="2.16.840 .1.113883. 6.12"
	27522	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27523	displayNam e="ZOSTER VACC SC"
	27524	/>
	27525
	27526	</code>
	27527
	27528	</manufact uredMateri al>
	27529
	27530	</manufact uredProduc t>
	27531
	27532	</consumab le>
	27533
	27534	<performer >
	27535
	27536	<assignedE ntity>
	27537
	27538	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27539
	27540	<id
	27541	root="2.16 .840.1.113 883.4.349"
	27542	/>
	27543
	27544	<assignedP erson>
	27545
	27546	<!-- CCD P rovider Na me, REQUIR ED -->
	27547
	27548	<name/>
	27549
	27550	</assigned Person>
	27551
	27552	</assigned Entity>
	27553
	27554	</performe r>
	27555
	27556	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27557
	27558	<author>
	27559
	27560	<time
	27561	nullFlavor ="NA"
	27562	/>
	27563
	27564	<assignedA uthor>
	27565
	27566	<id
	27567	nullFlavor ="NA"
	27568	/>
	27569
	27570	<represent edOrganiza tion>
	27571
	27572	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27573	FA CILITY NBR ) -->
	27574
	27575	<id
	27576	extension= "983"
	27577	nullFlavor ="NA"
	27578	/>
	27579
	27580	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27581
	27582	<name>
	27583	CHYSHR TES T LAB
	27584	</name>
	27585
	27586	</represen tedOrganiz ation>
	27587
	27588	</assigned Author>
	27589
	27590	</author>
	27591
	27592
	27593	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27594	immuni zations on ly -->
	27595
	27596	</substanc eAdministr ation>
	27597
	27598	</entry>
	27599	<entry
	27600	typeCode=" DRIV"
	27601	>
	27602
	27603	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27604
	27605	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27606
	27607	<substance Administra tion
	27608	classCode= "SBADM"
	27609	moodCode=" EVN"
	27610	negationIn d="false"
	27611	>
	27612
	27613	<templateI d
	27614	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27615	/>
	27616
	27617	<id
	27618	nullFlavor ="NA"
	27619	/>
	27620
	27621	<text>
	27622
	27623	<reference
	27624	value="#in dComments1 045"
	27625	/>
	27626
	27627	</text>
	27628
	27629	<statusCod e
	27630	code="comp leted"
	27631	/>
	27632
	27633	<effective Time
	27634	value="201 50203"
	27635	/>
	27636
	27637	<repeatNum ber
	27638	nullFlavor ="UNK"
	27639	/>
	27640
	27641	<consumabl e>
	27642
	27643	<manufactu redProduct
	27644	classCode= "MANU"
	27645	>
	27646
	27647	<templateI d
	27648	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27649	/>
	27650
	27651	<manufactu redMateria l>
	27652
	27653	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27654
	27655	<code
	27656	code="158"
	27657	codeSystem ="2.16.840 .1.113883. 12.292"
	27658	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27659	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	27660	>
	27661
	27662	<originalT ext>
	27663
	27664	<reference
	27665	value="#in dImmunizat ion1045"
	27666	/>
	27667
	27668	</original Text>
	27669
	27670	<translati on
	27671	code="9068 8"
	27672	codeSystem ="2.16.840 .1.113883. 6.12"
	27673	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27674	displayNam e="FLU VAC C 4 VAL 3 YRS PLUS I M"
	27675	/>
	27676
	27677	</code>
	27678
	27679	</manufact uredMateri al>
	27680
	27681	</manufact uredProduc t>
	27682
	27683	</consumab le>
	27684
	27685	<performer >
	27686
	27687	<assignedE ntity>
	27688
	27689	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27690
	27691	<id
	27692	root="2.16 .840.1.113 883.4.349"
	27693	/>
	27694
	27695	<assignedP erson>
	27696
	27697	<!-- CCD P rovider Na me, REQUIR ED -->
	27698
	27699	<name/>
	27700
	27701	</assigned Person>
	27702
	27703	</assigned Entity>
	27704
	27705	</performe r>
	27706
	27707	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27708
	27709	<author>
	27710
	27711	<time
	27712	nullFlavor ="NA"
	27713	/>
	27714
	27715	<assignedA uthor>
	27716
	27717	<id
	27718	nullFlavor ="NA"
	27719	/>
	27720
	27721	<represent edOrganiza tion>
	27722
	27723	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27724	FA CILITY NBR ) -->
	27725
	27726	<id
	27727	extension= "983"
	27728	nullFlavor ="NA"
	27729	/>
	27730
	27731	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27732
	27733	<name>
	27734	CHYSHR TES T LAB
	27735	</name>
	27736
	27737	</represen tedOrganiz ation>
	27738
	27739	</assigned Author>
	27740
	27741	</author>
	27742
	27743
	27744	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27745	immuni zations on ly -->
	27746
	27747	</substanc eAdministr ation>
	27748
	27749	</entry>
	27750	<entry
	27751	typeCode=" DRIV"
	27752	>
	27753
	27754	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27755
	27756	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27757
	27758	<substance Administra tion
	27759	classCode= "SBADM"
	27760	moodCode=" EVN"
	27761	negationIn d="false"
	27762	>
	27763
	27764	<templateI d
	27765	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27766	/>
	27767
	27768	<id
	27769	nullFlavor ="NA"
	27770	/>
	27771
	27772	<text>
	27773
	27774	<reference
	27775	value="#in dComments1 046"
	27776	/>
	27777
	27778	</text>
	27779
	27780	<statusCod e
	27781	code="comp leted"
	27782	/>
	27783
	27784	<effective Time
	27785	value="201 50202"
	27786	/>
	27787
	27788	<repeatNum ber
	27789	nullFlavor ="UNK"
	27790	/>
	27791
	27792	<consumabl e>
	27793
	27794	<manufactu redProduct
	27795	classCode= "MANU"
	27796	>
	27797
	27798	<templateI d
	27799	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27800	/>
	27801
	27802	<manufactu redMateria l>
	27803
	27804	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27805
	27806	<code
	27807	code="155"
	27808	codeSystem ="2.16.840 .1.113883. 12.292"
	27809	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27810	displayNam e="FLU VAC C RIV3 NO PRESERV"
	27811	>
	27812
	27813	<originalT ext>
	27814
	27815	<reference
	27816	value="#in dImmunizat ion1046"
	27817	/>
	27818
	27819	</original Text>
	27820
	27821	<translati on
	27822	code="9067 3"
	27823	codeSystem ="2.16.840 .1.113883. 6.12"
	27824	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27825	displayNam e="FLU VAC C RIV3 NO PRESERV"
	27826	/>
	27827
	27828	</code>
	27829
	27830	</manufact uredMateri al>
	27831
	27832	</manufact uredProduc t>
	27833
	27834	</consumab le>
	27835
	27836	<performer >
	27837
	27838	<assignedE ntity>
	27839
	27840	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27841
	27842	<id
	27843	root="2.16 .840.1.113 883.4.349"
	27844	/>
	27845
	27846	<assignedP erson>
	27847
	27848	<!-- CCD P rovider Na me, REQUIR ED -->
	27849
	27850	<name/>
	27851
	27852	</assigned Person>
	27853
	27854	</assigned Entity>
	27855
	27856	</performe r>
	27857
	27858	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	27859
	27860	<author>
	27861
	27862	<time
	27863	nullFlavor ="NA"
	27864	/>
	27865
	27866	<assignedA uthor>
	27867
	27868	<id
	27869	nullFlavor ="NA"
	27870	/>
	27871
	27872	<represent edOrganiza tion>
	27873
	27874	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	27875	FA CILITY NBR ) -->
	27876
	27877	<id
	27878	extension= "983"
	27879	nullFlavor ="NA"
	27880	/>
	27881
	27882	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	27883
	27884	<name>
	27885	CHYSHR TES T LAB
	27886	</name>
	27887
	27888	</represen tedOrganiz ation>
	27889
	27890	</assigned Author>
	27891
	27892	</author>
	27893
	27894
	27895	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	27896	immuni zations on ly -->
	27897
	27898	</substanc eAdministr ation>
	27899
	27900	</entry>
	27901	<entry
	27902	typeCode=" DRIV"
	27903	>
	27904
	27905	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	27906
	27907	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	27908
	27909	<substance Administra tion
	27910	classCode= "SBADM"
	27911	moodCode=" EVN"
	27912	negationIn d="false"
	27913	>
	27914
	27915	<templateI d
	27916	root="2.16 .840.1.113 883.10.20. 22.4.52"
	27917	/>
	27918
	27919	<id
	27920	nullFlavor ="NA"
	27921	/>
	27922
	27923	<text>
	27924
	27925	<reference
	27926	value="#in dComments1 047"
	27927	/>
	27928
	27929	</text>
	27930
	27931	<statusCod e
	27932	code="comp leted"
	27933	/>
	27934
	27935	<effective Time
	27936	value="201 50201"
	27937	/>
	27938
	27939	<repeatNum ber
	27940	nullFlavor ="UNK"
	27941	/>
	27942
	27943	<consumabl e>
	27944
	27945	<manufactu redProduct
	27946	classCode= "MANU"
	27947	>
	27948
	27949	<templateI d
	27950	root="2.16 .840.1.113 883.10.20. 22.4.54"
	27951	/>
	27952
	27953	<manufactu redMateria l>
	27954
	27955	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	27956
	27957	<code
	27958	code="149"
	27959	codeSystem ="2.16.840 .1.113883. 12.292"
	27960	codeSystem Name="Vacc ine Admini stered (CV X code)"
	27961	displayNam e="FLU VAC CINE 4 VAL ENT NASAL"
	27962	>
	27963
	27964	<originalT ext>
	27965
	27966	<reference
	27967	value="#in dImmunizat ion1047"
	27968	/>
	27969
	27970	</original Text>
	27971
	27972	<translati on
	27973	code="9067 2"
	27974	codeSystem ="2.16.840 .1.113883. 6.12"
	27975	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	27976	displayNam e="FLU VAC CINE 4 VAL ENT NASAL"
	27977	/>
	27978
	27979	</code>
	27980
	27981	</manufact uredMateri al>
	27982
	27983	</manufact uredProduc t>
	27984
	27985	</consumab le>
	27986
	27987	<performer >
	27988
	27989	<assignedE ntity>
	27990
	27991	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	27992
	27993	<id
	27994	root="2.16 .840.1.113 883.4.349"
	27995	/>
	27996
	27997	<assignedP erson>
	27998
	27999	<!-- CCD P rovider Na me, REQUIR ED -->
	28000
	28001	<name/>
	28002
	28003	</assigned Person>
	28004
	28005	</assigned Entity>
	28006
	28007	</performe r>
	28008
	28009	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28010
	28011	<author>
	28012
	28013	<time
	28014	nullFlavor ="NA"
	28015	/>
	28016
	28017	<assignedA uthor>
	28018
	28019	<id
	28020	nullFlavor ="NA"
	28021	/>
	28022
	28023	<represent edOrganiza tion>
	28024
	28025	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28026	FA CILITY NBR ) -->
	28027
	28028	<id
	28029	extension= "983"
	28030	nullFlavor ="NA"
	28031	/>
	28032
	28033	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28034
	28035	<name>
	28036	CHYSHR TES T LAB
	28037	</name>
	28038
	28039	</represen tedOrganiz ation>
	28040
	28041	</assigned Author>
	28042
	28043	</author>
	28044
	28045
	28046	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28047	immuni zations on ly -->
	28048
	28049	</substanc eAdministr ation>
	28050
	28051	</entry>
	28052	<entry
	28053	typeCode=" DRIV"
	28054	>
	28055
	28056	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28057
	28058	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28059
	28060	<substance Administra tion
	28061	classCode= "SBADM"
	28062	moodCode=" EVN"
	28063	negationIn d="false"
	28064	>
	28065
	28066	<templateI d
	28067	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28068	/>
	28069
	28070	<id
	28071	nullFlavor ="NA"
	28072	/>
	28073
	28074	<text>
	28075
	28076	<reference
	28077	value="#in dComments1 048"
	28078	/>
	28079
	28080	</text>
	28081
	28082	<statusCod e
	28083	code="comp leted"
	28084	/>
	28085
	28086	<effective Time
	28087	value="201 41208"
	28088	/>
	28089
	28090	<repeatNum ber
	28091	nullFlavor ="UNK"
	28092	/>
	28093
	28094	<consumabl e>
	28095
	28096	<manufactu redProduct
	28097	classCode= "MANU"
	28098	>
	28099
	28100	<templateI d
	28101	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28102	/>
	28103
	28104	<manufactu redMateria l>
	28105
	28106	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28107
	28108	<code
	28109	code="141"
	28110	codeSystem ="2.16.840 .1.113883. 12.292"
	28111	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28112	>
	28113
	28114	<originalT ext>
	28115
	28116	<reference
	28117	value="#in dImmunizat ion1048"
	28118	/>
	28119
	28120	</original Text>
	28121
	28122
	28123	</code>
	28124
	28125	</manufact uredMateri al>
	28126
	28127	</manufact uredProduc t>
	28128
	28129	</consumab le>
	28130
	28131	<performer >
	28132
	28133	<assignedE ntity>
	28134
	28135	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28136
	28137	<id
	28138	root="2.16 .840.1.113 883.4.349"
	28139	/>
	28140
	28141	<assignedP erson>
	28142
	28143	<!-- CCD P rovider Na me, REQUIR ED -->
	28144
	28145	<name/>
	28146
	28147	</assigned Person>
	28148
	28149	</assigned Entity>
	28150
	28151	</performe r>
	28152
	28153	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28154
	28155	<author>
	28156
	28157	<time
	28158	nullFlavor ="NA"
	28159	/>
	28160
	28161	<assignedA uthor>
	28162
	28163	<id
	28164	nullFlavor ="NA"
	28165	/>
	28166
	28167	<represent edOrganiza tion>
	28168
	28169	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28170	FA CILITY NBR ) -->
	28171
	28172	<id
	28173	extension= "983"
	28174	nullFlavor ="NA"
	28175	/>
	28176
	28177	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28178
	28179	<name>
	28180	CHYSHR TES T LAB
	28181	</name>
	28182
	28183	</represen tedOrganiz ation>
	28184
	28185	</assigned Author>
	28186
	28187	</author>
	28188
	28189
	28190	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28191	immuni zations on ly -->
	28192
	28193	</substanc eAdministr ation>
	28194
	28195	</entry>
	28196	<entry
	28197	typeCode=" DRIV"
	28198	>
	28199
	28200	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28201
	28202	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28203
	28204	<substance Administra tion
	28205	classCode= "SBADM"
	28206	moodCode=" EVN"
	28207	negationIn d="false"
	28208	>
	28209
	28210	<templateI d
	28211	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28212	/>
	28213
	28214	<id
	28215	nullFlavor ="NA"
	28216	/>
	28217
	28218	<text>
	28219
	28220	<reference
	28221	value="#in dComments1 049"
	28222	/>
	28223
	28224	</text>
	28225
	28226	<statusCod e
	28227	code="comp leted"
	28228	/>
	28229
	28230	<effective Time
	28231	value="201 41207"
	28232	/>
	28233
	28234	<repeatNum ber
	28235	nullFlavor ="UNK"
	28236	/>
	28237
	28238	<consumabl e>
	28239
	28240	<manufactu redProduct
	28241	classCode= "MANU"
	28242	>
	28243
	28244	<templateI d
	28245	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28246	/>
	28247
	28248	<manufactu redMateria l>
	28249
	28250	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28251
	28252	<code
	28253	code="141"
	28254	codeSystem ="2.16.840 .1.113883. 12.292"
	28255	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28256	>
	28257
	28258	<originalT ext>
	28259
	28260	<reference
	28261	value="#in dImmunizat ion1049"
	28262	/>
	28263
	28264	</original Text>
	28265
	28266
	28267	</code>
	28268
	28269	</manufact uredMateri al>
	28270
	28271	</manufact uredProduc t>
	28272
	28273	</consumab le>
	28274
	28275	<performer >
	28276
	28277	<assignedE ntity>
	28278
	28279	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28280
	28281	<id
	28282	root="2.16 .840.1.113 883.4.349"
	28283	/>
	28284
	28285	<assignedP erson>
	28286
	28287	<!-- CCD P rovider Na me, REQUIR ED -->
	28288
	28289	<name/>
	28290
	28291	</assigned Person>
	28292
	28293	</assigned Entity>
	28294
	28295	</performe r>
	28296
	28297	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28298
	28299	<author>
	28300
	28301	<time
	28302	nullFlavor ="NA"
	28303	/>
	28304
	28305	<assignedA uthor>
	28306
	28307	<id
	28308	nullFlavor ="NA"
	28309	/>
	28310
	28311	<represent edOrganiza tion>
	28312
	28313	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28314	FA CILITY NBR ) -->
	28315
	28316	<id
	28317	extension= "983"
	28318	nullFlavor ="NA"
	28319	/>
	28320
	28321	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28322
	28323	<name>
	28324	CHYSHR TES T LAB
	28325	</name>
	28326
	28327	</represen tedOrganiz ation>
	28328
	28329	</assigned Author>
	28330
	28331	</author>
	28332
	28333
	28334	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28335	immuni zations on ly -->
	28336
	28337	</substanc eAdministr ation>
	28338
	28339	</entry>
	28340	<entry
	28341	typeCode=" DRIV"
	28342	>
	28343
	28344	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28345
	28346	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28347
	28348	<substance Administra tion
	28349	classCode= "SBADM"
	28350	moodCode=" EVN"
	28351	negationIn d="false"
	28352	>
	28353
	28354	<templateI d
	28355	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28356	/>
	28357
	28358	<id
	28359	nullFlavor ="NA"
	28360	/>
	28361
	28362	<text>
	28363
	28364	<reference
	28365	value="#in dComments1 050"
	28366	/>
	28367
	28368	</text>
	28369
	28370	<statusCod e
	28371	code="comp leted"
	28372	/>
	28373
	28374	<effective Time
	28375	value="201 41205"
	28376	/>
	28377
	28378	<repeatNum ber
	28379	nullFlavor ="UNK"
	28380	/>
	28381
	28382	<consumabl e>
	28383
	28384	<manufactu redProduct
	28385	classCode= "MANU"
	28386	>
	28387
	28388	<templateI d
	28389	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28390	/>
	28391
	28392	<manufactu redMateria l>
	28393
	28394	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28395
	28396	<code
	28397	code="141"
	28398	codeSystem ="2.16.840 .1.113883. 12.292"
	28399	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28400	>
	28401
	28402	<originalT ext>
	28403
	28404	<reference
	28405	value="#in dImmunizat ion1050"
	28406	/>
	28407
	28408	</original Text>
	28409
	28410
	28411	</code>
	28412
	28413	</manufact uredMateri al>
	28414
	28415	</manufact uredProduc t>
	28416
	28417	</consumab le>
	28418
	28419	<performer >
	28420
	28421	<assignedE ntity>
	28422
	28423	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28424
	28425	<id
	28426	root="2.16 .840.1.113 883.4.349"
	28427	/>
	28428
	28429	<assignedP erson>
	28430
	28431	<!-- CCD P rovider Na me, REQUIR ED -->
	28432
	28433	<name/>
	28434
	28435	</assigned Person>
	28436
	28437	</assigned Entity>
	28438
	28439	</performe r>
	28440
	28441	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28442
	28443	<author>
	28444
	28445	<time
	28446	nullFlavor ="NA"
	28447	/>
	28448
	28449	<assignedA uthor>
	28450
	28451	<id
	28452	nullFlavor ="NA"
	28453	/>
	28454
	28455	<represent edOrganiza tion>
	28456
	28457	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28458	FA CILITY NBR ) -->
	28459
	28460	<id
	28461	extension= "983"
	28462	nullFlavor ="NA"
	28463	/>
	28464
	28465	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28466
	28467	<name>
	28468	CHYSHR TES T LAB
	28469	</name>
	28470
	28471	</represen tedOrganiz ation>
	28472
	28473	</assigned Author>
	28474
	28475	</author>
	28476
	28477
	28478	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28479	immuni zations on ly -->
	28480
	28481	</substanc eAdministr ation>
	28482
	28483	</entry>
	28484	<entry
	28485	typeCode=" DRIV"
	28486	>
	28487
	28488	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28489
	28490	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28491
	28492	<substance Administra tion
	28493	classCode= "SBADM"
	28494	moodCode=" EVN"
	28495	negationIn d="false"
	28496	>
	28497
	28498	<templateI d
	28499	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28500	/>
	28501
	28502	<id
	28503	nullFlavor ="NA"
	28504	/>
	28505
	28506	<text>
	28507
	28508	<reference
	28509	value="#in dComments1 051"
	28510	/>
	28511
	28512	</text>
	28513
	28514	<statusCod e
	28515	code="comp leted"
	28516	/>
	28517
	28518	<effective Time
	28519	value="201 41102"
	28520	/>
	28521
	28522	<repeatNum ber
	28523	nullFlavor ="UNK"
	28524	/>
	28525
	28526	<consumabl e>
	28527
	28528	<manufactu redProduct
	28529	classCode= "MANU"
	28530	>
	28531
	28532	<templateI d
	28533	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28534	/>
	28535
	28536	<manufactu redMateria l>
	28537
	28538	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28539
	28540	<code
	28541	code="141"
	28542	codeSystem ="2.16.840 .1.113883. 12.292"
	28543	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28544	>
	28545
	28546	<originalT ext>
	28547
	28548	<reference
	28549	value="#in dImmunizat ion1051"
	28550	/>
	28551
	28552	</original Text>
	28553
	28554
	28555	</code>
	28556
	28557	</manufact uredMateri al>
	28558
	28559	</manufact uredProduc t>
	28560
	28561	</consumab le>
	28562
	28563	<performer >
	28564
	28565	<assignedE ntity>
	28566
	28567	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28568
	28569	<id
	28570	root="2.16 .840.1.113 883.4.349"
	28571	/>
	28572
	28573	<assignedP erson>
	28574
	28575	<!-- CCD P rovider Na me, REQUIR ED -->
	28576
	28577	<name/>
	28578
	28579	</assigned Person>
	28580
	28581	</assigned Entity>
	28582
	28583	</performe r>
	28584
	28585	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28586
	28587	<author>
	28588
	28589	<time
	28590	nullFlavor ="NA"
	28591	/>
	28592
	28593	<assignedA uthor>
	28594
	28595	<id
	28596	nullFlavor ="NA"
	28597	/>
	28598
	28599	<represent edOrganiza tion>
	28600
	28601	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28602	FA CILITY NBR ) -->
	28603
	28604	<id
	28605	extension= "983"
	28606	nullFlavor ="NA"
	28607	/>
	28608
	28609	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28610
	28611	<name>
	28612	CHYSHR TES T LAB
	28613	</name>
	28614
	28615	</represen tedOrganiz ation>
	28616
	28617	</assigned Author>
	28618
	28619	</author>
	28620
	28621
	28622	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28623	immuni zations on ly -->
	28624
	28625	</substanc eAdministr ation>
	28626
	28627	</entry>
	28628	<entry
	28629	typeCode=" DRIV"
	28630	>
	28631
	28632	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28633
	28634	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28635
	28636	<substance Administra tion
	28637	classCode= "SBADM"
	28638	moodCode=" EVN"
	28639	negationIn d="false"
	28640	>
	28641
	28642	<templateI d
	28643	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28644	/>
	28645
	28646	<id
	28647	nullFlavor ="NA"
	28648	/>
	28649
	28650	<text>
	28651
	28652	<reference
	28653	value="#in dComments1 052"
	28654	/>
	28655
	28656	</text>
	28657
	28658	<statusCod e
	28659	code="comp leted"
	28660	/>
	28661
	28662	<effective Time
	28663	value="201 41101"
	28664	/>
	28665
	28666	<repeatNum ber
	28667	nullFlavor ="UNK"
	28668	/>
	28669
	28670	<consumabl e>
	28671
	28672	<manufactu redProduct
	28673	classCode= "MANU"
	28674	>
	28675
	28676	<templateI d
	28677	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28678	/>
	28679
	28680	<manufactu redMateria l>
	28681
	28682	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28683
	28684	<code
	28685	code="141"
	28686	codeSystem ="2.16.840 .1.113883. 12.292"
	28687	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28688	>
	28689
	28690	<originalT ext>
	28691
	28692	<reference
	28693	value="#in dImmunizat ion1052"
	28694	/>
	28695
	28696	</original Text>
	28697
	28698
	28699	</code>
	28700
	28701	</manufact uredMateri al>
	28702
	28703	</manufact uredProduc t>
	28704
	28705	</consumab le>
	28706
	28707	<performer >
	28708
	28709	<assignedE ntity>
	28710
	28711	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28712
	28713	<id
	28714	root="2.16 .840.1.113 883.4.349"
	28715	/>
	28716
	28717	<assignedP erson>
	28718
	28719	<!-- CCD P rovider Na me, REQUIR ED -->
	28720
	28721	<name/>
	28722
	28723	</assigned Person>
	28724
	28725	</assigned Entity>
	28726
	28727	</performe r>
	28728
	28729	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28730
	28731	<author>
	28732
	28733	<time
	28734	nullFlavor ="NA"
	28735	/>
	28736
	28737	<assignedA uthor>
	28738
	28739	<id
	28740	nullFlavor ="NA"
	28741	/>
	28742
	28743	<represent edOrganiza tion>
	28744
	28745	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28746	FA CILITY NBR ) -->
	28747
	28748	<id
	28749	extension= "983"
	28750	nullFlavor ="NA"
	28751	/>
	28752
	28753	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28754
	28755	<name>
	28756	CHYSHR TES T LAB
	28757	</name>
	28758
	28759	</represen tedOrganiz ation>
	28760
	28761	</assigned Author>
	28762
	28763	</author>
	28764
	28765
	28766	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28767	immuni zations on ly -->
	28768
	28769	</substanc eAdministr ation>
	28770
	28771	</entry>
	28772	<entry
	28773	typeCode=" DRIV"
	28774	>
	28775
	28776	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28777
	28778	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28779
	28780	<substance Administra tion
	28781	classCode= "SBADM"
	28782	moodCode=" EVN"
	28783	negationIn d="false"
	28784	>
	28785
	28786	<templateI d
	28787	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28788	/>
	28789
	28790	<id
	28791	nullFlavor ="NA"
	28792	/>
	28793
	28794	<text>
	28795
	28796	<reference
	28797	value="#in dComments1 053"
	28798	/>
	28799
	28800	</text>
	28801
	28802	<statusCod e
	28803	code="comp leted"
	28804	/>
	28805
	28806	<effective Time
	28807	value="201 40819"
	28808	/>
	28809
	28810	<repeatNum ber
	28811	nullFlavor ="UNK"
	28812	/>
	28813
	28814	<consumabl e>
	28815
	28816	<manufactu redProduct
	28817	classCode= "MANU"
	28818	>
	28819
	28820	<templateI d
	28821	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28822	/>
	28823
	28824	<manufactu redMateria l>
	28825
	28826	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28827
	28828	<code
	28829	code="135"
	28830	codeSystem ="2.16.840 .1.113883. 12.292"
	28831	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28832	displayNam e="FLU VAC C PRSV FRE E INC ANTI G"
	28833	>
	28834
	28835	<originalT ext>
	28836
	28837	<reference
	28838	value="#in dImmunizat ion1053"
	28839	/>
	28840
	28841	</original Text>
	28842
	28843	<translati on
	28844	code="9066 2"
	28845	codeSystem ="2.16.840 .1.113883. 6.12"
	28846	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	28847	displayNam e="FLU VAC C PRSV FRE E INC ANTI G"
	28848	/>
	28849
	28850	</code>
	28851
	28852	</manufact uredMateri al>
	28853
	28854	</manufact uredProduc t>
	28855
	28856	</consumab le>
	28857
	28858	<performer >
	28859
	28860	<assignedE ntity>
	28861
	28862	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	28863
	28864	<id
	28865	root="2.16 .840.1.113 883.4.349"
	28866	/>
	28867
	28868	<assignedP erson>
	28869
	28870	<!-- CCD P rovider Na me, REQUIR ED -->
	28871
	28872	<name/>
	28873
	28874	</assigned Person>
	28875
	28876	</assigned Entity>
	28877
	28878	</performe r>
	28879
	28880	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	28881
	28882	<author>
	28883
	28884	<time
	28885	nullFlavor ="NA"
	28886	/>
	28887
	28888	<assignedA uthor>
	28889
	28890	<id
	28891	nullFlavor ="NA"
	28892	/>
	28893
	28894	<represent edOrganiza tion>
	28895
	28896	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	28897	FA CILITY NBR ) -->
	28898
	28899	<id
	28900	extension= "983"
	28901	nullFlavor ="NA"
	28902	/>
	28903
	28904	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	28905
	28906	<name>
	28907	CHYSHR TES T LAB
	28908	</name>
	28909
	28910	</represen tedOrganiz ation>
	28911
	28912	</assigned Author>
	28913
	28914	</author>
	28915
	28916
	28917	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	28918	immuni zations on ly -->
	28919
	28920	</substanc eAdministr ation>
	28921
	28922	</entry>
	28923	<entry
	28924	typeCode=" DRIV"
	28925	>
	28926
	28927	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	28928
	28929	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	28930
	28931	<substance Administra tion
	28932	classCode= "SBADM"
	28933	moodCode=" EVN"
	28934	negationIn d="false"
	28935	>
	28936
	28937	<templateI d
	28938	root="2.16 .840.1.113 883.10.20. 22.4.52"
	28939	/>
	28940
	28941	<id
	28942	nullFlavor ="NA"
	28943	/>
	28944
	28945	<text>
	28946
	28947	<reference
	28948	value="#in dComments1 054"
	28949	/>
	28950
	28951	</text>
	28952
	28953	<statusCod e
	28954	code="comp leted"
	28955	/>
	28956
	28957	<effective Time
	28958	value="201 40801"
	28959	/>
	28960
	28961	<repeatNum ber
	28962	nullFlavor ="UNK"
	28963	/>
	28964
	28965	<consumabl e>
	28966
	28967	<manufactu redProduct
	28968	classCode= "MANU"
	28969	>
	28970
	28971	<templateI d
	28972	root="2.16 .840.1.113 883.10.20. 22.4.54"
	28973	/>
	28974
	28975	<manufactu redMateria l>
	28976
	28977	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	28978
	28979	<code
	28980	code="33"
	28981	codeSystem ="2.16.840 .1.113883. 12.292"
	28982	codeSystem Name="Vacc ine Admini stered (CV X code)"
	28983	displayNam e="PNEUMOC OCCAL VACC INE"
	28984	>
	28985
	28986	<originalT ext>
	28987
	28988	<reference
	28989	value="#in dImmunizat ion1054"
	28990	/>
	28991
	28992	</original Text>
	28993
	28994	<translati on
	28995	code="9073 2"
	28996	codeSystem ="2.16.840 .1.113883. 6.12"
	28997	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	28998	displayNam e="PNEUMOC OCCAL VACC INE"
	28999	/>
	29000
	29001	</code>
	29002
	29003	</manufact uredMateri al>
	29004
	29005	</manufact uredProduc t>
	29006
	29007	</consumab le>
	29008
	29009	<performer >
	29010
	29011	<assignedE ntity>
	29012
	29013	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29014
	29015	<id
	29016	root="2.16 .840.1.113 883.4.349"
	29017	/>
	29018
	29019	<assignedP erson>
	29020
	29021	<!-- CCD P rovider Na me, REQUIR ED -->
	29022
	29023	<name/>
	29024
	29025	</assigned Person>
	29026
	29027	</assigned Entity>
	29028
	29029	</performe r>
	29030
	29031	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29032
	29033	<author>
	29034
	29035	<time
	29036	nullFlavor ="NA"
	29037	/>
	29038
	29039	<assignedA uthor>
	29040
	29041	<id
	29042	nullFlavor ="NA"
	29043	/>
	29044
	29045	<represent edOrganiza tion>
	29046
	29047	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29048	FA CILITY NBR ) -->
	29049
	29050	<id
	29051	extension= "983"
	29052	nullFlavor ="NA"
	29053	/>
	29054
	29055	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29056
	29057	<name>
	29058	CHYSHR TES T LAB
	29059	</name>
	29060
	29061	</represen tedOrganiz ation>
	29062
	29063	</assigned Author>
	29064
	29065	</author>
	29066
	29067
	29068	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29069	immuni zations on ly -->
	29070
	29071	</substanc eAdministr ation>
	29072
	29073	</entry>
	29074	<entry
	29075	typeCode=" DRIV"
	29076	>
	29077
	29078	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29079
	29080	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29081
	29082	<substance Administra tion
	29083	classCode= "SBADM"
	29084	moodCode=" EVN"
	29085	negationIn d="false"
	29086	>
	29087
	29088	<templateI d
	29089	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29090	/>
	29091
	29092	<id
	29093	nullFlavor ="NA"
	29094	/>
	29095
	29096	<text>
	29097
	29098	<reference
	29099	value="#in dComments1 055"
	29100	/>
	29101
	29102	</text>
	29103
	29104	<statusCod e
	29105	code="comp leted"
	29106	/>
	29107
	29108	<effective Time
	29109	value="201 40801"
	29110	/>
	29111
	29112	<repeatNum ber
	29113	nullFlavor ="UNK"
	29114	/>
	29115
	29116	<consumabl e>
	29117
	29118	<manufactu redProduct
	29119	classCode= "MANU"
	29120	>
	29121
	29122	<templateI d
	29123	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29124	/>
	29125
	29126	<manufactu redMateria l>
	29127
	29128	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29129
	29130	<code
	29131	code="133"
	29132	codeSystem ="2.16.840 .1.113883. 12.292"
	29133	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29134	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	29135	>
	29136
	29137	<originalT ext>
	29138
	29139	<reference
	29140	value="#in dImmunizat ion1055"
	29141	/>
	29142
	29143	</original Text>
	29144
	29145	<translati on
	29146	code="9067 0"
	29147	codeSystem ="2.16.840 .1.113883. 6.12"
	29148	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29149	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	29150	/>
	29151
	29152	</code>
	29153
	29154	</manufact uredMateri al>
	29155
	29156	</manufact uredProduc t>
	29157
	29158	</consumab le>
	29159
	29160	<performer >
	29161
	29162	<assignedE ntity>
	29163
	29164	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29165
	29166	<id
	29167	root="2.16 .840.1.113 883.4.349"
	29168	/>
	29169
	29170	<assignedP erson>
	29171
	29172	<!-- CCD P rovider Na me, REQUIR ED -->
	29173
	29174	<name/>
	29175
	29176	</assigned Person>
	29177
	29178	</assigned Entity>
	29179
	29180	</performe r>
	29181
	29182	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29183
	29184	<author>
	29185
	29186	<time
	29187	nullFlavor ="NA"
	29188	/>
	29189
	29190	<assignedA uthor>
	29191
	29192	<id
	29193	nullFlavor ="NA"
	29194	/>
	29195
	29196	<represent edOrganiza tion>
	29197
	29198	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29199	FA CILITY NBR ) -->
	29200
	29201	<id
	29202	extension= "983"
	29203	nullFlavor ="NA"
	29204	/>
	29205
	29206	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29207
	29208	<name>
	29209	CHYSHR TES T LAB
	29210	</name>
	29211
	29212	</represen tedOrganiz ation>
	29213
	29214	</assigned Author>
	29215
	29216	</author>
	29217
	29218
	29219	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29220	immuni zations on ly -->
	29221
	29222	</substanc eAdministr ation>
	29223
	29224	</entry>
	29225	<entry
	29226	typeCode=" DRIV"
	29227	>
	29228
	29229	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29230
	29231	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29232
	29233	<substance Administra tion
	29234	classCode= "SBADM"
	29235	moodCode=" EVN"
	29236	negationIn d="false"
	29237	>
	29238
	29239	<templateI d
	29240	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29241	/>
	29242
	29243	<id
	29244	nullFlavor ="NA"
	29245	/>
	29246
	29247	<text>
	29248
	29249	<reference
	29250	value="#in dComments1 056"
	29251	/>
	29252
	29253	</text>
	29254
	29255	<statusCod e
	29256	code="comp leted"
	29257	/>
	29258
	29259	<effective Time
	29260	value="201 408"
	29261	/>
	29262
	29263	<repeatNum ber
	29264	nullFlavor ="UNK"
	29265	/>
	29266
	29267	<consumabl e>
	29268
	29269	<manufactu redProduct
	29270	classCode= "MANU"
	29271	>
	29272
	29273	<templateI d
	29274	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29275	/>
	29276
	29277	<manufactu redMateria l>
	29278
	29279	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29280
	29281	<code
	29282	code="121"
	29283	codeSystem ="2.16.840 .1.113883. 12.292"
	29284	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29285	displayNam e="ZOSTER VACC SC"
	29286	>
	29287
	29288	<originalT ext>
	29289
	29290	<reference
	29291	value="#in dImmunizat ion1056"
	29292	/>
	29293
	29294	</original Text>
	29295
	29296	<translati on
	29297	code="9073 6"
	29298	codeSystem ="2.16.840 .1.113883. 6.12"
	29299	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29300	displayNam e="ZOSTER VACC SC"
	29301	/>
	29302
	29303	</code>
	29304
	29305	</manufact uredMateri al>
	29306
	29307	</manufact uredProduc t>
	29308
	29309	</consumab le>
	29310
	29311	<performer >
	29312
	29313	<assignedE ntity>
	29314
	29315	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29316
	29317	<id
	29318	root="2.16 .840.1.113 883.4.349"
	29319	/>
	29320
	29321	<assignedP erson>
	29322
	29323	<!-- CCD P rovider Na me, REQUIR ED -->
	29324
	29325	<name/>
	29326
	29327	</assigned Person>
	29328
	29329	</assigned Entity>
	29330
	29331	</performe r>
	29332
	29333	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29334
	29335	<author>
	29336
	29337	<time
	29338	nullFlavor ="NA"
	29339	/>
	29340
	29341	<assignedA uthor>
	29342
	29343	<id
	29344	nullFlavor ="NA"
	29345	/>
	29346
	29347	<represent edOrganiza tion>
	29348
	29349	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29350	FA CILITY NBR ) -->
	29351
	29352	<id
	29353	extension= "983"
	29354	nullFlavor ="NA"
	29355	/>
	29356
	29357	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29358
	29359	<name>
	29360	CHYSHR TES T LAB
	29361	</name>
	29362
	29363	</represen tedOrganiz ation>
	29364
	29365	</assigned Author>
	29366
	29367	</author>
	29368
	29369
	29370	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29371	immuni zations on ly -->
	29372
	29373	</substanc eAdministr ation>
	29374
	29375	</entry>
	29376	<entry
	29377	typeCode=" DRIV"
	29378	>
	29379
	29380	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29381
	29382	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29383
	29384	<substance Administra tion
	29385	classCode= "SBADM"
	29386	moodCode=" EVN"
	29387	negationIn d="false"
	29388	>
	29389
	29390	<templateI d
	29391	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29392	/>
	29393
	29394	<id
	29395	nullFlavor ="NA"
	29396	/>
	29397
	29398	<text>
	29399
	29400	<reference
	29401	value="#in dComments1 057"
	29402	/>
	29403
	29404	</text>
	29405
	29406	<statusCod e
	29407	code="comp leted"
	29408	/>
	29409
	29410	<effective Time
	29411	value="201 40508"
	29412	/>
	29413
	29414	<repeatNum ber
	29415	nullFlavor ="UNK"
	29416	/>
	29417
	29418	<consumabl e>
	29419
	29420	<manufactu redProduct
	29421	classCode= "MANU"
	29422	>
	29423
	29424	<templateI d
	29425	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29426	/>
	29427
	29428	<manufactu redMateria l>
	29429
	29430	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29431
	29432	<code
	29433	code="133"
	29434	codeSystem ="2.16.840 .1.113883. 12.292"
	29435	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29436	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	29437	>
	29438
	29439	<originalT ext>
	29440
	29441	<reference
	29442	value="#in dImmunizat ion1057"
	29443	/>
	29444
	29445	</original Text>
	29446
	29447	<translati on
	29448	code="9067 0"
	29449	codeSystem ="2.16.840 .1.113883. 6.12"
	29450	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29451	displayNam e="PNEUMOC OCCAL VACC 13 VAL IM "
	29452	/>
	29453
	29454	</code>
	29455
	29456	</manufact uredMateri al>
	29457
	29458	</manufact uredProduc t>
	29459
	29460	</consumab le>
	29461
	29462	<performer >
	29463
	29464	<assignedE ntity>
	29465
	29466	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29467
	29468	<id
	29469	root="2.16 .840.1.113 883.4.349"
	29470	/>
	29471
	29472	<assignedP erson>
	29473
	29474	<!-- CCD P rovider Na me, REQUIR ED -->
	29475
	29476	<name/>
	29477
	29478	</assigned Person>
	29479
	29480	</assigned Entity>
	29481
	29482	</performe r>
	29483
	29484	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29485
	29486	<author>
	29487
	29488	<time
	29489	nullFlavor ="NA"
	29490	/>
	29491
	29492	<assignedA uthor>
	29493
	29494	<id
	29495	nullFlavor ="NA"
	29496	/>
	29497
	29498	<represent edOrganiza tion>
	29499
	29500	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29501	FA CILITY NBR ) -->
	29502
	29503	<id
	29504	extension= "983"
	29505	nullFlavor ="NA"
	29506	/>
	29507
	29508	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29509
	29510	<name>
	29511	CHYSHR TES T LAB
	29512	</name>
	29513
	29514	</represen tedOrganiz ation>
	29515
	29516	</assigned Author>
	29517
	29518	</author>
	29519
	29520
	29521	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29522	immuni zations on ly -->
	29523
	29524	</substanc eAdministr ation>
	29525
	29526	</entry>
	29527	<entry
	29528	typeCode=" DRIV"
	29529	>
	29530
	29531	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29532
	29533	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29534
	29535	<substance Administra tion
	29536	classCode= "SBADM"
	29537	moodCode=" EVN"
	29538	negationIn d="false"
	29539	>
	29540
	29541	<templateI d
	29542	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29543	/>
	29544
	29545	<id
	29546	nullFlavor ="NA"
	29547	/>
	29548
	29549	<text>
	29550
	29551	<reference
	29552	value="#in dComments1 058"
	29553	/>
	29554
	29555	</text>
	29556
	29557	<statusCod e
	29558	code="comp leted"
	29559	/>
	29560
	29561	<effective Time
	29562	value="201 40424"
	29563	/>
	29564
	29565	<repeatNum ber
	29566	nullFlavor ="UNK"
	29567	/>
	29568
	29569	<consumabl e>
	29570
	29571	<manufactu redProduct
	29572	classCode= "MANU"
	29573	>
	29574
	29575	<templateI d
	29576	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29577	/>
	29578
	29579	<manufactu redMateria l>
	29580
	29581	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29582
	29583	<code
	29584	code="121"
	29585	codeSystem ="2.16.840 .1.113883. 12.292"
	29586	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29587	displayNam e="ZOSTER VACC SC"
	29588	>
	29589
	29590	<originalT ext>
	29591
	29592	<reference
	29593	value="#in dImmunizat ion1058"
	29594	/>
	29595
	29596	</original Text>
	29597
	29598	<translati on
	29599	code="9073 6"
	29600	codeSystem ="2.16.840 .1.113883. 6.12"
	29601	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29602	displayNam e="ZOSTER VACC SC"
	29603	/>
	29604
	29605	</code>
	29606
	29607	</manufact uredMateri al>
	29608
	29609	</manufact uredProduc t>
	29610
	29611	</consumab le>
	29612
	29613	<performer >
	29614
	29615	<assignedE ntity>
	29616
	29617	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29618
	29619	<id
	29620	root="2.16 .840.1.113 883.4.349"
	29621	/>
	29622
	29623	<assignedP erson>
	29624
	29625	<!-- CCD P rovider Na me, REQUIR ED -->
	29626
	29627	<name/>
	29628
	29629	</assigned Person>
	29630
	29631	</assigned Entity>
	29632
	29633	</performe r>
	29634
	29635	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29636
	29637	<author>
	29638
	29639	<time
	29640	nullFlavor ="NA"
	29641	/>
	29642
	29643	<assignedA uthor>
	29644
	29645	<id
	29646	nullFlavor ="NA"
	29647	/>
	29648
	29649	<represent edOrganiza tion>
	29650
	29651	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29652	FA CILITY NBR ) -->
	29653
	29654	<id
	29655	extension= "983"
	29656	nullFlavor ="NA"
	29657	/>
	29658
	29659	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29660
	29661	<name>
	29662	CHYSHR TES T LAB
	29663	</name>
	29664
	29665	</represen tedOrganiz ation>
	29666
	29667	</assigned Author>
	29668
	29669	</author>
	29670
	29671
	29672	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29673	immuni zations on ly -->
	29674
	29675	</substanc eAdministr ation>
	29676
	29677	</entry>
	29678	<entry
	29679	typeCode=" DRIV"
	29680	>
	29681
	29682	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29683
	29684	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29685
	29686	<substance Administra tion
	29687	classCode= "SBADM"
	29688	moodCode=" EVN"
	29689	negationIn d="false"
	29690	>
	29691
	29692	<templateI d
	29693	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29694	/>
	29695
	29696	<id
	29697	nullFlavor ="NA"
	29698	/>
	29699
	29700	<text>
	29701
	29702	<reference
	29703	value="#in dComments1 059"
	29704	/>
	29705
	29706	</text>
	29707
	29708	<statusCod e
	29709	code="comp leted"
	29710	/>
	29711
	29712	<effective Time
	29713	value="201 30819"
	29714	/>
	29715
	29716	<repeatNum ber
	29717	nullFlavor ="UNK"
	29718	/>
	29719
	29720	<consumabl e>
	29721
	29722	<manufactu redProduct
	29723	classCode= "MANU"
	29724	>
	29725
	29726	<templateI d
	29727	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29728	/>
	29729
	29730	<manufactu redMateria l>
	29731
	29732	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29733
	29734	<code
	29735	code="144"
	29736	codeSystem ="2.16.840 .1.113883. 12.292"
	29737	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29738	displayNam e="FLU VAC C IIV3 NO PRESERV ID "
	29739	>
	29740
	29741	<originalT ext>
	29742
	29743	<reference
	29744	value="#in dImmunizat ion1059"
	29745	/>
	29746
	29747	</original Text>
	29748
	29749	<translati on
	29750	code="9065 4"
	29751	codeSystem ="2.16.840 .1.113883. 6.12"
	29752	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29753	displayNam e="FLU VAC C IIV3 NO PRESERV ID "
	29754	/>
	29755
	29756	</code>
	29757
	29758	</manufact uredMateri al>
	29759
	29760	</manufact uredProduc t>
	29761
	29762	</consumab le>
	29763
	29764	<performer >
	29765
	29766	<assignedE ntity>
	29767
	29768	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29769
	29770	<id
	29771	root="2.16 .840.1.113 883.4.349"
	29772	/>
	29773
	29774	<assignedP erson>
	29775
	29776	<!-- CCD P rovider Na me, REQUIR ED -->
	29777
	29778	<name/>
	29779
	29780	</assigned Person>
	29781
	29782	</assigned Entity>
	29783
	29784	</performe r>
	29785
	29786	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29787
	29788	<author>
	29789
	29790	<time
	29791	nullFlavor ="NA"
	29792	/>
	29793
	29794	<assignedA uthor>
	29795
	29796	<id
	29797	nullFlavor ="NA"
	29798	/>
	29799
	29800	<represent edOrganiza tion>
	29801
	29802	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29803	FA CILITY NBR ) -->
	29804
	29805	<id
	29806	extension= "983"
	29807	nullFlavor ="NA"
	29808	/>
	29809
	29810	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29811
	29812	<name>
	29813	CHYSHR TES T LAB
	29814	</name>
	29815
	29816	</represen tedOrganiz ation>
	29817
	29818	</assigned Author>
	29819
	29820	</author>
	29821
	29822
	29823	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29824	immuni zations on ly -->
	29825
	29826	</substanc eAdministr ation>
	29827
	29828	</entry>
	29829	<entry
	29830	typeCode=" DRIV"
	29831	>
	29832
	29833	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29834
	29835	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29836
	29837	<substance Administra tion
	29838	classCode= "SBADM"
	29839	moodCode=" EVN"
	29840	negationIn d="false"
	29841	>
	29842
	29843	<templateI d
	29844	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29845	/>
	29846
	29847	<id
	29848	nullFlavor ="NA"
	29849	/>
	29850
	29851	<text>
	29852
	29853	<reference
	29854	value="#in dComments1 060"
	29855	/>
	29856
	29857	</text>
	29858
	29859	<statusCod e
	29860	code="comp leted"
	29861	/>
	29862
	29863	<effective Time
	29864	value="201 30818"
	29865	/>
	29866
	29867	<repeatNum ber
	29868	nullFlavor ="UNK"
	29869	/>
	29870
	29871	<consumabl e>
	29872
	29873	<manufactu redProduct
	29874	classCode= "MANU"
	29875	>
	29876
	29877	<templateI d
	29878	root="2.16 .840.1.113 883.10.20. 22.4.54"
	29879	/>
	29880
	29881	<manufactu redMateria l>
	29882
	29883	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	29884
	29885	<code
	29886	code="33"
	29887	codeSystem ="2.16.840 .1.113883. 12.292"
	29888	codeSystem Name="Vacc ine Admini stered (CV X code)"
	29889	displayNam e="PNEUMOC OCCAL VACC INE"
	29890	>
	29891
	29892	<originalT ext>
	29893
	29894	<reference
	29895	value="#in dImmunizat ion1060"
	29896	/>
	29897
	29898	</original Text>
	29899
	29900	<translati on
	29901	code="9073 2"
	29902	codeSystem ="2.16.840 .1.113883. 6.12"
	29903	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	29904	displayNam e="PNEUMOC OCCAL VACC INE"
	29905	/>
	29906
	29907	</code>
	29908
	29909	</manufact uredMateri al>
	29910
	29911	</manufact uredProduc t>
	29912
	29913	</consumab le>
	29914
	29915	<performer >
	29916
	29917	<assignedE ntity>
	29918
	29919	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	29920
	29921	<id
	29922	root="2.16 .840.1.113 883.4.349"
	29923	/>
	29924
	29925	<assignedP erson>
	29926
	29927	<!-- CCD P rovider Na me, REQUIR ED -->
	29928
	29929	<name/>
	29930
	29931	</assigned Person>
	29932
	29933	</assigned Entity>
	29934
	29935	</performe r>
	29936
	29937	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	29938
	29939	<author>
	29940
	29941	<time
	29942	nullFlavor ="NA"
	29943	/>
	29944
	29945	<assignedA uthor>
	29946
	29947	<id
	29948	nullFlavor ="NA"
	29949	/>
	29950
	29951	<represent edOrganiza tion>
	29952
	29953	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	29954	FA CILITY NBR ) -->
	29955
	29956	<id
	29957	extension= "983"
	29958	nullFlavor ="NA"
	29959	/>
	29960
	29961	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	29962
	29963	<name>
	29964	CHYSHR TES T LAB
	29965	</name>
	29966
	29967	</represen tedOrganiz ation>
	29968
	29969	</assigned Author>
	29970
	29971	</author>
	29972
	29973
	29974	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	29975	immuni zations on ly -->
	29976
	29977	</substanc eAdministr ation>
	29978
	29979	</entry>
	29980	<entry
	29981	typeCode=" DRIV"
	29982	>
	29983
	29984	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	29985
	29986	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	29987
	29988	<substance Administra tion
	29989	classCode= "SBADM"
	29990	moodCode=" EVN"
	29991	negationIn d="false"
	29992	>
	29993
	29994	<templateI d
	29995	root="2.16 .840.1.113 883.10.20. 22.4.52"
	29996	/>
	29997
	29998	<id
	29999	nullFlavor ="NA"
	30000	/>
	30001
	30002	<text>
	30003
	30004	<reference
	30005	value="#in dComments1 061"
	30006	/>
	30007
	30008	</text>
	30009
	30010	<statusCod e
	30011	code="comp leted"
	30012	/>
	30013
	30014	<effective Time
	30015	value="201 20124"
	30016	/>
	30017
	30018	<repeatNum ber
	30019	nullFlavor ="UNK"
	30020	/>
	30021
	30022	<consumabl e>
	30023
	30024	<manufactu redProduct
	30025	classCode= "MANU"
	30026	>
	30027
	30028	<templateI d
	30029	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30030	/>
	30031
	30032	<manufactu redMateria l>
	30033
	30034	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30035
	30036	<code
	30037	code="141"
	30038	codeSystem ="2.16.840 .1.113883. 12.292"
	30039	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30040	>
	30041
	30042	<originalT ext>
	30043
	30044	<reference
	30045	value="#in dImmunizat ion1061"
	30046	/>
	30047
	30048	</original Text>
	30049
	30050
	30051	</code>
	30052
	30053	</manufact uredMateri al>
	30054
	30055	</manufact uredProduc t>
	30056
	30057	</consumab le>
	30058
	30059	<performer >
	30060
	30061	<assignedE ntity>
	30062
	30063	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30064
	30065	<id
	30066	root="2.16 .840.1.113 883.4.349"
	30067	/>
	30068
	30069	<assignedP erson>
	30070
	30071	<!-- CCD P rovider Na me, REQUIR ED -->
	30072
	30073	<name/>
	30074
	30075	</assigned Person>
	30076
	30077	</assigned Entity>
	30078
	30079	</performe r>
	30080
	30081	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30082
	30083	<author>
	30084
	30085	<time
	30086	nullFlavor ="NA"
	30087	/>
	30088
	30089	<assignedA uthor>
	30090
	30091	<id
	30092	nullFlavor ="NA"
	30093	/>
	30094
	30095	<represent edOrganiza tion>
	30096
	30097	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30098	FA CILITY NBR ) -->
	30099
	30100	<id
	30101	extension= "983"
	30102	nullFlavor ="NA"
	30103	/>
	30104
	30105	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30106
	30107	<name>
	30108	CHYSHR TES T LAB
	30109	</name>
	30110
	30111	</represen tedOrganiz ation>
	30112
	30113	</assigned Author>
	30114
	30115	</author>
	30116
	30117
	30118	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30119	immuni zations on ly -->
	30120
	30121	</substanc eAdministr ation>
	30122
	30123	</entry>
	30124	<entry
	30125	typeCode=" DRIV"
	30126	>
	30127
	30128	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30129
	30130	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30131
	30132	<substance Administra tion
	30133	classCode= "SBADM"
	30134	moodCode=" EVN"
	30135	negationIn d="false"
	30136	>
	30137
	30138	<templateI d
	30139	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30140	/>
	30141
	30142	<id
	30143	nullFlavor ="NA"
	30144	/>
	30145
	30146	<text>
	30147
	30148	<reference
	30149	value="#in dComments1 062"
	30150	/>
	30151
	30152	</text>
	30153
	30154	<statusCod e
	30155	code="comp leted"
	30156	/>
	30157
	30158	<effective Time
	30159	value="201 00124"
	30160	/>
	30161
	30162	<repeatNum ber
	30163	nullFlavor ="UNK"
	30164	/>
	30165
	30166	<consumabl e>
	30167
	30168	<manufactu redProduct
	30169	classCode= "MANU"
	30170	>
	30171
	30172	<templateI d
	30173	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30174	/>
	30175
	30176	<manufactu redMateria l>
	30177
	30178	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30179
	30180	<code
	30181	code="150"
	30182	codeSystem ="2.16.840 .1.113883. 12.292"
	30183	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30184	>
	30185
	30186	<originalT ext>
	30187
	30188	<reference
	30189	value="#in dImmunizat ion1062"
	30190	/>
	30191
	30192	</original Text>
	30193
	30194
	30195	</code>
	30196
	30197	</manufact uredMateri al>
	30198
	30199	</manufact uredProduc t>
	30200
	30201	</consumab le>
	30202
	30203	<performer >
	30204
	30205	<assignedE ntity>
	30206
	30207	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30208
	30209	<id
	30210	root="2.16 .840.1.113 883.4.349"
	30211	/>
	30212
	30213	<assignedP erson>
	30214
	30215	<!-- CCD P rovider Na me, REQUIR ED -->
	30216
	30217	<name/>
	30218
	30219	</assigned Person>
	30220
	30221	</assigned Entity>
	30222
	30223	</performe r>
	30224
	30225	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30226
	30227	<author>
	30228
	30229	<time
	30230	nullFlavor ="NA"
	30231	/>
	30232
	30233	<assignedA uthor>
	30234
	30235	<id
	30236	nullFlavor ="NA"
	30237	/>
	30238
	30239	<represent edOrganiza tion>
	30240
	30241	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30242	FA CILITY NBR ) -->
	30243
	30244	<id
	30245	extension= "983"
	30246	nullFlavor ="NA"
	30247	/>
	30248
	30249	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30250
	30251	<name>
	30252	CHYSHR TES T LAB
	30253	</name>
	30254
	30255	</represen tedOrganiz ation>
	30256
	30257	</assigned Author>
	30258
	30259	</author>
	30260
	30261
	30262	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30263	immuni zations on ly -->
	30264
	30265	</substanc eAdministr ation>
	30266
	30267	</entry>
	30268	<entry
	30269	typeCode=" DRIV"
	30270	>
	30271
	30272	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30273
	30274	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30275
	30276	<substance Administra tion
	30277	classCode= "SBADM"
	30278	moodCode=" EVN"
	30279	negationIn d="false"
	30280	>
	30281
	30282	<templateI d
	30283	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30284	/>
	30285
	30286	<id
	30287	nullFlavor ="NA"
	30288	/>
	30289
	30290	<text>
	30291
	30292	<reference
	30293	value="#in dComments1 063"
	30294	/>
	30295
	30296	</text>
	30297
	30298	<statusCod e
	30299	code="comp leted"
	30300	/>
	30301
	30302	<effective Time
	30303	value="201 0"
	30304	/>
	30305
	30306	<repeatNum ber
	30307	nullFlavor ="UNK"
	30308	/>
	30309
	30310	<consumabl e>
	30311
	30312	<manufactu redProduct
	30313	classCode= "MANU"
	30314	>
	30315
	30316	<templateI d
	30317	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30318	/>
	30319
	30320	<manufactu redMateria l>
	30321
	30322	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30323
	30324	<code
	30325	code="121"
	30326	codeSystem ="2.16.840 .1.113883. 12.292"
	30327	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30328	displayNam e="ZOSTER VACC SC"
	30329	>
	30330
	30331	<originalT ext>
	30332
	30333	<reference
	30334	value="#in dImmunizat ion1063"
	30335	/>
	30336
	30337	</original Text>
	30338
	30339	<translati on
	30340	code="9073 6"
	30341	codeSystem ="2.16.840 .1.113883. 6.12"
	30342	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	30343	displayNam e="ZOSTER VACC SC"
	30344	/>
	30345
	30346	</code>
	30347
	30348	</manufact uredMateri al>
	30349
	30350	</manufact uredProduc t>
	30351
	30352	</consumab le>
	30353
	30354	<performer >
	30355
	30356	<assignedE ntity>
	30357
	30358	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30359
	30360	<id
	30361	root="2.16 .840.1.113 883.4.349"
	30362	/>
	30363
	30364	<assignedP erson>
	30365
	30366	<!-- CCD P rovider Na me, REQUIR ED -->
	30367
	30368	<name/>
	30369
	30370	</assigned Person>
	30371
	30372	</assigned Entity>
	30373
	30374	</performe r>
	30375
	30376	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30377
	30378	<author>
	30379
	30380	<time
	30381	nullFlavor ="NA"
	30382	/>
	30383
	30384	<assignedA uthor>
	30385
	30386	<id
	30387	nullFlavor ="NA"
	30388	/>
	30389
	30390	<represent edOrganiza tion>
	30391
	30392	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30393	FA CILITY NBR ) -->
	30394
	30395	<id
	30396	extension= "983"
	30397	nullFlavor ="NA"
	30398	/>
	30399
	30400	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30401
	30402	<name>
	30403	CHYSHR TES T LAB
	30404	</name>
	30405
	30406	</represen tedOrganiz ation>
	30407
	30408	</assigned Author>
	30409
	30410	</author>
	30411
	30412
	30413	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30414	immuni zations on ly -->
	30415
	30416	</substanc eAdministr ation>
	30417
	30418	</entry>
	30419	<entry
	30420	typeCode=" DRIV"
	30421	>
	30422
	30423	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30424
	30425	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30426
	30427	<substance Administra tion
	30428	classCode= "SBADM"
	30429	moodCode=" EVN"
	30430	negationIn d="false"
	30431	>
	30432
	30433	<templateI d
	30434	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30435	/>
	30436
	30437	<id
	30438	nullFlavor ="NA"
	30439	/>
	30440
	30441	<text>
	30442
	30443	<reference
	30444	value="#in dComments1 064"
	30445	/>
	30446
	30447	</text>
	30448
	30449	<statusCod e
	30450	code="comp leted"
	30451	/>
	30452
	30453	<effective Time
	30454	value="200 90124"
	30455	/>
	30456
	30457	<repeatNum ber
	30458	nullFlavor ="UNK"
	30459	/>
	30460
	30461	<consumabl e>
	30462
	30463	<manufactu redProduct
	30464	classCode= "MANU"
	30465	>
	30466
	30467	<templateI d
	30468	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30469	/>
	30470
	30471	<manufactu redMateria l>
	30472
	30473	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30474
	30475	<code
	30476	code="153"
	30477	codeSystem ="2.16.840 .1.113883. 12.292"
	30478	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30479	displayNam e="FLU VAC C CELL CUL T PRSV FRE E"
	30480	>
	30481
	30482	<originalT ext>
	30483
	30484	<reference
	30485	value="#in dImmunizat ion1064"
	30486	/>
	30487
	30488	</original Text>
	30489
	30490	<translati on
	30491	code="9066 1"
	30492	codeSystem ="2.16.840 .1.113883. 6.12"
	30493	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	30494	displayNam e="FLU VAC C CELL CUL T PRSV FRE E"
	30495	/>
	30496
	30497	</code>
	30498
	30499	</manufact uredMateri al>
	30500
	30501	</manufact uredProduc t>
	30502
	30503	</consumab le>
	30504
	30505	<performer >
	30506
	30507	<assignedE ntity>
	30508
	30509	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30510
	30511	<id
	30512	root="2.16 .840.1.113 883.4.349"
	30513	/>
	30514
	30515	<assignedP erson>
	30516
	30517	<!-- CCD P rovider Na me, REQUIR ED -->
	30518
	30519	<name/>
	30520
	30521	</assigned Person>
	30522
	30523	</assigned Entity>
	30524
	30525	</performe r>
	30526
	30527	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30528
	30529	<author>
	30530
	30531	<time
	30532	nullFlavor ="NA"
	30533	/>
	30534
	30535	<assignedA uthor>
	30536
	30537	<id
	30538	nullFlavor ="NA"
	30539	/>
	30540
	30541	<represent edOrganiza tion>
	30542
	30543	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30544	FA CILITY NBR ) -->
	30545
	30546	<id
	30547	extension= "983"
	30548	nullFlavor ="NA"
	30549	/>
	30550
	30551	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30552
	30553	<name>
	30554	CHYSHR TES T LAB
	30555	</name>
	30556
	30557	</represen tedOrganiz ation>
	30558
	30559	</assigned Author>
	30560
	30561	</author>
	30562
	30563
	30564	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30565	immuni zations on ly -->
	30566
	30567	</substanc eAdministr ation>
	30568
	30569	</entry>
	30570	<entry
	30571	typeCode=" DRIV"
	30572	>
	30573
	30574	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30575
	30576	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30577
	30578	<substance Administra tion
	30579	classCode= "SBADM"
	30580	moodCode=" EVN"
	30581	negationIn d="false"
	30582	>
	30583
	30584	<templateI d
	30585	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30586	/>
	30587
	30588	<id
	30589	nullFlavor ="NA"
	30590	/>
	30591
	30592	<text>
	30593
	30594	<reference
	30595	value="#in dComments1 065"
	30596	/>
	30597
	30598	</text>
	30599
	30600	<statusCod e
	30601	code="comp leted"
	30602	/>
	30603
	30604	<effective Time
	30605	value="200 80624"
	30606	/>
	30607
	30608	<repeatNum ber
	30609	nullFlavor ="UNK"
	30610	/>
	30611
	30612	<consumabl e>
	30613
	30614	<manufactu redProduct
	30615	classCode= "MANU"
	30616	>
	30617
	30618	<templateI d
	30619	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30620	/>
	30621
	30622	<manufactu redMateria l>
	30623
	30624	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30625
	30626	<code
	30627	code="121"
	30628	codeSystem ="2.16.840 .1.113883. 12.292"
	30629	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30630	displayNam e="ZOSTER VACC SC"
	30631	>
	30632
	30633	<originalT ext>
	30634
	30635	<reference
	30636	value="#in dImmunizat ion1065"
	30637	/>
	30638
	30639	</original Text>
	30640
	30641	<translati on
	30642	code="9073 6"
	30643	codeSystem ="2.16.840 .1.113883. 6.12"
	30644	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	30645	displayNam e="ZOSTER VACC SC"
	30646	/>
	30647
	30648	</code>
	30649
	30650	</manufact uredMateri al>
	30651
	30652	</manufact uredProduc t>
	30653
	30654	</consumab le>
	30655
	30656	<performer >
	30657
	30658	<assignedE ntity>
	30659
	30660	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30661
	30662	<id
	30663	root="2.16 .840.1.113 883.4.349"
	30664	/>
	30665
	30666	<assignedP erson>
	30667
	30668	<!-- CCD P rovider Na me, REQUIR ED -->
	30669
	30670	<name/>
	30671
	30672	</assigned Person>
	30673
	30674	</assigned Entity>
	30675
	30676	</performe r>
	30677
	30678	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30679
	30680	<author>
	30681
	30682	<time
	30683	nullFlavor ="NA"
	30684	/>
	30685
	30686	<assignedA uthor>
	30687
	30688	<id
	30689	nullFlavor ="NA"
	30690	/>
	30691
	30692	<represent edOrganiza tion>
	30693
	30694	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30695	FA CILITY NBR ) -->
	30696
	30697	<id
	30698	extension= "983"
	30699	nullFlavor ="NA"
	30700	/>
	30701
	30702	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30703
	30704	<name>
	30705	CHYSHR TES T LAB
	30706	</name>
	30707
	30708	</represen tedOrganiz ation>
	30709
	30710	</assigned Author>
	30711
	30712	</author>
	30713
	30714
	30715	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30716	immuni zations on ly -->
	30717
	30718	</substanc eAdministr ation>
	30719
	30720	</entry>
	30721	<entry
	30722	typeCode=" DRIV"
	30723	>
	30724
	30725	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30726
	30727	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30728
	30729	<substance Administra tion
	30730	classCode= "SBADM"
	30731	moodCode=" EVN"
	30732	negationIn d="false"
	30733	>
	30734
	30735	<templateI d
	30736	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30737	/>
	30738
	30739	<id
	30740	nullFlavor ="NA"
	30741	/>
	30742
	30743	<text>
	30744
	30745	<reference
	30746	value="#in dComments1 066"
	30747	/>
	30748
	30749	</text>
	30750
	30751	<statusCod e
	30752	code="comp leted"
	30753	/>
	30754
	30755	<effective Time
	30756	value="200 80612"
	30757	/>
	30758
	30759	<repeatNum ber
	30760	nullFlavor ="UNK"
	30761	/>
	30762
	30763	<consumabl e>
	30764
	30765	<manufactu redProduct
	30766	classCode= "MANU"
	30767	>
	30768
	30769	<templateI d
	30770	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30771	/>
	30772
	30773	<manufactu redMateria l>
	30774
	30775	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30776
	30777	<code
	30778	code="33"
	30779	codeSystem ="2.16.840 .1.113883. 12.292"
	30780	codeSystem Name="Vacc ine Admini stered (CV X code)"
	30781	displayNam e="PNEUMOC OCCAL VACC INE"
	30782	>
	30783
	30784	<originalT ext>
	30785
	30786	<reference
	30787	value="#in dImmunizat ion1066"
	30788	/>
	30789
	30790	</original Text>
	30791
	30792	<translati on
	30793	code="9073 2"
	30794	codeSystem ="2.16.840 .1.113883. 6.12"
	30795	codeSystem Name="Curr ent Proced ural Termi nology (CP T) Fourth Edition (C PT-4)"
	30796	displayNam e="PNEUMOC OCCAL VACC INE"
	30797	/>
	30798
	30799	</code>
	30800
	30801	</manufact uredMateri al>
	30802
	30803	</manufact uredProduc t>
	30804
	30805	</consumab le>
	30806
	30807	<performer >
	30808
	30809	<assignedE ntity>
	30810
	30811	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30812
	30813	<id
	30814	root="2.16 .840.1.113 883.4.349"
	30815	/>
	30816
	30817	<assignedP erson>
	30818
	30819	<!-- CCD P rovider Na me, REQUIR ED -->
	30820
	30821	<name/>
	30822
	30823	</assigned Person>
	30824
	30825	</assigned Entity>
	30826
	30827	</performe r>
	30828
	30829	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30830
	30831	<author>
	30832
	30833	<time
	30834	nullFlavor ="NA"
	30835	/>
	30836
	30837	<assignedA uthor>
	30838
	30839	<id
	30840	nullFlavor ="NA"
	30841	/>
	30842
	30843	<represent edOrganiza tion>
	30844
	30845	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30846	FA CILITY NBR ) -->
	30847
	30848	<id
	30849	extension= "983"
	30850	nullFlavor ="NA"
	30851	/>
	30852
	30853	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30854
	30855	<name>
	30856	CHYSHR TES T LAB
	30857	</name>
	30858
	30859	</represen tedOrganiz ation>
	30860
	30861	</assigned Author>
	30862
	30863	</author>
	30864
	30865
	30866	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	30867	immuni zations on ly -->
	30868
	30869	</substanc eAdministr ation>
	30870
	30871	</entry>
	30872	<entry
	30873	typeCode=" DRIV"
	30874	>
	30875
	30876	<!-- CCD I mmunizatio n Activity Entry, RE QUIRED -->
	30877
	30878	<!-- 13.01 IMMUNIZAT ION REFUSA L (negatio n ind="tru e"), REQUI RED -->
	30879
	30880	<substance Administra tion
	30881	classCode= "SBADM"
	30882	moodCode=" EVN"
	30883	negationIn d="false"
	30884	>
	30885
	30886	<templateI d
	30887	root="2.16 .840.1.113 883.10.20. 22.4.52"
	30888	/>
	30889
	30890	<id
	30891	nullFlavor ="NA"
	30892	/>
	30893
	30894	<text>
	30895
	30896	<reference
	30897	value="#in dComments1 067"
	30898	/>
	30899
	30900	</text>
	30901
	30902	<statusCod e
	30903	code="comp leted"
	30904	/>
	30905
	30906	<effective Time
	30907	value="196 91231"
	30908	/>
	30909
	30910	<repeatNum ber
	30911	nullFlavor ="UNK"
	30912	/>
	30913
	30914	<consumabl e>
	30915
	30916	<manufactu redProduct
	30917	classCode= "MANU"
	30918	>
	30919
	30920	<templateI d
	30921	root="2.16 .840.1.113 883.10.20. 22.4.54"
	30922	/>
	30923
	30924	<manufactu redMateria l>
	30925
	30926	<!-- 13.06 CODED IMM UNIZATION PRODUCT NA ME -->
	30927
	30928	<code
	30929	nullFlavor ="UNK"
	30930	>
	30931
	30932	<originalT ext>
	30933
	30934	<reference
	30935	value="#in dImmunizat ion1067"
	30936	/>
	30937
	30938	</original Text>
	30939
	30940
	30941	</code>
	30942
	30943	</manufact uredMateri al>
	30944
	30945	</manufact uredProduc t>
	30946
	30947	</consumab le>
	30948
	30949	<performer >
	30950
	30951	<assignedE ntity>
	30952
	30953	<!-- CCD P rovider ID , extensio n = VA Pro vider ID, root=VA OI D, REQUIRE D -->
	30954
	30955	<id
	30956	root="2.16 .840.1.113 883.4.349"
	30957	/>
	30958
	30959	<assignedP erson>
	30960
	30961	<!-- CCD P rovider Na me, REQUIR ED -->
	30962
	30963	<name/>
	30964
	30965	</assigned Person>
	30966
	30967	</assigned Entity>
	30968
	30969	</performe r>
	30970
	30971	<!-- INFOR MATION SOU RCE FOR IM MUNIZATION , Optional -->
	30972
	30973	<author>
	30974
	30975	<time
	30976	nullFlavor ="NA"
	30977	/>
	30978
	30979	<assignedA uthor>
	30980
	30981	<id
	30982	nullFlavor ="NA"
	30983	/>
	30984
	30985	<represent edOrganiza tion>
	30986
	30987	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	30988	FA CILITY NBR ) -->
	30989
	30990	<id
	30991	extension= "983"
	30992	nullFlavor ="NA"
	30993	/>
	30994
	30995	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	30996
	30997	<name>
	30998	CHYSHR TES T LAB
	30999	</name>
	31000
	31001	</represen tedOrganiz ation>
	31002
	31003	</assigned Author>
	31004
	31005	</author>
	31006
	31007
	31008	<!-- 13.10 REFUSAL R EASON ENTR Y, Optiona l, VA prov ides admin istered
	31009	immuni zations on ly -->
	31010
	31011	</substanc eAdministr ation>
	31012
	31013	</entry>
	31014
	31015	</section>
	31016
	31017	</componen t>
	31018
	31019	<component >
	31020
	31021	<!-- *** ****** ****** ****** ****** ******** * PROCEDUR ES
	31022	SECTION ****** ****** ****** ****** ****** ** -->
	31023
	31024	<section
	31025	nullFlavor ="NI"
	31026	>
	31027
	31028	<!-- CCD P rocedures Section En tries REQU IRED -->
	31029
	31030	<templateI d
	31031	root="2.16 .840.1.113 883.10.20. 22.2.7.1"
	31032	/>
	31033
	31034	<code
	31035	code="4751 9-4"
	31036	codeSystem ="2.16.840 .1.113883. 6.1"
	31037	codeSystem Name="LOIN C"
	31038	displayNam e="History of Proced ures"
	31039	/>
	31040
	31041	<title>
	31042	History of Procedure s
	31043	</title>
	31044
	31045	<!-- PROCE DURE NARRA TIVE BLOCK -->
	31046
	31047	<text>
	31048	No Data Pr ovided for This Sect ion
	31049	</text>
	31050
	31051	<!-- PROCE DURE STRUC TURED -->
	31052
	31053
	31054	</section>
	31055
	31056	</componen t>
	31057
	31058	<component >
	31059
	31060	<!-- *** ****** ****** ****** ****** ******** * SOCIAL
	31061	HISTORY SE CTION, Opt ional ** ****** ****** ****** ****** ****** -->
	31062
	31063	<section>
	31064
	31065	<!-- CCD S ocial Hist ory Sectio n Entries -->
	31066
	31067	<templateI d
	31068	root="2.16 .840.1.113 883.10.20. 22.2.17"
	31069	/>
	31070
	31071	<code
	31072	code="2976 2-2"
	31073	codeSystem ="2.16.840 .1.113883. 6.1"
	31074	codeSystem Name="LOIN C"
	31075	displayNam e="Social history"
	31076	/>
	31077
	31078	<title>
	31079	Social His tory Secti on
	31080	</title>
	31081
	31082	<text>
	31083
	31084	<!-- VA Pr ocedure Bu siness Rul es for Med ical Conte nt -->
	31085
	31086	<paragraph >
	31087	This secti on display s the smok ing status on record with VA f or
	31088	the patient.
	31089	</paragrap h>
	31090
	31091	<table
	31092	ID="factor sNarrative "
	31093	border="1"
	31094	width="100 %"
	31095	>
	31096
	31097	<thead>
	31098
	31099	<tr>
	31100
	31101	<th>
	31102	Smoking St atus
	31103	</th>
	31104
	31105	<th>
	31106	Comment
	31107	</th>
	31108
	31109	<th>
	31110	Facility
	31111	</th>
	31112
	31113	</tr>
	31114
	31115	</thead>
	31116
	31117	<tbody>
	31118
	31119	<tr>
	31120
	31121	<td>
	31122
	31123	<content
	31124	ID="hfName 1001"
	31125	>
	31126	CURRENT SM OKER
	31127	</content>
	31128
	31129	</td>
	31130
	31131	<td>
	31132
	31133	<content
	31134	ID="hfComm ent1001"
	31135	>
	31136	5/23/2016
	31137	</content>
	31138
	31139	</td>
	31140
	31141	<td>
	31142
	31143	<content
	31144	ID="hfFaci lity1001"
	31145	>
	31146	CHEYENNE V AMC
	31147	</content>
	31148
	31149	</td>
	31150
	31151	</tr>
	31152	<tr>
	31153
	31154	<td>
	31155
	31156	<content
	31157	ID="hfName 1002"
	31158	>
	31159	CURRENT SM OKER
	31160	</content>
	31161
	31162	</td>
	31163
	31164	<td>
	31165
	31166	<content
	31167	ID="hfComm ent1002"
	31168	>
	31169	Entered on 5/20/2016
	31170	</content>
	31171
	31172	</td>
	31173
	31174	<td>
	31175
	31176	<content
	31177	ID="hfFaci lity1002"
	31178	>
	31179	CHEYENNE V AMC
	31180	</content>
	31181
	31182	</td>
	31183
	31184	</tr>
	31185	<tr>
	31186
	31187	<td>
	31188
	31189	<content
	31190	ID="hfName 1003"
	31191	>
	31192	CURRENT SM OKER
	31193	</content>
	31194
	31195	</td>
	31196
	31197	<td>
	31198
	31199	<content
	31200	ID="hfComm ent1003"
	31201	>
	31202	Second ent ry for 5/2 0/2016
	31203	</content>
	31204
	31205	</td>
	31206
	31207	<td>
	31208
	31209	<content
	31210	ID="hfFaci lity1003"
	31211	>
	31212	CHEYENNE V AMC
	31213	</content>
	31214
	31215	</td>
	31216
	31217	</tr>
	31218	<tr>
	31219
	31220	<td>
	31221
	31222	<content
	31223	ID="hfName 1004"
	31224	>
	31225	CURRENT SM OKER
	31226	</content>
	31227
	31228	</td>
	31229
	31230	<td>
	31231
	31232	<content
	31233	ID="hfComm ent1004"
	31234	>
	31235	TESTING C- CDA
	31236	</content>
	31237
	31238	</td>
	31239
	31240	<td>
	31241
	31242	<content
	31243	ID="hfFaci lity1004"
	31244	>
	31245	CHEYENNE V AMC
	31246	</content>
	31247
	31248	</td>
	31249
	31250	</tr>
	31251
	31252	</tbody>
	31253
	31254	</table>
	31255
	31256	</text>
	31257
	31258	<entry>
	31259
	31260	<observati on
	31261	classCode= "OBS"
	31262	moodCode=" EVN"
	31263	>
	31264
	31265	<templateI d
	31266	root="2.16 .840.1.113 883.10.20. 22.4.78"
	31267	/>
	31268
	31269	<templateI d
	31270	root="2.16 .840.1.113 883.10.20. 22.4.85"
	31271	/>
	31272
	31273	<code
	31274	code="ASSE RTION"
	31275	codeSystem ="2.16.840 .1.113883. 5.4"
	31276	/>
	31277
	31278	<statusCod e
	31279	code="comp leted"
	31280	/>
	31281
	31282	<!-- CCD S moking Sta tus Effect ive Time, R2 -->
	31283
	31284	<effective Time
	31285	nullFlavor ="UNK"
	31286	/>
	31287
	31288
	31289
	31290	<!-- CCD S moking Sta tus Value, REQURIED, SNOMED CT -->
	31291
	31292	<value
	31293	code="7717 6002"
	31294	codeSystem ="2.16.840 .1.113883. 6.96"
	31295	codeSystem Name="SNOM ED CT"
	31296	displayNam e="Smoker, current s tatus unkn own"
	31297	xsi:type=" CD"
	31298	>
	31299
	31300	<originalT ext>
	31301	CURRENT SM OKER
	31302	</original Text>
	31303
	31304	</value>
	31305
	31306	<!-- INFOR MATION SOU RCE FOR SM OKING STAT US, Option al -->
	31307
	31308	<author>
	31309
	31310	<time
	31311	nullFlavor ="UNK"
	31312	/>
	31313
	31314	<assignedA uthor>
	31315
	31316	<id
	31317	nullFlavor ="NI"
	31318	/>
	31319
	31320	<assignedP erson>
	31321
	31322	<name/>
	31323
	31324	</assigned Person>
	31325
	31326	<represent edOrganiza tion>
	31327
	31328	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	31329	FA CILITY NBR ) -->
	31330
	31331	<id
	31332	extension= "442"
	31333	root="2.16 .840.1.113 883.4.349"
	31334	/>
	31335
	31336	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	31337
	31338	<name>
	31339	CHEYENNE V AMC
	31340	</name>
	31341
	31342	</represen tedOrganiz ation>
	31343
	31344	</assigned Author>
	31345
	31346	</author>
	31347
	31348	<!-- CCD S moking Sta tus Commen t Entry, O ptional -- >
	31349
	31350	<entryRela tionship
	31351	inversionI nd="true"
	31352	typeCode=" SUBJ"
	31353	>
	31354
	31355	<act
	31356	classCode= "ACT"
	31357	moodCode=" EVN"
	31358	>
	31359
	31360	<templateI d
	31361	root="2.16 .840.1.113 883.10.20. 22.4.64"
	31362	/>
	31363
	31364	<code
	31365	code="4876 7-8"
	31366	codeSystem ="2.16.840 .1.113883. 6.1"
	31367	codeSystem Name="LOIN C"
	31368	displayNam e="Annotat ion commen t"
	31369	/>
	31370
	31371	<!-- CCD S moking Sta tus Commen t, REQUIRE D -->
	31372
	31373	<text>
	31374
	31375	<reference
	31376	value="#hf Comment100 1"
	31377	/>
	31378
	31379	</text>
	31380
	31381	</act>
	31382
	31383	</entryRel ationship>
	31384
	31385	</observat ion>
	31386
	31387	</entry>
	31388	<entry>
	31389
	31390	<observati on
	31391	classCode= "OBS"
	31392	moodCode=" EVN"
	31393	>
	31394
	31395	<templateI d
	31396	root="2.16 .840.1.113 883.10.20. 22.4.78"
	31397	/>
	31398
	31399	<templateI d
	31400	root="2.16 .840.1.113 883.10.20. 22.4.85"
	31401	/>
	31402
	31403	<code
	31404	code="ASSE RTION"
	31405	codeSystem ="2.16.840 .1.113883. 5.4"
	31406	/>
	31407
	31408	<statusCod e
	31409	code="comp leted"
	31410	/>
	31411
	31412	<!-- CCD S moking Sta tus Effect ive Time, R2 -->
	31413
	31414	<effective Time
	31415	nullFlavor ="UNK"
	31416	/>
	31417
	31418
	31419
	31420	<!-- CCD S moking Sta tus Value, REQURIED, SNOMED CT -->
	31421
	31422	<value
	31423	code="7717 6002"
	31424	codeSystem ="2.16.840 .1.113883. 6.96"
	31425	codeSystem Name="SNOM ED CT"
	31426	displayNam e="Smoker, current s tatus unkn own"
	31427	xsi:type=" CD"
	31428	>
	31429
	31430	<originalT ext>
	31431	CURRENT SM OKER
	31432	</original Text>
	31433
	31434	</value>
	31435
	31436	<!-- INFOR MATION SOU RCE FOR SM OKING STAT US, Option al -->
	31437
	31438	<author>
	31439
	31440	<time
	31441	nullFlavor ="UNK"
	31442	/>
	31443
	31444	<assignedA uthor>
	31445
	31446	<id
	31447	nullFlavor ="NI"
	31448	/>
	31449
	31450	<assignedP erson>
	31451
	31452	<name/>
	31453
	31454	</assigned Person>
	31455
	31456	<represent edOrganiza tion>
	31457
	31458	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	31459	FA CILITY NBR ) -->
	31460
	31461	<id
	31462	extension= "442"
	31463	root="2.16 .840.1.113 883.4.349"
	31464	/>
	31465
	31466	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	31467
	31468	<name>
	31469	CHEYENNE V AMC
	31470	</name>
	31471
	31472	</represen tedOrganiz ation>
	31473
	31474	</assigned Author>
	31475
	31476	</author>
	31477
	31478	<!-- CCD S moking Sta tus Commen t Entry, O ptional -- >
	31479
	31480	<entryRela tionship
	31481	inversionI nd="true"
	31482	typeCode=" SUBJ"
	31483	>
	31484
	31485	<act
	31486	classCode= "ACT"
	31487	moodCode=" EVN"
	31488	>
	31489
	31490	<templateI d
	31491	root="2.16 .840.1.113 883.10.20. 22.4.64"
	31492	/>
	31493
	31494	<code
	31495	code="4876 7-8"
	31496	codeSystem ="2.16.840 .1.113883. 6.1"
	31497	codeSystem Name="LOIN C"
	31498	displayNam e="Annotat ion commen t"
	31499	/>
	31500
	31501	<!-- CCD S moking Sta tus Commen t, REQUIRE D -->
	31502
	31503	<text>
	31504
	31505	<reference
	31506	value="#hf Comment100 2"
	31507	/>
	31508
	31509	</text>
	31510
	31511	</act>
	31512
	31513	</entryRel ationship>
	31514
	31515	</observat ion>
	31516
	31517	</entry>
	31518	<entry>
	31519
	31520	<observati on
	31521	classCode= "OBS"
	31522	moodCode=" EVN"
	31523	>
	31524
	31525	<templateI d
	31526	root="2.16 .840.1.113 883.10.20. 22.4.78"
	31527	/>
	31528
	31529	<templateI d
	31530	root="2.16 .840.1.113 883.10.20. 22.4.85"
	31531	/>
	31532
	31533	<code
	31534	code="ASSE RTION"
	31535	codeSystem ="2.16.840 .1.113883. 5.4"
	31536	/>
	31537
	31538	<statusCod e
	31539	code="comp leted"
	31540	/>
	31541
	31542	<!-- CCD S moking Sta tus Effect ive Time, R2 -->
	31543
	31544	<effective Time
	31545	nullFlavor ="UNK"
	31546	/>
	31547
	31548
	31549
	31550	<!-- CCD S moking Sta tus Value, REQURIED, SNOMED CT -->
	31551
	31552	<value
	31553	code="7717 6002"
	31554	codeSystem ="2.16.840 .1.113883. 6.96"
	31555	codeSystem Name="SNOM ED CT"
	31556	displayNam e="Smoker, current s tatus unkn own"
	31557	xsi:type=" CD"
	31558	>
	31559
	31560	<originalT ext>
	31561	CURRENT SM OKER
	31562	</original Text>
	31563
	31564	</value>
	31565
	31566	<!-- INFOR MATION SOU RCE FOR SM OKING STAT US, Option al -->
	31567
	31568	<author>
	31569
	31570	<time
	31571	nullFlavor ="UNK"
	31572	/>
	31573
	31574	<assignedA uthor>
	31575
	31576	<id
	31577	nullFlavor ="NI"
	31578	/>
	31579
	31580	<assignedP erson>
	31581
	31582	<name/>
	31583
	31584	</assigned Person>
	31585
	31586	<represent edOrganiza tion>
	31587
	31588	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	31589	FA CILITY NBR ) -->
	31590
	31591	<id
	31592	extension= "442"
	31593	root="2.16 .840.1.113 883.4.349"
	31594	/>
	31595
	31596	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	31597
	31598	<name>
	31599	CHEYENNE V AMC
	31600	</name>
	31601
	31602	</represen tedOrganiz ation>
	31603
	31604	</assigned Author>
	31605
	31606	</author>
	31607
	31608	<!-- CCD S moking Sta tus Commen t Entry, O ptional -- >
	31609
	31610	<entryRela tionship
	31611	inversionI nd="true"
	31612	typeCode=" SUBJ"
	31613	>
	31614
	31615	<act
	31616	classCode= "ACT"
	31617	moodCode=" EVN"
	31618	>
	31619
	31620	<templateI d
	31621	root="2.16 .840.1.113 883.10.20. 22.4.64"
	31622	/>
	31623
	31624	<code
	31625	code="4876 7-8"
	31626	codeSystem ="2.16.840 .1.113883. 6.1"
	31627	codeSystem Name="LOIN C"
	31628	displayNam e="Annotat ion commen t"
	31629	/>
	31630
	31631	<!-- CCD S moking Sta tus Commen t, REQUIRE D -->
	31632
	31633	<text>
	31634
	31635	<reference
	31636	value="#hf Comment100 3"
	31637	/>
	31638
	31639	</text>
	31640
	31641	</act>
	31642
	31643	</entryRel ationship>
	31644
	31645	</observat ion>
	31646
	31647	</entry>
	31648	<entry>
	31649
	31650	<observati on
	31651	classCode= "OBS"
	31652	moodCode=" EVN"
	31653	>
	31654
	31655	<templateI d
	31656	root="2.16 .840.1.113 883.10.20. 22.4.78"
	31657	/>
	31658
	31659	<templateI d
	31660	root="2.16 .840.1.113 883.10.20. 22.4.85"
	31661	/>
	31662
	31663	<code
	31664	code="ASSE RTION"
	31665	codeSystem ="2.16.840 .1.113883. 5.4"
	31666	/>
	31667
	31668	<statusCod e
	31669	code="comp leted"
	31670	/>
	31671
	31672	<!-- CCD S moking Sta tus Effect ive Time, R2 -->
	31673
	31674	<effective Time
	31675	nullFlavor ="UNK"
	31676	/>
	31677
	31678
	31679
	31680	<!-- CCD S moking Sta tus Value, REQURIED, SNOMED CT -->
	31681
	31682	<value
	31683	code="7717 6002"
	31684	codeSystem ="2.16.840 .1.113883. 6.96"
	31685	codeSystem Name="SNOM ED CT"
	31686	displayNam e="Smoker, current s tatus unkn own"
	31687	xsi:type=" CD"
	31688	>
	31689
	31690	<originalT ext>
	31691	CURRENT SM OKER
	31692	</original Text>
	31693
	31694	</value>
	31695
	31696	<!-- INFOR MATION SOU RCE FOR SM OKING STAT US, Option al -->
	31697
	31698	<author>
	31699
	31700	<time
	31701	nullFlavor ="UNK"
	31702	/>
	31703
	31704	<assignedA uthor>
	31705
	31706	<id
	31707	nullFlavor ="NI"
	31708	/>
	31709
	31710	<assignedP erson>
	31711
	31712	<name/>
	31713
	31714	</assigned Person>
	31715
	31716	<represent edOrganiza tion>
	31717
	31718	<!-- INFOR MATION SOU RCE FACILI TY OID (ID = VA OID, EXT = TRE ATING
	31719	FA CILITY NBR ) -->
	31720
	31721	<id
	31722	extension= "442"
	31723	root="2.16 .840.1.113 883.4.349"
	31724	/>
	31725
	31726	<!-- INFOR MATION SOU RCE FACILI TY NAME (f acilityNam e) -->
	31727
	31728	<name>
	31729	CHEYENNE V AMC
	31730	</name>
	31731
	31732	</represen tedOrganiz ation>
	31733
	31734	</assigned Author>
	31735
	31736	</author>
	31737
	31738	<!-- CCD S moking Sta tus Commen t Entry, O ptional -- >
	31739
	31740	<entryRela tionship
	31741	inversionI nd="true"
	31742	typeCode=" SUBJ"
	31743	>
	31744
	31745	<act
	31746	classCode= "ACT"
	31747	moodCode=" EVN"
	31748	>
	31749
	31750	<templateI d
	31751	root="2.16 .840.1.113 883.10.20. 22.4.64"
	31752	/>
	31753
	31754	<code
	31755	code="4876 7-8"
	31756	codeSystem ="2.16.840 .1.113883. 6.1"
	31757	codeSystem Name="LOIN C"
	31758	displayNam e="Annotat ion commen t"
	31759	/>
	31760
	31761	<!-- CCD S moking Sta tus Commen t, REQUIRE D -->
	31762
	31763	<text>
	31764
	31765	<reference
	31766	value="#hf Comment100 4"
	31767	/>
	31768
	31769	</text>
	31770
	31771	</act>
	31772
	31773	</entryRel ationship>
	31774
	31775	</observat ion>
	31776
	31777	</entry>
	31778
	31779	</section>
	31780
	31781	</componen t>
	31782
	31783	<component >
	31784
	31785	<!-- *** ****** ****** ****** ****** ******** * PLAN OF
	31786	CARE SECTI ON, Option al ***** ****** ****** ****** ****** ******* -->
	31787
	31788	<section>
	31789
	31790	<!-- CCD P lan of Car e Section Entries -- >
	31791
	31792	<templateI d
	31793	root="2.16 .840.1.113 883.10.20. 22.2.10"
	31794	/>
	31795
	31796	<code
	31797	code="1877 6-5"
	31798	codeSystem ="2.16.840 .1.113883. 6.1"
	31799	codeSystem Name="LOIN C"
	31800	displayNam e="Treatme nt plan"
	31801	/>
	31802
	31803	<title>
	31804	Treatment Plan
	31805	</title>
	31806
	31807	<text>
	31808
	31809	<paragraph >
	31810	This secti on contain s future c are activi ties for t he patient from all VA treatme nt facilit ies. Plan of Care in cludes fut ure appoin tments, ac tive and p ending rad iology ord ers, and a ctive and pending ch emistry/he matology o rders.
	31811	</paragrap h>
	31812
	31813	<table
	31814	ID="future Appointmen tsRules"
	31815	border="1"
	31816	width="100 %"
	31817	>
	31818
	31819	<thead>
	31820
	31821	<tr>
	31822
	31823	<th>
	31824	Future App ointments
	31825	</th>
	31826
	31827	</tr>
	31828
	31829	</thead>
	31830
	31831	<tbody>
	31832
	31833	<tr>
	31834
	31835	<td>
	31836	This secti on display s appointm ents sched uled in th e next 12
	31837	months up to a maxim um of 50 a ppointment s. Patient s may have
	31838	recurring appointmen ts, with m ultiple in stances of the same
	31839	appointmen t. Not all appointme nts are do cumented b ased upon
	31840	variabilit y in workf lows
	31841	from facil ity to fac ility. As a result, all future appointme nts
	31842	may not be included.
	31843
	31844	</td>
	31845
	31846	</tr>
	31847
	31848	</tbody>
	31849
	31850	</table>
	31851
	31852	<table
	31853	ID="future Appointmen ts"
	31854	border="1"
	31855	width="100 %"
	31856	>
	31857
	31858	<thead>
	31859
	31860	<tr>
	31861
	31862	<th>
	31863	Appointmen t Date/Tim e
	31864	</th>
	31865
	31866	<th>
	31867	Appointmen t Type
	31868	</th>
	31869
	31870	<th>
	31871	Appointmen t Facility Name
	31872	</th>
	31873
	31874	</tr>
	31875
	31876	</thead>
	31877
	31878	<tbody>
	31879
	31880	<tr>
	31881
	31882	<td
	31883	ID="apptDa teTime1001 "
	31884	>
	31885	May 15, 20 17, 09:00 AM
	31886	</td>
	31887
	31888	<td>
	31889
	31890	<content
	31891	ID="conten tType1001"
	31892	>
	31893	AMBULATORY - MEDICIN E
	31894	</content>
	31895
	31896	</td>
	31897
	31898	<td>
	31899
	31900	<content
	31901	ID="orderD etails1001 "
	31902	>
	31903	DAYTON
	31904	</content>
	31905
	31906	</td>
	31907
	31908	</tr>
	31909	<tr>
	31910
	31911	<td
	31912	ID="apptDa teTime1002 "
	31913	>
	31914	Jan 19, 20 17, 04:15 PM
	31915	</td>
	31916
	31917	<td>
	31918
	31919	<content
	31920	ID="conten tType1002"
	31921	>
	31922	AMBULATORY - NONE
	31923	</content>
	31924
	31925	</td>
	31926
	31927	<td>
	31928
	31929	<content
	31930	ID="orderD etails1002 "
	31931	>
	31932	DAYTON
	31933	</content>
	31934
	31935	</td>
	31936
	31937	</tr>
	31938
	31939	</tbody>
	31940
	31941	</table>
	31942
	31943
	31944
	31945
	31946
	31947
	31948
	31949	</text>
	31950
	31951	<!-- PLAN OF CARE (P OC) STRUCT URED DATA -->
	31952
	31953	<!-- CCD P lan of Car e (POC) Ac tivity Enc ounter (Fu ture VA Ap pointments ,
	31954	Fu ture Sched uled Tests , Wellness Reminders ), Optiona l -->
	31955
	31956	<entry>
	31957
	31958	<encounter
	31959	classCode= "ENC"
	31960	moodCode=" INT"
	31961	>
	31962
	31963	<templateI d
	31964	root="2.16 .840.1.113 883.10.20. 22.4.40"
	31965	/>
	31966
	31967	<id
	31968	nullFlavor ="UNK"
	31969	root="2.16 .840.1.113 883.4.349"
	31970	/>
	31971
	31972	<code>
	31973
	31974	<originalT ext>
	31975
	31976	<reference
	31977	value="#co ntentType1 001"
	31978	/>
	31979
	31980	</original Text>
	31981
	31982	</code>
	31983
	31984	<text/>
	31985
	31986	<statusCod e
	31987	code="SCHE DULED/KEPT "
	31988	/>
	31989
	31990	<effective Time>
	31991
	31992	<center
	31993	value="201 7051509"
	31994	/>
	31995
	31996	</effectiv eTime>
	31997
	31998	<performer >
	31999
	32000	<assignedE ntity>
	32001
	32002	<id
	32003	extension= "35294"
	32004	root="2.16 .840.1.113 883.4.349"
	32005	/>
	32006
	32007	<assignedP erson>
	32008
	32009	<name>
	32010	BENNETT,JA MIE
	32011	</name>
	32012
	32013	</assigned Person>
	32014
	32015	</assigned Entity>
	32016
	32017	</performe r>
	32018
	32019	<author>
	32020
	32021	<time
	32022	nullFlavor ="UNK"
	32023	/>
	32024
	32025	<assignedA uthor>
	32026
	32027	<id
	32028	nullFlavor ="UNK"
	32029	/>
	32030
	32031
	32032	<represent edOrganiza tion>
	32033
	32034	<id
	32035	extension= "552"
	32036	root="2.16 .840.1.113 883.4.349"
	32037	/>
	32038
	32039	<name>
	32040	DAYTON
	32041	</name>
	32042
	32043	</represen tedOrganiz ation>
	32044
	32045	</assigned Author>
	32046
	32047	</author>
	32048
	32049
	32050
	32051
	32052	</encounte r>
	32053
	32054	</entry>
	32055	<entry>
	32056
	32057	<encounter
	32058	classCode= "ENC"
	32059	moodCode=" INT"
	32060	>
	32061
	32062	<templateI d
	32063	root="2.16 .840.1.113 883.10.20. 22.4.40"
	32064	/>
	32065
	32066	<id
	32067	nullFlavor ="UNK"
	32068	root="2.16 .840.1.113 883.4.349"
	32069	/>
	32070
	32071	<code>
	32072
	32073	<originalT ext>
	32074
	32075	<reference
	32076	value="#co ntentType1 002"
	32077	/>
	32078
	32079	</original Text>
	32080
	32081	</code>
	32082
	32083	<text/>
	32084
	32085	<statusCod e
	32086	code="SCHE DULED/KEPT "
	32087	/>
	32088
	32089	<effective Time>
	32090
	32091	<center
	32092	value="201 701191615"
	32093	/>
	32094
	32095	</effectiv eTime>
	32096
	32097	<performer >
	32098
	32099	<assignedE ntity>
	32100
	32101	<id
	32102	extension= "814"
	32103	root="2.16 .840.1.113 883.4.349"
	32104	/>
	32105
	32106	<assignedP erson>
	32107
	32108	<name>
	32109	LAMBERT,PA UL M
	32110	</name>
	32111
	32112	</assigned Person>
	32113
	32114	</assigned Entity>
	32115
	32116	</performe r>
	32117
	32118	<author>
	32119
	32120	<time
	32121	nullFlavor ="UNK"
	32122	/>
	32123
	32124	<assignedA uthor>
	32125
	32126	<id
	32127	nullFlavor ="UNK"
	32128	/>
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	32130
	32131	<represent edOrganiza tion>
	32132
	32133	<id
	32134	extension= "552"
	32135	root="2.16 .840.1.113 883.4.349"
	32136	/>
	32137
	32138	<name>
	32139	DAYTON
	32140	</name>
	32141
	32142	</represen tedOrganiz ation>
	32143
	32144	</assigned Author>
	32145
	32146	</author>
	32147
	32148
	32149
	32150
	32151	</encounte r>
	32152
	32153	</entry>
	32154
	32155	</section>
	32156
	32157	</componen t>
	32158
	32159
	32160	<!-- ***** FUNCTIONA L STATUS, Optional * ********** * -->
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	32162	<component >
	32163
	32164	<section
	32165	nullFlavor ="NI"
	32166	>
	32167
	32168	<templateI d
	32169	root="2.16 .840.1.113 883.10.20. 22.2.14"
	32170	/>
	32171
	32172	<code
	32173	code="4742 0-5"
	32174	codeSystem ="2.16.840 .1.113883. 6.1"
	32175	codeSystem Name="LOIN C"
	32176	displayNam e="Functio nal status assessmen t note"
	32177	/>
	32178
	32179	<title>
	32180	Functional Status
	32181	</title>
	32182
	32183	<text>
	32184	No Data Pr ovided for This Sect ion
	32185	</text>
	32186
	32187	<!-- FUNC TIONAL STA TUS STRUCT URED ENTRI ES -->
	32188
	32189	<entry
	32190	typeCode=" DRIV"
	32191	>
	32192
	32193	<organizer
	32194	classCode= "CLUSTER"
	32195	moodCode=" EVN"
	32196	>
	32197
	32198	<!-- ** Functional Status Re sult Organ izer templ ate ** - ->
	32199
	32200	<templateI d
	32201	root="2.16 .840.1.113 883.10.20. 22.4.66"
	32202	/>
	32203
	32204	<id
	32205	nullFlavor ="UNK"
	32206	root="2.16 .840.1.113 883.4.349"
	32207	/>
	32208
	32209	<!-- Funct ional Stat us Result Organizer Code, ICF or SNOMED CT, FIM A ssessment Type -->
	32210
	32211	<code
	32212	nullFlavor ="UNK"
	32213	>
	32214
	32215	<originalT ext>
	32216
	32217	<reference
	32218	value="#fi mAssessmen t"
	32219	/>
	32220
	32221	</original Text>
	32222
	32223	</code>
	32224
	32225	<statusCod e
	32226	code="comp leted"
	32227	/>
	32228
	32229	<!-- Func tional Sta tus Result Organizer Date/Time , FIM Asse ssment Dat e -->
	32230
	32231	<effective Time>
	32232
	32233	<low
	32234	value="ass essTime"
	32235	/>
	32236
	32237	</effectiv eTime>
	32238
	32239	<!-- * Inf ormation S ource for Functional Status, V A Facility -->
	32240
	32241	<author>
	32242
	32243	<time
	32244	nullFlavor ="NA"
	32245	/>
	32246
	32247	<assignedA uthor>
	32248
	32249	<id
	32250	nullFlavor ="NA"
	32251	/>
	32252
	32253	<represent edOrganiza tion>
	32254
	32255	<id
	32256	extension= "442"
	32257	root="2.16 .840.1.113 883.3.1275 "
	32258	/>
	32259
	32260	<name>
	32261	CHEYENNE V AMC
	32262	</name>
	32263
	32264	</represen tedOrganiz ation>
	32265
	32266	</assigned Author>
	32267
	32268	</author>
	32269
	32270	<component >
	32271
	32272	<!-- Funct ional Stat us Result Observatio n -->
	32273
	32274	<observati on
	32275	classCode= "OBS"
	32276	moodCode=" EVN"
	32277	>
	32278
	32279	<templateI d
	32280	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32281	/>
	32282
	32283	<!-- Funct ional Stat us Result Observatio n ID -->
	32284
	32285	<id
	32286	nullFlavor ="UNK"
	32287	root="2.16 .840.1.113 883.4.349"
	32288	/>
	32289
	32290	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32291
	32292	<code
	32293	nullFlavor ="UNK"
	32294	/>
	32295
	32296	<text>
	32297
	32298	<reference
	32299	value="#fi mEatName"
	32300	/>
	32301
	32302	</text>
	32303
	32304	<statusCod e
	32305	code="comp leted"
	32306	/>
	32307
	32308	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32309
	32310	<effective Time>
	32311
	32312	<low
	32313	value="ski llTime"
	32314	/>
	32315
	32316	</effectiv eTime>
	32317
	32318	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32319
	32320	<value
	32321	nullFlavor ="NA"
	32322	xsi:type=" CD"
	32323	>
	32324
	32325	<originalT ext>
	32326
	32327	<reference
	32328	value="#fi mEat"
	32329	/>
	32330
	32331	</original Text>
	32332
	32333	</value>
	32334
	32335	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32336
	32337	<entryRela tionship
	32338	inversionI nd="true"
	32339	typeCode=" SUBJ"
	32340	>
	32341
	32342	<act
	32343	classCode= "ACT"
	32344	moodCode=" EVN"
	32345	>
	32346
	32347	<templateI d
	32348	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32349	/>
	32350
	32351	<code
	32352	code="4876 7-8"
	32353	codeSystem ="2.16.840 .1.113883. 6.1"
	32354	codeSystem Name="LOIN C"
	32355	displayNam e="Annotat ion commen t"
	32356	/>
	32357
	32358	<text>
	32359
	32360	<reference
	32361	value="#fi mEatDetail "
	32362	/>
	32363
	32364	</text>
	32365
	32366	</act>
	32367
	32368	</entryRel ationship>
	32369
	32370	</observat ion>
	32371
	32372	</componen t>
	32373
	32374	<component >
	32375
	32376	<!-- Funct ional Stat us Result Observatio n -->
	32377
	32378	<observati on
	32379	classCode= "OBS"
	32380	moodCode=" EVN"
	32381	>
	32382
	32383	<templateI d
	32384	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32385	/>
	32386
	32387	<!-- Funct ional Stat us Result Observatio n ID -->
	32388
	32389	<id
	32390	nullFlavor ="UNK"
	32391	root="2.16 .840.1.113 883.4.349"
	32392	/>
	32393
	32394	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32395
	32396	<code
	32397	nullFlavor ="UNK"
	32398	/>
	32399
	32400	<text>
	32401
	32402	<reference
	32403	value="#fi mGroomName "
	32404	/>
	32405
	32406	</text>
	32407
	32408	<statusCod e
	32409	code="comp leted"
	32410	/>
	32411
	32412	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32413
	32414	<effective Time>
	32415
	32416	<low
	32417	value="ski llTime"
	32418	/>
	32419
	32420	</effectiv eTime>
	32421
	32422	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32423
	32424	<value
	32425	nullFlavor ="NA"
	32426	xsi:type=" CD"
	32427	>
	32428
	32429	<originalT ext>
	32430
	32431	<reference
	32432	value="#fi mGroom"
	32433	/>
	32434
	32435	</original Text>
	32436
	32437	</value>
	32438
	32439	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32440
	32441	<entryRela tionship
	32442	inversionI nd="true"
	32443	typeCode=" SUBJ"
	32444	>
	32445
	32446	<act
	32447	classCode= "ACT"
	32448	moodCode=" EVN"
	32449	>
	32450
	32451	<templateI d
	32452	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32453	/>
	32454
	32455	<code
	32456	code="4876 7-8"
	32457	codeSystem ="2.16.840 .1.113883. 6.1"
	32458	codeSystem Name="LOIN C"
	32459	displayNam e="Annotat ion commen t"
	32460	/>
	32461
	32462	<text>
	32463
	32464	<reference
	32465	value="#fi mGroomDeta il"
	32466	/>
	32467
	32468	</text>
	32469
	32470	</act>
	32471
	32472	</entryRel ationship>
	32473
	32474	</observat ion>
	32475
	32476	</componen t>
	32477
	32478	<component >
	32479
	32480	<!-- Funct ional Stat us Result Observatio n -->
	32481
	32482	<observati on
	32483	classCode= "OBS"
	32484	moodCode=" EVN"
	32485	>
	32486
	32487	<templateI d
	32488	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32489	/>
	32490
	32491	<!-- Funct ional Stat us Result Observatio n ID -->
	32492
	32493	<id
	32494	nullFlavor ="UNK"
	32495	root="2.16 .840.1.113 883.4.349"
	32496	/>
	32497
	32498	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32499
	32500	<code
	32501	nullFlavor ="UNK"
	32502	/>
	32503
	32504	<text>
	32505
	32506	<reference
	32507	value="#fi mBathName"
	32508	/>
	32509
	32510	</text>
	32511
	32512	<statusCod e
	32513	code="comp leted"
	32514	/>
	32515
	32516	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32517
	32518	<effective Time>
	32519
	32520	<low
	32521	value="ski llTime"
	32522	/>
	32523
	32524	</effectiv eTime>
	32525
	32526	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32527
	32528	<value
	32529	nullFlavor ="NA"
	32530	xsi:type=" CD"
	32531	>
	32532
	32533	<originalT ext>
	32534
	32535	<reference
	32536	value="#fi mBath"
	32537	/>
	32538
	32539	</original Text>
	32540
	32541	</value>
	32542
	32543	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32544
	32545	<entryRela tionship
	32546	inversionI nd="true"
	32547	typeCode=" SUBJ"
	32548	>
	32549
	32550	<act
	32551	classCode= "ACT"
	32552	moodCode=" EVN"
	32553	>
	32554
	32555	<templateI d
	32556	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32557	/>
	32558
	32559	<code
	32560	code="4876 7-8"
	32561	codeSystem ="2.16.840 .1.113883. 6.1"
	32562	codeSystem Name="LOIN C"
	32563	displayNam e="Annotat ion commen t"
	32564	/>
	32565
	32566	<text>
	32567
	32568	<reference
	32569	value="#fi mBathDetai l"
	32570	/>
	32571
	32572	</text>
	32573
	32574	</act>
	32575
	32576	</entryRel ationship>
	32577
	32578	</observat ion>
	32579
	32580	</componen t>
	32581
	32582	<component >
	32583
	32584	<!-- Funct ional Stat us Result Observatio n -->
	32585
	32586	<observati on
	32587	classCode= "OBS"
	32588	moodCode=" EVN"
	32589	>
	32590
	32591	<templateI d
	32592	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32593	/>
	32594
	32595	<!-- Funct ional Stat us Result Observatio n ID -->
	32596
	32597	<id
	32598	nullFlavor ="UNK"
	32599	root="2.16 .840.1.113 883.4.349"
	32600	/>
	32601
	32602	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32603
	32604	<code
	32605	nullFlavor ="UNK"
	32606	/>
	32607
	32608	<text>
	32609
	32610	<reference
	32611	value="#fi mDressUpNa me"
	32612	/>
	32613
	32614	</text>
	32615
	32616	<statusCod e
	32617	code="comp leted"
	32618	/>
	32619
	32620	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32621
	32622	<effective Time>
	32623
	32624	<low
	32625	value="ski llTime"
	32626	/>
	32627
	32628	</effectiv eTime>
	32629
	32630	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32631
	32632	<value
	32633	nullFlavor ="NA"
	32634	xsi:type=" CD"
	32635	>
	32636
	32637	<originalT ext>
	32638
	32639	<reference
	32640	value="#fi mDressUp"
	32641	/>
	32642
	32643	</original Text>
	32644
	32645	</value>
	32646
	32647	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32648
	32649	<entryRela tionship
	32650	inversionI nd="true"
	32651	typeCode=" SUBJ"
	32652	>
	32653
	32654	<act
	32655	classCode= "ACT"
	32656	moodCode=" EVN"
	32657	>
	32658
	32659	<templateI d
	32660	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32661	/>
	32662
	32663	<code
	32664	code="4876 7-8"
	32665	codeSystem ="2.16.840 .1.113883. 6.1"
	32666	codeSystem Name="LOIN C"
	32667	displayNam e="Annotat ion commen t"
	32668	/>
	32669
	32670	<text>
	32671
	32672	<reference
	32673	value="#fi mDressUpDe tail"
	32674	/>
	32675
	32676	</text>
	32677
	32678	</act>
	32679
	32680	</entryRel ationship>
	32681
	32682	</observat ion>
	32683
	32684	</componen t>
	32685
	32686	<component >
	32687
	32688	<!-- Funct ional Stat us Result Observatio n -->
	32689
	32690	<observati on
	32691	classCode= "OBS"
	32692	moodCode=" EVN"
	32693	>
	32694
	32695	<templateI d
	32696	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32697	/>
	32698
	32699	<!-- Funct ional Stat us Result Observatio n ID -->
	32700
	32701	<id
	32702	nullFlavor ="UNK"
	32703	root="2.16 .840.1.113 883.4.349"
	32704	/>
	32705
	32706	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32707
	32708	<code
	32709	nullFlavor ="UNK"
	32710	/>
	32711
	32712	<text>
	32713
	32714	<reference
	32715	value="#fi mDressLoNa me"
	32716	/>
	32717
	32718	</text>
	32719
	32720	<statusCod e
	32721	code="comp leted"
	32722	/>
	32723
	32724	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32725
	32726	<effective Time>
	32727
	32728	<low
	32729	value="ski llTime"
	32730	/>
	32731
	32732	</effectiv eTime>
	32733
	32734	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32735
	32736	<value
	32737	nullFlavor ="NA"
	32738	xsi:type=" CD"
	32739	>
	32740
	32741	<originalT ext>
	32742
	32743	<reference
	32744	value="#fi mDressLo"
	32745	/>
	32746
	32747	</original Text>
	32748
	32749	</value>
	32750
	32751	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32752
	32753	<entryRela tionship
	32754	inversionI nd="true"
	32755	typeCode=" SUBJ"
	32756	>
	32757
	32758	<act
	32759	classCode= "ACT"
	32760	moodCode=" EVN"
	32761	>
	32762
	32763	<templateI d
	32764	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32765	/>
	32766
	32767	<code
	32768	code="4876 7-8"
	32769	codeSystem ="2.16.840 .1.113883. 6.1"
	32770	codeSystem Name="LOIN C"
	32771	displayNam e="Annotat ion commen t"
	32772	/>
	32773
	32774	<text>
	32775
	32776	<reference
	32777	value="#fi mDressLoDe tail"
	32778	/>
	32779
	32780	</text>
	32781
	32782	</act>
	32783
	32784	</entryRel ationship>
	32785
	32786	</observat ion>
	32787
	32788	</componen t>
	32789
	32790	<component >
	32791
	32792	<!-- Funct ional Stat us Result Observatio n -->
	32793
	32794	<observati on
	32795	classCode= "OBS"
	32796	moodCode=" EVN"
	32797	>
	32798
	32799	<templateI d
	32800	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32801	/>
	32802
	32803	<!-- Funct ional Stat us Result Observatio n ID -->
	32804
	32805	<id
	32806	nullFlavor ="UNK"
	32807	root="2.16 .840.1.113 883.4.349"
	32808	/>
	32809
	32810	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32811
	32812	<code
	32813	nullFlavor ="UNK"
	32814	/>
	32815
	32816	<text>
	32817
	32818	<reference
	32819	value="#fi mToiletNam e"
	32820	/>
	32821
	32822	</text>
	32823
	32824	<statusCod e
	32825	code="comp leted"
	32826	/>
	32827
	32828	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32829
	32830	<effective Time>
	32831
	32832	<low
	32833	value="ski llTime"
	32834	/>
	32835
	32836	</effectiv eTime>
	32837
	32838	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32839
	32840	<value
	32841	nullFlavor ="NA"
	32842	xsi:type=" CD"
	32843	>
	32844
	32845	<originalT ext>
	32846
	32847	<reference
	32848	value="#fi mToilet"
	32849	/>
	32850
	32851	</original Text>
	32852
	32853	</value>
	32854
	32855	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32856
	32857	<entryRela tionship
	32858	inversionI nd="true"
	32859	typeCode=" SUBJ"
	32860	>
	32861
	32862	<act
	32863	classCode= "ACT"
	32864	moodCode=" EVN"
	32865	>
	32866
	32867	<templateI d
	32868	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32869	/>
	32870
	32871	<code
	32872	code="4876 7-8"
	32873	codeSystem ="2.16.840 .1.113883. 6.1"
	32874	codeSystem Name="LOIN C"
	32875	displayNam e="Annotat ion commen t"
	32876	/>
	32877
	32878	<text>
	32879
	32880	<reference
	32881	value="#fi mToiletDet ail"
	32882	/>
	32883
	32884	</text>
	32885
	32886	</act>
	32887
	32888	</entryRel ationship>
	32889
	32890	</observat ion>
	32891
	32892	</componen t>
	32893
	32894	<component >
	32895
	32896	<!-- Funct ional Stat us Result Observatio n -->
	32897
	32898	<observati on
	32899	classCode= "OBS"
	32900	moodCode=" EVN"
	32901	>
	32902
	32903	<templateI d
	32904	root="2.16 .840.1.113 883.10.20. 22.4.67"
	32905	/>
	32906
	32907	<!-- Funct ional Stat us Result Observatio n ID -->
	32908
	32909	<id
	32910	nullFlavor ="UNK"
	32911	root="2.16 .840.1.113 883.4.349"
	32912	/>
	32913
	32914	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	32915
	32916	<code
	32917	nullFlavor ="UNK"
	32918	/>
	32919
	32920	<text>
	32921
	32922	<reference
	32923	value="#fi mBladderNa me"
	32924	/>
	32925
	32926	</text>
	32927
	32928	<statusCod e
	32929	code="comp leted"
	32930	/>
	32931
	32932	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	32933
	32934	<effective Time>
	32935
	32936	<low
	32937	value="ski llTime"
	32938	/>
	32939
	32940	</effectiv eTime>
	32941
	32942	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	32943
	32944	<value
	32945	nullFlavor ="NA"
	32946	xsi:type=" CD"
	32947	>
	32948
	32949	<originalT ext>
	32950
	32951	<reference
	32952	value="#fi mBladder"
	32953	/>
	32954
	32955	</original Text>
	32956
	32957	</value>
	32958
	32959	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	32960
	32961	<entryRela tionship
	32962	inversionI nd="true"
	32963	typeCode=" SUBJ"
	32964	>
	32965
	32966	<act
	32967	classCode= "ACT"
	32968	moodCode=" EVN"
	32969	>
	32970
	32971	<templateI d
	32972	root="2.16 .840.1.113 883.10.20. 22.4.64"
	32973	/>
	32974
	32975	<code
	32976	code="4876 7-8"
	32977	codeSystem ="2.16.840 .1.113883. 6.1"
	32978	codeSystem Name="LOIN C"
	32979	displayNam e="Annotat ion commen t"
	32980	/>
	32981
	32982	<text>
	32983
	32984	<reference
	32985	value="#fi mBladderDe tail"
	32986	/>
	32987
	32988	</text>
	32989
	32990	</act>
	32991
	32992	</entryRel ationship>
	32993
	32994	</observat ion>
	32995
	32996	</componen t>
	32997
	32998	<component >
	32999
	33000	<!-- Funct ional Stat us Result Observatio n -->
	33001
	33002	<observati on
	33003	classCode= "OBS"
	33004	moodCode=" EVN"
	33005	>
	33006
	33007	<templateI d
	33008	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33009	/>
	33010
	33011	<!-- Funct ional Stat us Result Observatio n ID -->
	33012
	33013	<id
	33014	nullFlavor ="UNK"
	33015	root="2.16 .840.1.113 883.4.349"
	33016	/>
	33017
	33018	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33019
	33020	<code
	33021	nullFlavor ="UNK"
	33022	/>
	33023
	33024	<text>
	33025
	33026	<reference
	33027	value="#fi mBowelName "
	33028	/>
	33029
	33030	</text>
	33031
	33032	<statusCod e
	33033	code="comp leted"
	33034	/>
	33035
	33036	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33037
	33038	<effective Time>
	33039
	33040	<low
	33041	value="ski llTime"
	33042	/>
	33043
	33044	</effectiv eTime>
	33045
	33046	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33047
	33048	<value
	33049	nullFlavor ="NA"
	33050	xsi:type=" CD"
	33051	>
	33052
	33053	<originalT ext>
	33054
	33055	<reference
	33056	value="#fi mBowel"
	33057	/>
	33058
	33059	</original Text>
	33060
	33061	</value>
	33062
	33063	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33064
	33065	<entryRela tionship
	33066	inversionI nd="true"
	33067	typeCode=" SUBJ"
	33068	>
	33069
	33070	<act
	33071	classCode= "ACT"
	33072	moodCode=" EVN"
	33073	>
	33074
	33075	<templateI d
	33076	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33077	/>
	33078
	33079	<code
	33080	code="4876 7-8"
	33081	codeSystem ="2.16.840 .1.113883. 6.1"
	33082	codeSystem Name="LOIN C"
	33083	displayNam e="Annotat ion commen t"
	33084	/>
	33085
	33086	<text>
	33087
	33088	<reference
	33089	value="#fi mBowelDeta il"
	33090	/>
	33091
	33092	</text>
	33093
	33094	</act>
	33095
	33096	</entryRel ationship>
	33097
	33098	</observat ion>
	33099
	33100	</componen t>
	33101
	33102	<component >
	33103
	33104	<!-- Funct ional Stat us Result Observatio n -->
	33105
	33106	<observati on
	33107	classCode= "OBS"
	33108	moodCode=" EVN"
	33109	>
	33110
	33111	<templateI d
	33112	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33113	/>
	33114
	33115	<!-- Funct ional Stat us Result Observatio n ID -->
	33116
	33117	<id
	33118	nullFlavor ="UNK"
	33119	root="2.16 .840.1.113 883.4.349"
	33120	/>
	33121
	33122	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33123
	33124	<code
	33125	nullFlavor ="UNK"
	33126	/>
	33127
	33128	<text>
	33129
	33130	<reference
	33131	value="#fi mTransChai rName"
	33132	/>
	33133
	33134	</text>
	33135
	33136	<statusCod e
	33137	code="comp leted"
	33138	/>
	33139
	33140	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33141
	33142	<effective Time>
	33143
	33144	<low
	33145	value="ski llTime"
	33146	/>
	33147
	33148	</effectiv eTime>
	33149
	33150	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33151
	33152	<value
	33153	nullFlavor ="NA"
	33154	xsi:type=" CD"
	33155	>
	33156
	33157	<originalT ext>
	33158
	33159	<reference
	33160	value="#fi mTransChai r"
	33161	/>
	33162
	33163	</original Text>
	33164
	33165	</value>
	33166
	33167	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33168
	33169	<entryRela tionship
	33170	inversionI nd="true"
	33171	typeCode=" SUBJ"
	33172	>
	33173
	33174	<act
	33175	classCode= "ACT"
	33176	moodCode=" EVN"
	33177	>
	33178
	33179	<templateI d
	33180	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33181	/>
	33182
	33183	<code
	33184	code="4876 7-8"
	33185	codeSystem ="2.16.840 .1.113883. 6.1"
	33186	codeSystem Name="LOIN C"
	33187	displayNam e="Annotat ion commen t"
	33188	/>
	33189
	33190	<text>
	33191
	33192	<reference
	33193	value="#fi mTransChai rDetail"
	33194	/>
	33195
	33196	</text>
	33197
	33198	</act>
	33199
	33200	</entryRel ationship>
	33201
	33202	</observat ion>
	33203
	33204	</componen t>
	33205
	33206	<component >
	33207
	33208	<!-- Funct ional Stat us Result Observatio n -->
	33209
	33210	<observati on
	33211	classCode= "OBS"
	33212	moodCode=" EVN"
	33213	>
	33214
	33215	<templateI d
	33216	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33217	/>
	33218
	33219	<!-- Funct ional Stat us Result Observatio n ID -->
	33220
	33221	<id
	33222	nullFlavor ="UNK"
	33223	root="2.16 .840.1.113 883.4.349"
	33224	/>
	33225
	33226	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33227
	33228	<code
	33229	nullFlavor ="UNK"
	33230	/>
	33231
	33232	<text>
	33233
	33234	<reference
	33235	value="#fi mTransToil etName"
	33236	/>
	33237
	33238	</text>
	33239
	33240	<statusCod e
	33241	code="comp leted"
	33242	/>
	33243
	33244	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33245
	33246	<effective Time>
	33247
	33248	<low
	33249	value="ski llTime"
	33250	/>
	33251
	33252	</effectiv eTime>
	33253
	33254	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33255
	33256	<value
	33257	nullFlavor ="NA"
	33258	xsi:type=" CD"
	33259	>
	33260
	33261	<originalT ext>
	33262
	33263	<reference
	33264	value="#fi mTransToil et"
	33265	/>
	33266
	33267	</original Text>
	33268
	33269	</value>
	33270
	33271	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33272
	33273	<entryRela tionship
	33274	inversionI nd="true"
	33275	typeCode=" SUBJ"
	33276	>
	33277
	33278	<act
	33279	classCode= "ACT"
	33280	moodCode=" EVN"
	33281	>
	33282
	33283	<templateI d
	33284	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33285	/>
	33286
	33287	<code
	33288	code="4876 7-8"
	33289	codeSystem ="2.16.840 .1.113883. 6.1"
	33290	codeSystem Name="LOIN C"
	33291	displayNam e="Annotat ion commen t"
	33292	/>
	33293
	33294	<text>
	33295
	33296	<reference
	33297	value="#fi mTransToil etDetail"
	33298	/>
	33299
	33300	</text>
	33301
	33302	</act>
	33303
	33304	</entryRel ationship>
	33305
	33306	</observat ion>
	33307
	33308	</componen t>
	33309
	33310	<component >
	33311
	33312	<!-- Funct ional Stat us Result Observatio n -->
	33313
	33314	<observati on
	33315	classCode= "OBS"
	33316	moodCode=" EVN"
	33317	>
	33318
	33319	<templateI d
	33320	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33321	/>
	33322
	33323	<!-- Funct ional Stat us Result Observatio n ID -->
	33324
	33325	<id
	33326	nullFlavor ="UNK"
	33327	root="2.16 .840.1.113 883.4.349"
	33328	/>
	33329
	33330	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33331
	33332	<code
	33333	nullFlavor ="UNK"
	33334	/>
	33335
	33336	<text>
	33337
	33338	<reference
	33339	value="#fi mTransTubN ame"
	33340	/>
	33341
	33342	</text>
	33343
	33344	<statusCod e
	33345	code="comp leted"
	33346	/>
	33347
	33348	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33349
	33350	<effective Time>
	33351
	33352	<low
	33353	value="ski llTime"
	33354	/>
	33355
	33356	</effectiv eTime>
	33357
	33358	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33359
	33360	<value
	33361	nullFlavor ="NA"
	33362	xsi:type=" CD"
	33363	>
	33364
	33365	<originalT ext>
	33366
	33367	<reference
	33368	value="#fi mTransTub"
	33369	/>
	33370
	33371	</original Text>
	33372
	33373	</value>
	33374
	33375	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33376
	33377	<entryRela tionship
	33378	inversionI nd="true"
	33379	typeCode=" SUBJ"
	33380	>
	33381
	33382	<act
	33383	classCode= "ACT"
	33384	moodCode=" EVN"
	33385	>
	33386
	33387	<templateI d
	33388	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33389	/>
	33390
	33391	<code
	33392	code="4876 7-8"
	33393	codeSystem ="2.16.840 .1.113883. 6.1"
	33394	codeSystem Name="LOIN C"
	33395	displayNam e="Annotat ion commen t"
	33396	/>
	33397
	33398	<text>
	33399
	33400	<reference
	33401	value="#fi mTransTubD etail"
	33402	/>
	33403
	33404	</text>
	33405
	33406	</act>
	33407
	33408	</entryRel ationship>
	33409
	33410	</observat ion>
	33411
	33412	</componen t>
	33413
	33414	<component >
	33415
	33416	<!-- Funct ional Stat us Result Observatio n -->
	33417
	33418	<observati on
	33419	classCode= "OBS"
	33420	moodCode=" EVN"
	33421	>
	33422
	33423	<templateI d
	33424	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33425	/>
	33426
	33427	<!-- Funct ional Stat us Result Observatio n ID -->
	33428
	33429	<id
	33430	nullFlavor ="UNK"
	33431	root="2.16 .840.1.113 883.4.349"
	33432	/>
	33433
	33434	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33435
	33436	<code
	33437	nullFlavor ="UNK"
	33438	/>
	33439
	33440	<text>
	33441
	33442	<reference
	33443	value="#fi mLocomWalk Name"
	33444	/>
	33445
	33446	</text>
	33447
	33448	<statusCod e
	33449	code="comp leted"
	33450	/>
	33451
	33452	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33453
	33454	<effective Time>
	33455
	33456	<low
	33457	value="ski llTime"
	33458	/>
	33459
	33460	</effectiv eTime>
	33461
	33462	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33463
	33464	<value
	33465	nullFlavor ="NA"
	33466	xsi:type=" CD"
	33467	>
	33468
	33469	<originalT ext>
	33470
	33471	<reference
	33472	value="#fi mLocomWalk "
	33473	/>
	33474
	33475	</original Text>
	33476
	33477	</value>
	33478
	33479	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33480
	33481	<entryRela tionship
	33482	inversionI nd="true"
	33483	typeCode=" SUBJ"
	33484	>
	33485
	33486	<act
	33487	classCode= "ACT"
	33488	moodCode=" EVN"
	33489	>
	33490
	33491	<templateI d
	33492	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33493	/>
	33494
	33495	<code
	33496	code="4876 7-8"
	33497	codeSystem ="2.16.840 .1.113883. 6.1"
	33498	codeSystem Name="LOIN C"
	33499	displayNam e="Annotat ion commen t"
	33500	/>
	33501
	33502	<text>
	33503
	33504	<reference
	33505	value="#fi mLocomWalk Detail"
	33506	/>
	33507
	33508	</text>
	33509
	33510	</act>
	33511
	33512	</entryRel ationship>
	33513
	33514	</observat ion>
	33515
	33516	</componen t>
	33517
	33518	<component >
	33519
	33520	<!-- Funct ional Stat us Result Observatio n -->
	33521
	33522	<observati on
	33523	classCode= "OBS"
	33524	moodCode=" EVN"
	33525	>
	33526
	33527	<templateI d
	33528	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33529	/>
	33530
	33531	<!-- Funct ional Stat us Result Observatio n ID -->
	33532
	33533	<id
	33534	nullFlavor ="UNK"
	33535	root="2.16 .840.1.113 883.4.349"
	33536	/>
	33537
	33538	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33539
	33540	<code
	33541	nullFlavor ="UNK"
	33542	/>
	33543
	33544	<text>
	33545
	33546	<reference
	33547	value="#fi mLocomStai rName"
	33548	/>
	33549
	33550	</text>
	33551
	33552	<statusCod e
	33553	code="comp leted"
	33554	/>
	33555
	33556	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33557
	33558	<effective Time>
	33559
	33560	<low
	33561	value="ski llTime"
	33562	/>
	33563
	33564	</effectiv eTime>
	33565
	33566	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33567
	33568	<value
	33569	nullFlavor ="NA"
	33570	xsi:type=" CD"
	33571	>
	33572
	33573	<originalT ext>
	33574
	33575	<reference
	33576	value="#fi mLocomStai r"
	33577	/>
	33578
	33579	</original Text>
	33580
	33581	</value>
	33582
	33583	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33584
	33585	<entryRela tionship
	33586	inversionI nd="true"
	33587	typeCode=" SUBJ"
	33588	>
	33589
	33590	<act
	33591	classCode= "ACT"
	33592	moodCode=" EVN"
	33593	>
	33594
	33595	<templateI d
	33596	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33597	/>
	33598
	33599	<code
	33600	code="4876 7-8"
	33601	codeSystem ="2.16.840 .1.113883. 6.1"
	33602	codeSystem Name="LOIN C"
	33603	displayNam e="Annotat ion commen t"
	33604	/>
	33605
	33606	<text>
	33607
	33608	<reference
	33609	value="#fi mLocomStai rDetail"
	33610	/>
	33611
	33612	</text>
	33613
	33614	</act>
	33615
	33616	</entryRel ationship>
	33617
	33618	</observat ion>
	33619
	33620	</componen t>
	33621
	33622	<component >
	33623
	33624	<!-- Funct ional Stat us Result Observatio n -->
	33625
	33626	<observati on
	33627	classCode= "OBS"
	33628	moodCode=" EVN"
	33629	>
	33630
	33631	<templateI d
	33632	root="2.16 .840.1.113 883.10.20. 22.4.67"
	33633	/>
	33634
	33635	<!-- Funct ional Stat us Result Observatio n ID -->
	33636
	33637	<id
	33638	nullFlavor ="UNK"
	33639	root="2.16 .840.1.113 883.4.349"
	33640	/>
	33641
	33642	<!-- Func tional Sta tus Result Observati on Code, I CF or SNOM ED CT, FIM Skill -- >
	33643
	33644	<code
	33645	nullFlavor ="UNK"
	33646	/>
	33647
	33648	<text>
	33649
	33650	<reference
	33651	value="#fi mComprehen dName"
	33652	/>
	33653
	33654	</text>
	33655
	33656	<statusCod e
	33657	code="comp leted"
	33658	/>
	33659
	33660	<!-- Funct ional Stat us Result Observatio n Date/Tim e, FIM Ass essment Da te/Time -- >
	33661
	33662	<effective Time>
	33663
	33664	<low
	33665	value="ski llTime"
	33666	/>
	33667
	33668	</effectiv eTime>
	33669
	33670	<!-- Func tional Sta tus Result Observati on Date/Ti me, FIM Sk ill Score -->
	33671
	33672	<value
	33673	nullFlavor ="NA"
	33674	xsi:type=" CD"
	33675	>
	33676
	33677	<originalT ext>
	33678
	33679	<reference
	33680	value="#fi mComprehen d"
	33681	/>
	33682
	33683	</original Text>
	33684
	33685	</value>
	33686
	33687	<!-- Func tional Sta tus Result Observati on Comment , FIM Deta ils -->
	33688
	33689	<entryRela tionship
	33690	inversionI nd="true"
	33691	typeCode=" SUBJ"
	33692	>
	33693
	33694	<act
	33695	classCode= "ACT"
	33696	moodCode=" EVN"
	33697	>
	33698
	33699	<templateI d
	33700	root="2.16 .840.1.113 883.10.20. 22.4.64"
	33701	/>
	33702
	33703	<code
	33704	code="4876 7-8"
	33705	codeSystem ="2.16.840 .1.113883. 6.1"
	33706	codeSystem Name="LOIN C"
	33707	displayNam e="Annotat ion commen t"
	33708	/>
	33709
	33710	<text>
	33711
	33712	<reference
	33713	value="#fi mComprehen dDetail"
	33714	/>
	33715
	33716	</text>
	33717
	33718	</act>
	33719
	33720	</entryRel ationship>
	33721
	33722	</observat ion>
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