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| # | 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\KAISER PERMANENTE | 374358_C32_20161201.xml | Thu Jan 12 19:48:34 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\KAISER PERMANENTE | 374358_C32_20161201.xml | Mon Apr 3 14:15:16 2017 UTC |
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| Character case | Differences in character case are significant |
| Line endings | Differences in line endings (CR and LF characters) are ignored |
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| 1 | <?xml | |
| 2 | version="1 .0" | |
| 3 | encoding=" UTF-8" | |
| 4 | ?> | |
| 5 | <ClinicalD ocument | |
| 6 | xmlns="urn :hl7-org:v 3" | |
| 7 | > | |
| 8 | <realmCode | |
| 9 | code="US" | |
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| 11 | <typeId | |
| 12 | extension= "POCD_HD00 0040" | |
| 13 | root="2.16 .840.1.113 883.1.3" | |
| 14 | /> | |
| 15 | <templateI d | |
| 16 | root="1.2. 840.114350 .1.72.1.51 693" | |
| 17 | /> | |
| 18 | <templateI d | |
| 19 | root="2.16 .840.1.113 883.10" | |
| 20 | extension= "IMPL_CDAR 2_LEVEL1" | |
| 21 | /> | |
| 22 | <templateI d | |
| 23 | root="2.16 .840.1.113 883.10.20. 3" | |
| 24 | /> | |
| 25 | <templateI d | |
| 26 | root="2.16 .840.1.113 883.10.20. 1" | |
| 27 | /> | |
| 28 | <templateI d | |
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| 30 | /> | |
| 31 | <templateI d | |
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| 37 | <templateI d | |
| 38 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.1.1" | |
| 39 | /> | |
| 40 | <id | |
| 41 | assigningA uthorityNa me="EPC" | |
| 42 | root="1.2. 840.114350 .1.13.119. 3.7.8.6888 83.4954608 " | |
| 43 | /> | |
| 44 | <code | |
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| 47 | codeSystem Name="LOIN C" | |
| 48 | displayNam e="Summari zation of Episode No te" | |
| 49 | /> | |
| 50 | <title> | |
| 51 | Continuity of Care D ocument | |
| 52 | </title> | |
| 53 | <effective Time | |
| 54 | value="201 6120113551 6-0800" | |
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| 59 | /> | |
| 60 | <languageC ode | |
| 61 | code="en-U S" | |
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| 63 | <setId | |
| 64 | assigningA uthorityNa me="EPC" | |
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| 66 | root="1.2. 840.114350 .1.13.119. 3.7.1.1" | |
| 67 | /> | |
| 68 | <versionNu mber | |
| 69 | value="193 " | |
| 70 | /> | |
| 71 | <recordTar get> | |
| 72 | <patientRo le> | |
| 73 | <id | |
| 74 | root="1.2. 840.114350 .1.13.119. 3.7.3.6888 84.100" | |
| 75 | extension= "KW2000240 0" | |
| 76 | /> | |
| 77 | <addr | |
| 78 | use="HP" | |
| 79 | > | |
| 80 | <streetAdd ressLine> | |
| 81 | 1100 Test Street | |
| 82 | </streetAd dressLine> | |
| 83 | <city> | |
| 84 | HELENA | |
| 85 | </city> | |
| 86 | <state> | |
| 87 | AL | |
| 88 | </state> | |
| 89 | <postalCod e> | |
| 90 | 35080 | |
| 91 | </postalCo de> | |
| 92 | <country> | |
| 93 | USA | |
| 94 | </country> | |
| 95 | </addr> | |
| 96 | <telecom | |
| 97 | use="HP" | |
| 98 | value="tel :+12051111 111" | |
| 99 | /> | |
| 100 | <telecom | |
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| 102 | value="tel :+14154755 555" | |
| 103 | /> | |
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| 105 | <name | |
| 106 | use="L" | |
| 107 | > | |
| 108 | <given> | |
| 109 | Nwhinone | |
| 110 | </given> | |
| 111 | <family> | |
| 112 | Nwhinzzzte stpatient | |
| 113 | </family> | |
| 114 | </name> | |
| 115 | <name | |
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| 118 | <given | |
| 119 | nullFlavor ="NA" | |
| 120 | /> | |
| 121 | <family> | |
| 122 | Witsgg2 | |
| 123 | </family> | |
| 124 | </name> | |
| 125 | <administr ativeGende rCode | |
| 126 | code="M" | |
| 127 | codeSystem ="2.16.840 .1.113883. 5.1" | |
| 128 | codeSystem Name="Admi nistrative GenderCode " | |
| 129 | displayNam e="Male" | |
| 130 | /> | |
| 131 | <birthTime | |
| 132 | value="198 10101" | |
| 133 | /> | |
| 134 | <maritalSt atusCode | |
| 135 | code="M" | |
| 136 | codeSystem ="2.16.840 .1.113883. 5.2" | |
| 137 | codeSystem Name="Mari talStatusC ode" | |
| 138 | displayNam e="Married " | |
| 139 | /> | |
| 140 | <raceCode | |
| 141 | code="2106 -3" | |
| 142 | codeSystem ="2.16.840 .1.113883. 6.238" | |
| 143 | codeSystem Name="CDC Race and E thnicity" | |
| 144 | displayNam e="White" | |
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| 146 | <ethnicGro upCode | |
| 147 | codeSystem ="2.16.840 .1.113883. 6.238" | |
| 148 | codeSystem Name="CDC Race and E thnicity" | |
| 149 | nullFlavor ="UNK" | |
| 150 | /> | |
| 151 | <languageC ommunicati on> | |
| 152 | <languageC ode | |
| 153 | code="eng" | |
| 154 | /> | |
| 155 | <modeCode | |
| 156 | code="ESP" | |
| 157 | codeSystem ="2.16.840 .1.113883. 5.60" | |
| 158 | displayNam e="Express ed Spoken" | |
| 159 | /> | |
| 160 | <preferenc eInd | |
| 161 | value="tru e" | |
| 162 | /> | |
| 163 | </language Communicat ion> | |
| 164 | <languageC ommunicati on> | |
| 165 | <languageC ode | |
| 166 | code="eng" | |
| 167 | /> | |
| 168 | <modeCode | |
| 169 | code="EWR" | |
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| 173 | <preferenc eInd | |
| 174 | value="tru e" | |
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| 176 | </language Communicat ion> | |
| 177 | </patient> | |
| 178 | <providerO rganizatio n> | |
| 179 | <id | |
| 180 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 181 | extension= "159" | |
| 182 | /> | |
| 183 | <name> | |
| 184 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 185 | </name> | |
| 186 | <telecom | |
| 187 | use="WP" | |
| 188 | value="tel :+19569876 543" | |
| 189 | /> | |
| 190 | <addr | |
| 191 | nullFlavor ="NA" | |
| 192 | > | |
| 193 | <city> | |
| 194 | Oakland | |
| 195 | </city> | |
| 196 | <state> | |
| 197 | CA | |
| 198 | </state> | |
| 199 | <postalCod e> | |
| 200 | 94607 | |
| 201 | </postalCo de> | |
| 202 | <country> | |
| 203 | USA | |
| 204 | </country> | |
| 205 | </addr> | |
| 206 | </provider Organizati on> | |
| 207 | </patientR ole> | |
| 208 | </recordTa rget> | |
| 209 | <author> | |
| 210 | <time | |
| 211 | value="201 6120113551 6" | |
| 212 | /> | |
| 213 | <assignedA uthor> | |
| 214 | <id | |
| 215 | nullFlavor ="NA" | |
| 216 | /> | |
| 217 | <addr | |
| 218 | nullFlavor ="NA" | |
| 219 | > | |
| 220 | <streetAdd ressLine | |
| 221 | nullFlavor ="UNK" | |
| 222 | /> | |
| 223 | <city | |
| 224 | nullFlavor ="UNK" | |
| 225 | /> | |
| 226 | </addr> | |
| 227 | <telecom | |
| 228 | nullFlavor ="NA" | |
| 229 | /> | |
| 230 | <assignedP erson> | |
| 231 | <name | |
| 232 | nullFlavor ="NA" | |
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| 235 | <represent edOrganiza tion> | |
| 236 | <id | |
| 237 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 238 | extension= "159" | |
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| 240 | <name> | |
| 241 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 242 | </name> | |
| 243 | <telecom | |
| 244 | use="WP" | |
| 245 | value="tel :+19569876 543" | |
| 246 | /> | |
| 247 | <addr | |
| 248 | nullFlavor ="NA" | |
| 249 | > | |
| 250 | <city> | |
| 251 | Oakland | |
| 252 | </city> | |
| 253 | <state> | |
| 254 | CA | |
| 255 | </state> | |
| 256 | <postalCod e> | |
| 257 | 94607 | |
| 258 | </postalCo de> | |
| 259 | <country> | |
| 260 | USA | |
| 261 | </country> | |
| 262 | </addr> | |
| 263 | </represen tedOrganiz ation> | |
| 264 | </assigned Author> | |
| 265 | </author> | |
| 266 | <author> | |
| 267 | <time | |
| 268 | value="201 6120113551 6" | |
| 269 | /> | |
| 270 | <assignedA uthor> | |
| 271 | <id | |
| 272 | root="1.2. 840.114350 .1.1" | |
| 273 | extension= "8.1" | |
| 274 | /> | |
| 275 | <addr | |
| 276 | nullFlavor ="NA" | |
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| 278 | <streetAdd ressLine | |
| 279 | nullFlavor ="UNK" | |
| 280 | /> | |
| 281 | <city | |
| 282 | nullFlavor ="UNK" | |
| 283 | /> | |
| 284 | </addr> | |
| 285 | <telecom | |
| 286 | nullFlavor ="NA" | |
| 287 | /> | |
| 288 | <assignedA uthoringDe vice> | |
| 289 | <manufactu rerModelNa me> | |
| 290 | Epic - Ver sion 8.1 | |
| 291 | </manufact urerModelN ame> | |
| 292 | <softwareN ame> | |
| 293 | Epic - Ver sion 8.1 | |
| 294 | </software Name> | |
| 295 | </assigned AuthoringD evice> | |
| 296 | <represent edOrganiza tion> | |
| 297 | <id | |
| 298 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 299 | extension= "159" | |
| 300 | /> | |
| 301 | <name> | |
| 302 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 303 | </name> | |
| 304 | <telecom | |
| 305 | use="WP" | |
| 306 | value="tel :+19569876 543" | |
| 307 | /> | |
| 308 | <addr | |
| 309 | nullFlavor ="NA" | |
| 310 | > | |
| 311 | <city> | |
| 312 | Oakland | |
| 313 | </city> | |
| 314 | <state> | |
| 315 | CA | |
| 316 | </state> | |
| 317 | <postalCod e> | |
| 318 | 94607 | |
| 319 | </postalCo de> | |
| 320 | <country> | |
| 321 | USA | |
| 322 | </country> | |
| 323 | </addr> | |
| 324 | </represen tedOrganiz ation> | |
| 325 | </assigned Author> | |
| 326 | </author> | |
| 327 | <custodian > | |
| 328 | <assignedC ustodian> | |
| 329 | <represent edCustodia nOrganizat ion> | |
| 330 | <id | |
| 331 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 332 | extension= "159" | |
| 333 | /> | |
| 334 | <name> | |
| 335 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 336 | </name> | |
| 337 | <telecom | |
| 338 | use="WP" | |
| 339 | value="tel :+19569876 543" | |
| 340 | /> | |
| 341 | <addr | |
| 342 | nullFlavor ="NA" | |
| 343 | > | |
| 344 | <city> | |
| 345 | Oakland | |
| 346 | </city> | |
| 347 | <state> | |
| 348 | CA | |
| 349 | </state> | |
| 350 | <postalCod e> | |
| 351 | 94607 | |
| 352 | </postalCo de> | |
| 353 | <country> | |
| 354 | USA | |
| 355 | </country> | |
| 356 | </addr> | |
| 357 | </represen tedCustodi anOrganiza tion> | |
| 358 | </assigned Custodian> | |
| 359 | </custodia n> | |
| 360 | <relatedDo cument | |
| 361 | typeCode=" RPLC" | |
| 362 | > | |
| 363 | <parentDoc ument> | |
| 364 | <id | |
| 365 | assigningA uthorityNa me="EPC" | |
| 366 | root="1.2. 840.114350 .1.13.119. 3.7.8.6888 83.4954606 " | |
| 367 | /> | |
| 368 | </parentDo cument> | |
| 369 | </relatedD ocument> | |
| 370 | <component > | |
| 371 | <structure dBody> | |
| 372 | <component > | |
| 373 | <section> | |
| 374 | <code | |
| 375 | code="X-DO CCMT" | |
| 376 | displayNam e="Documen t Comments " | |
| 377 | /> | |
| 378 | <title> | |
| 379 | Source Com ments | |
| 380 | </title> | |
| 381 | <text> | |
| 382 | NOTE: The informati on display ed by Care Epic is e xtracted f rom the co mplete med ical recor d and may not identi fy all cur rent or pa st patient condition s. See bel ow for fur ther instr uctions re garding Me ntal Healt h and CDRP patients. | |
| 383 | <footnote> | |
| 384 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 385 | </footnote > | |
| 386 | </text> | |
| 387 | </section> | |
| 388 | </componen t> | |
| 389 | <component > | |
| 390 | <section> | |
| 391 | <templateI d | |
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| 393 | /> | |
| 394 | <templateI d | |
| 395 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.3.13" | |
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| 397 | <templateI d | |
| 398 | root="2.16 .840.1.113 883.3.88.1 1.83.102" | |
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| 400 | <id | |
| 401 | root="D849 3EC6-B810- 11E6-B9F0- EC029123A2 3B" | |
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| 403 | <code | |
| 404 | code="4876 5-2" | |
| 405 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 406 | codeSystem Name="LOIN C" | |
| 407 | displayNam e="Allergi es, Advers e Reaction s, Alerts" | |
| 408 | /> | |
| 409 | <title> | |
| 410 | Active All ergies and Adverse R eactions | |
| 411 | </title> | |
| 412 | <text> | |
| 413 | <table> | |
| 414 | <colgroup> | |
| 415 | <col | |
| 416 | width="25% " | |
| 417 | /> | |
| 418 | <col | |
| 419 | width="13% " | |
| 420 | /> | |
| 421 | <col | |
| 422 | width="12% " | |
| 423 | /> | |
| 424 | <col | |
| 425 | width="25% " | |
| 426 | /> | |
| 427 | <col | |
| 428 | width="25% " | |
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| 430 | </colgroup > | |
| 431 | <thead> | |
| 432 | <tr> | |
| 433 | <th> | |
| 434 | Allergen | |
| 435 | </th> | |
| 436 | <th> | |
| 437 | Noted Date | |
| 438 | </th> | |
| 439 | <th> | |
| 440 | Severity | |
| 441 | </th> | |
| 442 | <th> | |
| 443 | Reactions | |
| 444 | </th> | |
| 445 | <th> | |
| 446 | Comments | |
| 447 | </th> | |
| 448 | </tr> | |
| 449 | </thead> | |
| 450 | <tbody> | |
| 451 | <tr | |
| 452 | ID="allerg y2" | |
| 453 | > | |
| 454 | <td | |
| 455 | ID="allerg y2allergen " | |
| 456 | > | |
| 457 | Peanut - D ietary | |
| 458 | </td> | |
| 459 | <td | |
| 460 | ID="allerg y2noted" | |
| 461 | > | |
| 462 | 05/18/2016 | |
| 463 | </td> | |
| 464 | <td | |
| 465 | ID="allerg y2severity " | |
| 466 | > | |
| 467 | High | |
| 468 | </td> | |
| 469 | <td> | |
| 470 | <content | |
| 471 | ID="allerg y2reaction 1" | |
| 472 | > | |
| 473 | Seizures | |
| 474 | </content> | |
| 475 | </td> | |
| 476 | <td | |
| 477 | ID="allerg y2comments " | |
| 478 | /> | |
| 479 | </tr> | |
| 480 | <tr | |
| 481 | ID="allerg y3" | |
| 482 | > | |
| 483 | <td | |
| 484 | ID="allerg y3allergen " | |
| 485 | > | |
| 486 | Pollen | |
| 487 | </td> | |
| 488 | <td | |
| 489 | ID="allerg y3noted" | |
| 490 | > | |
| 491 | 06/18/2015 | |
| 492 | </td> | |
| 493 | <td | |
| 494 | ID="allerg y3severity " | |
| 495 | > | |
| 496 | Medium | |
| 497 | </td> | |
| 498 | <td> | |
| 499 | <content | |
| 500 | ID="allerg y3reaction 1" | |
| 501 | > | |
| 502 | Sneezing | |
| 503 | </content> | |
| 504 | </td> | |
| 505 | <td | |
| 506 | ID="allerg y3comments " | |
| 507 | /> | |
| 508 | </tr> | |
| 509 | </tbody> | |
| 510 | </table> | |
| 511 | </text> | |
| 512 | <entry> | |
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| 514 | classCode= "ACT" | |
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| 542 | <effective Time> | |
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| 546 | </effectiv eTime> | |
| 547 | <entryRela tionship | |
| 548 | inversionI nd="false" | |
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| 551 | <observati on | |
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| 567 | extension= "allergy" | |
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| 579 | codeSystem Name="SNOM ED CT" | |
| 580 | displayNam e="Drug Al lergy" | |
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| 582 | <text> | |
| 583 | <reference | |
| 584 | value="#al lergy2" | |
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| 586 | </text> | |
| 587 | <statusCod e | |
| 588 | code="comp leted" | |
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| 590 | <effective Time> | |
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| 594 | <high | |
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| 1181 | <th> | |
| 1182 | Disp. | |
| 1183 | </th> | |
| 1184 | <th> | |
| 1185 | Refills | |
| 1186 | </th> | |
| 1187 | <th> | |
| 1188 | Start Date | |
| 1189 | </th> | |
| 1190 | <th> | |
| 1191 | End Date | |
| 1192 | </th> | |
| 1193 | <th> | |
| 1194 | Status | |
| 1195 | </th> | |
| 1196 | </tr> | |
| 1197 | </thead> | |
| 1198 | <tbody> | |
| 1199 | <tr | |
| 1200 | ID="currx4 " | |
| 1201 | > | |
| 1202 | <td | |
| 1203 | ID="med4" | |
| 1204 | > | |
| 1205 | metFORMIN (GLUCOPHAG E XR) 500 mg Oral 24 hr SR Tab | |
| 1206 | </td> | |
| 1207 | <td | |
| 1208 | ID="sig4" | |
| 1209 | > | |
| 1210 | TAKE 1 TAB LET ORALLY DAILY WIT H EVENING MEAL | |
| 1211 | </td> | |
| 1212 | <td> | |
| 1213 | <paragraph > | |
| 1214 | 100 | |
| 1215 | </paragrap h> | |
| 1216 | </td> | |
| 1217 | <td> | |
| 1218 | 3 | |
| 1219 | </td> | |
| 1220 | <td> | |
| 1221 | 06/18/2015 | |
| 1222 | </td> | |
| 1223 | <td /> | |
| 1224 | <td> | |
| 1225 | Active | |
| 1226 | </td> | |
| 1227 | </tr> | |
| 1228 | </tbody> | |
| 1229 | </table> | |
| 1230 | </text> | |
| 1231 | <entry> | |
| 1232 | <substance Administra tion | |
| 1233 | classCode= "SBADM" | |
| 1234 | moodCode=" INT" | |
| 1235 | > | |
| 1236 | <templateI d | |
| 1237 | root="2.16 .840.1.113 883.10.20. 1.24" | |
| 1238 | /> | |
| 1239 | <templateI d | |
| 1240 | root="2.16 .840.1.113 883.3.88.1 1.83.8" | |
| 1241 | /> | |
| 1242 | <templateI d | |
| 1243 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.7" | |
| 1244 | /> | |
| 1245 | <templateI d | |
| 1246 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.7.1" | |
| 1247 | /> | |
| 1248 | <templateI d | |
| 1249 | root="2.16 .840.1.113 883.3.88.1 1.32.8" | |
| 1250 | /> | |
| 1251 | <id | |
| 1252 | root="1.2. 840.114350 .1.13.119. 3.7.2.7982 68" | |
| 1253 | extension= "531707760 " | |
| 1254 | /> | |
| 1255 | <text | |
| 1256 | mediaType= "text/xml" | |
| 1257 | > | |
| 1258 | <reference | |
| 1259 | value="#si g4" | |
| 1260 | /> | |
| 1261 | </text> | |
| 1262 | <statusCod e | |
| 1263 | code="comp leted" | |
| 1264 | /> | |
| 1265 | <effective Time | |
| 1266 | xsi:type=" IVL_TS" | |
| 1267 | xmlns:xsi= "http://ww w.w3.org/2 001/XMLSch ema-instan ce" | |
| 1268 | > | |
| 1269 | <low | |
| 1270 | value="201 50618" | |
| 1271 | /> | |
| 1272 | <high | |
| 1273 | nullFlavor ="UNK" | |
| 1274 | /> | |
| 1275 | </effectiv eTime> | |
| 1276 | <routeCode | |
| 1277 | code="C382 88" | |
| 1278 | codeSystem ="2.16.840 .1.113883. 3.26.1.1" | |
| 1279 | codeSystem Name="NCI Thesaurus" | |
| 1280 | displayNam e="Oral" | |
| 1281 | /> | |
| 1282 | <consumabl e | |
| 1283 | typeCode=" CSM" | |
| 1284 | > | |
| 1285 | <manufactu redProduct | |
| 1286 | classCode= "MANU" | |
| 1287 | > | |
| 1288 | <templateI d | |
| 1289 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.7.2" | |
| 1290 | /> | |
| 1291 | <templateI d | |
| 1292 | root="2.16 .840.1.113 883.10.20. 1.53" | |
| 1293 | /> | |
| 1294 | <templateI d | |
| 1295 | root="2.16 .840.1.113 883.3.88.1 1.32.9" | |
| 1296 | /> | |
| 1297 | <templateI d | |
| 1298 | root="2.16 .840.1.113 883.3.88.1 1.83.8.2" | |
| 1299 | /> | |
| 1300 | <templateI d | |
| 1301 | root="2.16 .840.1.113 883.3.249. 11.100.13" | |
| 1302 | /> | |
| 1303 | <manufactu redMateria l> | |
| 1304 | <code | |
| 1305 | code="8609 75" | |
| 1306 | codeSystem ="2.16.840 .1.113883. 6.88" | |
| 1307 | codeSystem Name="RxNo rm" | |
| 1308 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1309 | > | |
| 1310 | <originalT ext> | |
| 1311 | <reference | |
| 1312 | value="#me d4" | |
| 1313 | /> | |
| 1314 | </original Text> | |
| 1315 | <translati on | |
| 1316 | code="5456 9-5546-0" | |
| 1317 | codeSystem ="2.16.840 .1.113883. 6.69" | |
| 1318 | codeSystem Name="NDC" | |
| 1319 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1320 | /> | |
| 1321 | <translati on | |
| 1322 | code="2876 34" | |
| 1323 | codeSystem ="2.16.840 .1.113883. 6.208" | |
| 1324 | codeSystem Name="NDDF (First Da taBank)" | |
| 1325 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1326 | /> | |
| 1327 | </code> | |
| 1328 | </manufact uredMateri al> | |
| 1329 | </manufact uredProduc t> | |
| 1330 | </consumab le> | |
| 1331 | <author> | |
| 1332 | <time | |
| 1333 | value="201 5061818301 6+0000" | |
| 1334 | /> | |
| 1335 | <assignedA uthor> | |
| 1336 | <id | |
| 1337 | root="1.2. 840.114350 .1.13.119. 3.7.2.8369 82" | |
| 1338 | extension= "213135" | |
| 1339 | /> | |
| 1340 | <addr> | |
| 1341 | <streetAdd ressLine> | |
| 1342 | 280 WEST M ACARTHUR B OULEVARD | |
| 1343 | </streetAd dressLine> | |
| 1344 | <city> | |
| 1345 | OAKLAND | |
| 1346 | </city> | |
| 1347 | <state> | |
| 1348 | CA | |
| 1349 | </state> | |
| 1350 | <postalCod e> | |
| 1351 | 94611-5642 | |
| 1352 | </postalCo de> | |
| 1353 | </addr> | |
| 1354 | <telecom | |
| 1355 | nullFlavor ="UNK" | |
| 1356 | /> | |
| 1357 | <assignedP erson> | |
| 1358 | <name> | |
| 1359 | <given> | |
| 1360 | Brendan | |
| 1361 | </given> | |
| 1362 | <given> | |
| 1363 | (M.D.) | |
| 1364 | </given> | |
| 1365 | <family> | |
| 1366 | Smith | |
| 1367 | </family> | |
| 1368 | </name> | |
| 1369 | </assigned Person> | |
| 1370 | <represent edOrganiza tion> | |
| 1371 | <id | |
| 1372 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 1373 | extension= "159" | |
| 1374 | /> | |
| 1375 | <name> | |
| 1376 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 1377 | </name> | |
| 1378 | <telecom | |
| 1379 | use="WP" | |
| 1380 | value="tel :+19569876 543" | |
| 1381 | /> | |
| 1382 | <addr | |
| 1383 | nullFlavor ="NA" | |
| 1384 | > | |
| 1385 | <city> | |
| 1386 | Oakland | |
| 1387 | </city> | |
| 1388 | <state> | |
| 1389 | CA | |
| 1390 | </state> | |
| 1391 | <postalCod e> | |
| 1392 | 94607 | |
| 1393 | </postalCo de> | |
| 1394 | <country> | |
| 1395 | USA | |
| 1396 | </country> | |
| 1397 | </addr> | |
| 1398 | </represen tedOrganiz ation> | |
| 1399 | </assigned Author> | |
| 1400 | </author> | |
| 1401 | <entryRela tionship | |
| 1402 | typeCode=" SUBJ" | |
| 1403 | > | |
| 1404 | <observati on | |
| 1405 | classCode= "OBS" | |
| 1406 | moodCode=" EVN" | |
| 1407 | > | |
| 1408 | <templateI d | |
| 1409 | root="2.16 .840.1.113 883.3.88.1 1.32.10" | |
| 1410 | /> | |
| 1411 | <templateI d | |
| 1412 | root="2.16 .840.1.113 883.3.88.1 1.83.8.1" | |
| 1413 | /> | |
| 1414 | <code | |
| 1415 | code="7363 9000" | |
| 1416 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 1417 | codeSystem Name="SNOM ED CT" | |
| 1418 | displayNam e="Prescri ption Drug " | |
| 1419 | /> | |
| 1420 | <statusCod e | |
| 1421 | code="comp leted" | |
| 1422 | /> | |
| 1423 | </observat ion> | |
| 1424 | </entryRel ationship> | |
| 1425 | <entryRela tionship | |
| 1426 | inversionI nd="true" | |
| 1427 | typeCode=" SUBJ" | |
| 1428 | > | |
| 1429 | <act | |
| 1430 | classCode= "ACT" | |
| 1431 | moodCode=" EVN" | |
| 1432 | > | |
| 1433 | <templateI d | |
| 1434 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.2" | |
| 1435 | /> | |
| 1436 | <templateI d | |
| 1437 | root="2.16 .840.1.113 883.10.20. 1.40" | |
| 1438 | /> | |
| 1439 | <templateI d | |
| 1440 | root="2.16 .840.1.113 883.3.88.1 1.32.12" | |
| 1441 | /> | |
| 1442 | <templateI d | |
| 1443 | root="2.16 .840.1.113 883.3.88.1 1.83.11" | |
| 1444 | /> | |
| 1445 | <code | |
| 1446 | code="4876 7-8" | |
| 1447 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 1448 | codeSystem Name="LOIN C" | |
| 1449 | /> | |
| 1450 | <text> | |
| 1451 | <reference | |
| 1452 | value="#si g4" | |
| 1453 | /> | |
| 1454 | </text> | |
| 1455 | <statusCod e | |
| 1456 | code="comp leted" | |
| 1457 | /> | |
| 1458 | <author> | |
| 1459 | <time | |
| 1460 | value="201 5061818301 6+0000" | |
| 1461 | /> | |
| 1462 | <assignedA uthor> | |
| 1463 | <id | |
| 1464 | root="1.2. 840.114350 .1.13.119. 3.7.2.8369 82" | |
| 1465 | extension= "213135" | |
| 1466 | /> | |
| 1467 | <addr> | |
| 1468 | <streetAdd ressLine> | |
| 1469 | 280 WEST M ACARTHUR B OULEVARD | |
| 1470 | </streetAd dressLine> | |
| 1471 | <city> | |
| 1472 | OAKLAND | |
| 1473 | </city> | |
| 1474 | <state> | |
| 1475 | CA | |
| 1476 | </state> | |
| 1477 | <postalCod e> | |
| 1478 | 94611-5642 | |
| 1479 | </postalCo de> | |
| 1480 | </addr> | |
| 1481 | <telecom | |
| 1482 | nullFlavor ="UNK" | |
| 1483 | /> | |
| 1484 | <assignedP erson> | |
| 1485 | <name> | |
| 1486 | <given> | |
| 1487 | Brendan | |
| 1488 | </given> | |
| 1489 | <given> | |
| 1490 | (M.D.) | |
| 1491 | </given> | |
| 1492 | <family> | |
| 1493 | Smith | |
| 1494 | </family> | |
| 1495 | </name> | |
| 1496 | </assigned Person> | |
| 1497 | <represent edOrganiza tion> | |
| 1498 | <id | |
| 1499 | root="1.2. 840.114350 .1.13.119. 3.7.2.6888 79" | |
| 1500 | extension= "159" | |
| 1501 | /> | |
| 1502 | <name> | |
| 1503 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 1504 | </name> | |
| 1505 | <telecom | |
| 1506 | use="WP" | |
| 1507 | value="tel :+19569876 543" | |
| 1508 | /> | |
| 1509 | <addr | |
| 1510 | nullFlavor ="NA" | |
| 1511 | > | |
| 1512 | <city> | |
| 1513 | Oakland | |
| 1514 | </city> | |
| 1515 | <state> | |
| 1516 | CA | |
| 1517 | </state> | |
| 1518 | <postalCod e> | |
| 1519 | 94607 | |
| 1520 | </postalCo de> | |
| 1521 | <country> | |
| 1522 | USA | |
| 1523 | </country> | |
| 1524 | </addr> | |
| 1525 | </represen tedOrganiz ation> | |
| 1526 | </assigned Author> | |
| 1527 | </author> | |
| 1528 | </act> | |
| 1529 | </entryRel ationship> | |
| 1530 | <entryRela tionship | |
| 1531 | typeCode=" REFR" | |
| 1532 | > | |
| 1533 | <supply | |
| 1534 | classCode= "SPLY" | |
| 1535 | moodCode=" INT" | |
| 1536 | > | |
| 1537 | <templateI d | |
| 1538 | root="2.16 .840.1.113 883.3.88.1 .11.32.11" | |
| 1539 | /> | |
| 1540 | <id | |
| 1541 | root="1.2. 840.114350 .1.13.119. 3.7.2.7982 68" | |
| 1542 | extension= "531707760 " | |
| 1543 | /> | |
| 1544 | <statusCod e | |
| 1545 | code="comp leted" | |
| 1546 | /> | |
| 1547 | <repeatNum ber | |
| 1548 | value="4" | |
| 1549 | /> | |
| 1550 | <product> | |
| 1551 | <manufactu redProduct | |
| 1552 | classCode= "MANU" | |
| 1553 | > | |
| 1554 | <templateI d | |
| 1555 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.7.2" | |
| 1556 | /> | |
| 1557 | <templateI d | |
| 1558 | root="2.16 .840.1.113 883.10.20. 1.53" | |
| 1559 | /> | |
| 1560 | <templateI d | |
| 1561 | root="2.16 .840.1.113 883.3.88.1 1.32.9" | |
| 1562 | /> | |
| 1563 | <templateI d | |
| 1564 | root="2.16 .840.1.113 883.3.88.1 1.83.8.2" | |
| 1565 | /> | |
| 1566 | <templateI d | |
| 1567 | root="2.16 .840.1.113 883.3.249. 11.100.13" | |
| 1568 | /> | |
| 1569 | <manufactu redMateria l> | |
| 1570 | <code | |
| 1571 | code="8609 75" | |
| 1572 | codeSystem ="2.16.840 .1.113883. 6.88" | |
| 1573 | codeSystem Name="RxNo rm" | |
| 1574 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1575 | > | |
| 1576 | <originalT ext> | |
| 1577 | <reference | |
| 1578 | value="#me d4" | |
| 1579 | /> | |
| 1580 | </original Text> | |
| 1581 | <translati on | |
| 1582 | code="5456 9-5546-0" | |
| 1583 | codeSystem ="2.16.840 .1.113883. 6.69" | |
| 1584 | codeSystem Name="NDC" | |
| 1585 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1586 | /> | |
| 1587 | <translati on | |
| 1588 | code="2876 34" | |
| 1589 | codeSystem ="2.16.840 .1.113883. 6.208" | |
| 1590 | codeSystem Name="NDDF (First Da taBank)" | |
| 1591 | displayNam e="Metform in 500 Mg Oral 24hr Sr Tab" | |
| 1592 | /> | |
| 1593 | </code> | |
| 1594 | </manufact uredMateri al> | |
| 1595 | </manufact uredProduc t> | |
| 1596 | </product> | |
| 1597 | </supply> | |
| 1598 | </entryRel ationship> | |
| 1599 | <entryRela tionship | |
| 1600 | typeCode=" REFR" | |
| 1601 | > | |
| 1602 | <observati on | |
| 1603 | classCode= "OBS" | |
| 1604 | moodCode=" EVN" | |
| 1605 | > | |
| 1606 | <templateI d | |
| 1607 | root="2.16 .840.1.113 883.10.20. 1.47" | |
| 1608 | /> | |
| 1609 | <code | |
| 1610 | code="3399 9-4" | |
| 1611 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 1612 | codeSystem Name="LOIN C" | |
| 1613 | displayNam e="Status" | |
| 1614 | /> | |
| 1615 | <statusCod e | |
| 1616 | code="comp leted" | |
| 1617 | /> | |
| 1618 | <value | |
| 1619 | code="5556 1003" | |
| 1620 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 1621 | codeSystem Name="SNOM ED CT" | |
| 1622 | xsi:type=" CE" | |
| 1623 | displayNam e="Active" | |
| 1624 | xmlns:xsi= "http://ww w.w3.org/2 001/XMLSch ema-instan ce" | |
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| 1626 | </observat ion> | |
| 1627 | </entryRel ationship> | |
| 1628 | </substanc eAdministr ation> | |
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| 1630 | </section> | |
| 1631 | </componen t> | |
| 1632 | <component > | |
| 1633 | <section> | |
| 1634 | <templateI d | |
| 1635 | root="2.16 .840.1.113 883.10.20. 1.11" | |
| 1636 | /> | |
| 1637 | <templateI d | |
| 1638 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.3.6" | |
| 1639 | /> | |
| 1640 | <templateI d | |
| 1641 | root="2.16 .840.1.113 883.3.88.1 1.83.103" | |
| 1642 | /> | |
| 1643 | <id | |
| 1644 | root="D9AA D608-B810- 11E6-B9F0- EC029123A2 3B" | |
| 1645 | /> | |
| 1646 | <code | |
| 1647 | code="1145 0-4" | |
| 1648 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 1649 | codeSystem Name="LOIN C" | |
| 1650 | displayNam e="PROBLEM LIST" | |
| 1651 | /> | |
| 1652 | <title> | |
| 1653 | Active Pro blems | |
| 1654 | </title> | |
| 1655 | <text> | |
| 1656 | <table> | |
| 1657 | <colgroup> | |
| 1658 | <col | |
| 1659 | width="75% " | |
| 1660 | /> | |
| 1661 | <col | |
| 1662 | width="25% " | |
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| 1664 | </colgroup > | |
| 1665 | <thead> | |
| 1666 | <tr> | |
| 1667 | <th> | |
| 1668 | Problem | |
| 1669 | </th> | |
| 1670 | <th> | |
| 1671 | Noted Date | |
| 1672 | </th> | |
| 1673 | </tr> | |
| 1674 | </thead> | |
| 1675 | <tbody> | |
| 1676 | <tr | |
| 1677 | ID="proble m5" | |
| 1678 | styleCode= "normRow" | |
| 1679 | > | |
| 1680 | <td | |
| 1681 | ID="proble m5name" | |
| 1682 | styleCode= "header" | |
| 1683 | > | |
| 1684 | HYPERGLYCE MIA | |
| 1685 | </td> | |
| 1686 | <td> | |
| 1687 | 06/18/2015 | |
| 1688 | </td> | |
| 1689 | </tr> | |
| 1690 | </tbody> | |
| 1691 | </table> | |
| 1692 | </text> | |
| 1693 | <entry> | |
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| 1695 | classCode= "ACT" | |
| 1696 | moodCode=" EVN" | |
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| 1698 | <templateI d | |
| 1699 | root="2.16 .840.1.113 883.10.20. 1.27" | |
| 1700 | /> | |
| 1701 | <templateI d | |
| 1702 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5.1" | |
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| 1704 | <templateI d | |
| 1705 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5.2" | |
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| 1707 | <templateI d | |
| 1708 | root="2.16 .840.1.113 883.3.88.1 1.32.7" | |
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| 1710 | <templateI d | |
| 1711 | root="2.16 .840.1.113 883.3.88.1 1.83.7" | |
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| 1714 | root="1.2. 840.114350 .1.13.119. 3.7.2.7680 76" | |
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| 1718 | nullFlavor ="NA" | |
| 1719 | /> | |
| 1720 | <statusCod e | |
| 1721 | code="acti ve" | |
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| 1723 | <effective Time> | |
| 1724 | <low | |
| 1725 | value="201 50618" | |
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| 1728 | <entryRela tionship | |
| 1729 | inversionI nd="false" | |
| 1730 | typeCode=" SUBJ" | |
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| 1733 | classCode= "OBS" | |
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| 1737 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5" | |
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| 1742 | <id | |
| 1743 | root="1.2. 840.114350 .1.13.119. 3.7.2.7680 76" | |
| 1744 | extension= "39360480" | |
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| 1747 | code="5560 7006" | |
| 1748 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 1749 | codeSystem Name="SNOM ED CT" | |
| 1750 | displayNam e="Problem " | |
| 1751 | /> | |
| 1752 | <text> | |
| 1753 | <reference | |
| 1754 | value="#pr oblem5name " | |
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| 2349 | 05/18/2016 | |
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| 2518 | <name> | |
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| 2542 | <title> | |
| 2543 | Social His tory | |
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| 2566 | <th> | |
| 2567 | Tobacco Us e | |
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| 2569 | <th> | |
| 2570 | Types | |
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| 2572 | <th> | |
| 2573 | Packs/Day | |
| 2574 | </th> | |
| 2575 | <th> | |
| 2576 | Years Used | |
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| 2578 | <th> | |
| 2579 | Date | |
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| 2582 | </thead> | |
| 2583 | <tbody> | |
| 2584 | <tr> | |
| 2585 | <td> | |
| 2586 | Current So me Day Smo ker | |
| 2587 | </td> | |
| 2588 | <td> | |
| 2589 | Cigarettes | |
| 2590 | </td> | |
| 2591 | <td> | |
| 2592 | 0.5 | |
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| 2594 | <td /> | |
| 2595 | <td /> | |
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| 2597 | <tr> | |
| 2598 | <td> | |
| 2599 | Smokeless Tobacco: N ever Used | |
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| 2618 | Tobacco Ce ssation: | |
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| 2620 | Ready to Quit: No | |
| 2621 | <br /> | |
| 2622 | <content | |
| 2623 | styleCode= "cellHeade r" | |
| 2624 | > | |
| 2625 | Comments: | |
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| 2627 | ||
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| 2646 | code="ASSE RTION" | |
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| 2715 | <title> | |
| 2716 | Plan of Ca re | |
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| 2737 | Health Mai ntenance | |
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| 2739 | <th> | |
| 2740 | Due Date | |
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| 2742 | <th> | |
| 2743 | Last Done | |
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| 2746 | Comments | |
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| 2751 | <tr | |
| 2752 | ID="hm12" | |
| 2753 | > | |
| 2754 | <td> | |
| 2755 | Test Flu V accine (#1 ) | |
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| 2757 | <td | |
| 2758 | styleCode= "Bold" | |
| 2759 | > | |
| 2760 | Overdue | |
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| 2763 | <td /> | |
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| 2765 | <tr | |
| 2766 | ID="hm13" | |
| 2767 | > | |
| 2768 | <td> | |
| 2769 | Flu Vaccin e (1) | |
| 2770 | </td> | |
| 2771 | <td | |
| 2772 | styleCode= "Bold" | |
| 2773 | > | |
| 2774 | 08/01/2016 | |
| 2775 | </td> | |
| 2776 | <td> | |
| 2777 | 08/18/2014 | |
| 2778 | </td> | |
| 2779 | <td /> | |
| 2780 | </tr> | |
| 2781 | <tr | |
| 2782 | ID="hm14" | |
| 2783 | > | |
| 2784 | <td> | |
| 2785 | Dtap/Tdap/ Td Vaccine (1 - Tdap ) | |
| 2786 | </td> | |
| 2787 | <td> | |
| 2788 | 06/01/2017 | |
| 2789 | </td> | |
| 2790 | <td /> | |
| 2791 | <td> | |
| 2792 | Postponed from 01/01 /1988 (Rec ent (24 hr s) receipt of antivi rals (eg. acyclovir, famciclov ir or vala cyclovir)) | |
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| 2823 | <title> | |
| 2824 | Results fr om Last 3 Months | |
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| 2827 | <list> | |
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| 2968 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2969 | codeSystem Name="LOIN C" | |
| 2970 | displayNam e="Payment Sources" | |
| 2971 | /> | |
| 2972 | <title> | |
| 2973 | Insurance | |
| 2974 | </title> | |
| 2975 | <text> | |
| 2976 | <table> | |
| 2977 | <colgroup> | |
| 2978 | <col | |
| 2979 | width="25% " | |
| 2980 | /> | |
| 2981 | <col | |
| 2982 | width="10% " | |
| 2983 | /> | |
| 2984 | <col | |
| 2985 | width="15% " | |
| 2986 | /> | |
| 2987 | <col | |
| 2988 | width="10% " | |
| 2989 | /> | |
| 2990 | <col | |
| 2991 | width="15% " | |
| 2992 | /> | |
| 2993 | <col | |
| 2994 | width="25% " | |
| 2995 | /> | |
| 2996 | </colgroup > | |
| 2997 | <thead> | |
| 2998 | <tr> | |
| 2999 | <th> | |
| 3000 | Payer | |
| 3001 | </th> | |
| 3002 | <th> | |
| 3003 | Benefit Pl an / Group | |
| 3004 | </th> | |
| 3005 | <th> | |
| 3006 | Subscriber ID | |
| 3007 | </th> | |
| 3008 | <th> | |
| 3009 | Type | |
| 3010 | </th> | |
| 3011 | <th> | |
| 3012 | Phone | |
| 3013 | </th> | |
| 3014 | <th> | |
| 3015 | Address | |
| 3016 | </th> | |
| 3017 | </tr> | |
| 3018 | </thead> | |
| 3019 | <tbody> | |
| 3020 | <tr | |
| 3021 | ID="covera ge16" | |
| 3022 | > | |
| 3023 | <td> | |
| 3024 | KFHP 1001 | |
| 3025 | </td> | |
| 3026 | <td> | |
| 3027 | HMO COINS( E) HMO3 PL AN 4011129 / WELLS F ARGO NAME CHANGE HAR ISH WELLS FARGO AND COMPANY | |
| 3028 | </td> | |
| 3029 | <td> | |
| 3030 | 1100146279 44 | |
| 3031 | </td> | |
| 3032 | <td> | |
| 3033 | HMO-Coinsu rance | |
| 3034 | </td> | |
| 3035 | <td /> | |
| 3036 | <td> | |
| 3037 | <paragraph > | |
| 3038 | 393 E WALN UT ST | |
| 3039 | </paragrap h> | |
| 3040 | <paragraph > | |
| 3041 | PASADENA, CA 91188 | |
| 3042 | </paragrap h> | |
| 3043 | </td> | |
| 3044 | </tr> | |
| 3045 | </tbody> | |
| 3046 | </table> | |
| 3047 | <table> | |
| 3048 | <colgroup> | |
| 3049 | <col | |
| 3050 | width="25% " | |
| 3051 | /> | |
| 3052 | <col | |
| 3053 | width="10% " | |
| 3054 | /> | |
| 3055 | <col | |
| 3056 | width="15% " | |
| 3057 | /> | |
| 3058 | <col | |
| 3059 | width="10% " | |
| 3060 | /> | |
| 3061 | <col | |
| 3062 | width="15% " | |
| 3063 | /> | |
| 3064 | <col | |
| 3065 | width="25% " | |
| 3066 | /> | |
| 3067 | </colgroup > | |
| 3068 | <thead> | |
| 3069 | <tr> | |
| 3070 | <th> | |
| 3071 | Guarantor Name | |
| 3072 | </th> | |
| 3073 | <th> | |
| 3074 | Account Ty pe | |
| 3075 | </th> | |
| 3076 | <th> | |
| 3077 | Relation t o Patient | |
| 3078 | </th> | |
| 3079 | <th> | |
| 3080 | Date of Bi rth | |
| 3081 | </th> | |
| 3082 | <th> | |
| 3083 | Phone | |
| 3084 | </th> | |
| 3085 | <th> | |
| 3086 | Billing Ad dress | |
| 3087 | </th> | |
| 3088 | </tr> | |
| 3089 | </thead> | |
| 3090 | <tbody> | |
| 3091 | <tr> | |
| 3092 | <td> | |
| 3093 | NWHINZZZTE STPATIENT, NWHINONE | |
| 3094 | </td> | |
| 3095 | <td> | |
| 3096 | Personal/F amily | |
| 3097 | </td> | |
| 3098 | <td> | |
| 3099 | Self | |
| 3100 | </td> | |
| 3101 | <td> | |
| 3102 | 02/01/1981 | |
| 3103 | </td> | |
| 3104 | <td> | |
| 3105 | <paragraph > | |
| 3106 | Work: +141 54755555 | |
| 3107 | </paragrap h> | |
| 3108 | <paragraph > | |
| 3109 | Home: +120 51111111 | |
| 3110 | </paragrap h> | |
| 3111 | </td> | |
| 3112 | <td> | |
| 3113 | <paragraph > | |
| 3114 | 1100 Test Street | |
| 3115 | </paragrap h> | |
| 3116 | <paragraph > | |
| 3117 | HELENA, AL 35080 | |
| 3118 | </paragrap h> | |
| 3119 | </td> | |
| 3120 | </tr> | |
| 3121 | </tbody> | |
| 3122 | </table> | |
| 3123 | </text> | |
| 3124 | <entry> | |
| 3125 | <act | |
| 3126 | classCode= "ACT" | |
| 3127 | moodCode=" DEF" | |
| 3128 | > | |
| 3129 | <templateI d | |
| 3130 | root="2.16 .840.1.113 883.10.20. 1.20" | |
| 3131 | /> | |
| 3132 | <templateI d | |
| 3133 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.17" | |
| 3134 | /> | |
| 3135 | <id | |
| 3136 | root="1.2. 840.114350 .1.13.119. 3.7.2.6786 71" | |
| 3137 | extension= "5330934" | |
| 3138 | /> | |
| 3139 | <code | |
| 3140 | code="4876 8-6" | |
| 3141 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 3142 | codeSystem Name="LOIN C" | |
| 3143 | displayNam e="Payment sources" | |
| 3144 | /> | |
| 3145 | <statusCod e | |
| 3146 | code="comp leted" | |
| 3147 | /> | |
| 3148 | <entryRela tionship | |
| 3149 | typeCode=" COMP" | |
| 3150 | > | |
| 3151 | <act | |
| 3152 | classCode= "ACT" | |
| 3153 | moodCode=" EVN" | |
| 3154 | > | |
| 3155 | <templateI d | |
| 3156 | root="2.16 .840.1.113 883.10.20. 1.26" | |
| 3157 | /> | |
| 3158 | <templateI d | |
| 3159 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.18" | |
| 3160 | /> | |
| 3161 | <templateI d | |
| 3162 | root="2.16 .840.1.113 883.3.249. 11.100.7" | |
| 3163 | /> | |
| 3164 | <id | |
| 3165 | root="1.2. 840.114350 .1.13.119. 3.7.2.6980 80" | |
| 3166 | extension= "4011129" | |
| 3167 | /> | |
| 3168 | <code | |
| 3169 | code="EHCP OL" | |
| 3170 | codeSystem ="2.16.840 .1.113883. 5.4" | |
| 3171 | displayNam e="extende d healthca re" | |
| 3172 | /> | |
| 3173 | <statusCod e | |
| 3174 | code="comp leted" | |
| 3175 | /> | |
| 3176 | <performer | |
| 3177 | typeCode=" PRF" | |
| 3178 | > | |
| 3179 | <assignedE ntity | |
| 3180 | classCode= "ASSIGNED" | |
| 3181 | > | |
| 3182 | <id | |
| 3183 | root="1.2. 840.114350 .1.13.119. 3.7.2.6980 77" | |
| 3184 | extension= "1001" | |
| 3185 | /> | |
| 3186 | <id | |
| 3187 | root="2.16 .840.1.113 883.12.86" | |
| 3188 | extension= "PI" | |
| 3189 | /> | |
| 3190 | <addr> | |
| 3191 | <streetAdd ressLine> | |
| 3192 | 393 E WALN UT ST | |
| 3193 | </streetAd dressLine> | |
| 3194 | <city> | |
| 3195 | PASADENA | |
| 3196 | </city> | |
| 3197 | <state> | |
| 3198 | CA | |
| 3199 | </state> | |
| 3200 | <postalCod e> | |
| 3201 | 91188 | |
| 3202 | </postalCo de> | |
| 3203 | </addr> | |
| 3204 | <telecom | |
| 3205 | nullFlavor ="UNK" | |
| 3206 | /> | |
| 3207 | <represent edOrganiza tion | |
| 3208 | classCode= "ORG" | |
| 3209 | > | |
| 3210 | <name> | |
| 3211 | KFHP 1001 | |
| 3212 | </name> | |
| 3213 | <telecom | |
| 3214 | nullFlavor ="UNK" | |
| 3215 | /> | |
| 3216 | <addr> | |
| 3217 | <streetAdd ressLine> | |
| 3218 | 393 E WALN UT ST | |
| 3219 | </streetAd dressLine> | |
| 3220 | <city> | |
| 3221 | PASADENA | |
| 3222 | </city> | |
| 3223 | <state> | |
| 3224 | CA | |
| 3225 | </state> | |
| 3226 | <postalCod e> | |
| 3227 | 91188 | |
| 3228 | </postalCo de> | |
| 3229 | </addr> | |
| 3230 | </represen tedOrganiz ation> | |
| 3231 | </assigned Entity> | |
| 3232 | </performe r> | |
| 3233 | <participa nt | |
| 3234 | typeCode=" COV" | |
| 3235 | > | |
| 3236 | <participa ntRole> | |
| 3237 | <id | |
| 3238 | root="2.16 .840.1.113 883.3.249. 13" | |
| 3239 | extension= "110014627 944" | |
| 3240 | /> | |
| 3241 | </particip antRole> | |
| 3242 | </particip ant> | |
| 3243 | </act> | |
| 3244 | </entryRel ationship> | |
| 3245 | </act> | |
| 3246 | </entry> | |
| 3247 | </section> | |
| 3248 | </componen t> | |
| 3249 | <component > | |
| 3250 | <section> | |
| 3251 | <code | |
| 3252 | code="X-DO CCMT" | |
| 3253 | displayNam e="Documen t Comments " | |
| 3254 | /> | |
| 3255 | <title> | |
| 3256 | Additional Source Co mments | |
| 3257 | </title> | |
| 3258 | <text> | |
| 3259 | FOR RECOR DS PERTAIN ING TO PAT IENTS WHO ARE OR HAV E BEEN ENR OLLED IN A CHEMICAL DEPENDENCY /SUBSTANCE ABUSE PRO GRAM - PLE ASE NOTE: Some of t he enclose d informat ion may co ntain reco rds from t he patient 's treatme nt in a su bstance ab use progra m that are protected by Federa l confiden tiality ru les (42 CF R part 2). The Feder al rules p rohibit yo u from mak ing any fu rther disc losure of this infor mation unl ess furthe r disclosu res of thi s informat ion is exp ressly per mitted by the person to whom i t pertains or as oth erwise per mitted by 42 CFR par t 2. A gen eral autho rization f or the rel ease of me dical or o ther infor mation is NOT suffic ient for t his purpos e. The Fed eral rules restrict any use of the infor mation to criminally investiga te or pros ecute any alcohol or drug abus e patient. | |
| 3260 | <footnote> | |
| 3261 | Kaiser Per manente No rthern Cal ifornia - WITS 2 | |
| 3262 | </footnote > | |
| 3263 | </text> | |
| 3264 | </section> | |
| 3265 | </componen t> | |
| 3266 | </structur edBody> | |
| 3267 | </componen t> | |
| 3268 | </Clinical Document> |
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