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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\SAN DIEGO HEALTH CONNECT | 374411_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\SAN DIEGO HEALTH CONNECT | 374411_C32_20161201.xml | Mon Apr 3 14:15:34 2017 UTC |
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| Changed | 19 | 38 |
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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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| 307 | NWHINZZZTE STPATIENT | |
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| 1392 | </streetAd dressLine> | |
| 1393 | <city> | |
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| 1395 | </city> | |
| 1396 | <state> | |
| 1397 | CA | |
| 1398 | </state> | |
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| 1426 | Sam | |
| 1427 | </given> | |
| 1428 | <given> | |
| 1429 | D | |
| 1430 | </given> | |
| 1431 | <prefix> | |
| 1432 | Mr | |
| 1433 | </prefix> | |
| 1434 | <suffix | |
| 1435 | qualifier= "TITLE" | |
| 1436 | > | |
| 1437 | PhD | |
| 1438 | </suffix> | |
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| 1457 | ||
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| 1511 | <streetAdd ressLine> | |
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| 1513 | </streetAd dressLine> | |
| 1514 | <city> | |
| 1515 | Irvine | |
| 1516 | </city> | |
| 1517 | <state> | |
| 1518 | CA | |
| 1519 | </state> | |
| 1520 | <postalCod e> | |
| 1521 | 92617 | |
| 1522 | </postalCo de> | |
| 1523 | <country> | |
| 1524 | US | |
| 1525 | </country> | |
| 1526 | </addr> | |
| 1527 | ||
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| 1529 | value="tel :1-111-222 -5556" | |
| 1530 | /> | |
| 1531 | ||
| 1532 | <telecom | |
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| 1534 | /> | |
| 1535 | ||
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| 1541 | ||
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| 1547 | Sam | |
| 1548 | </given> | |
| 1549 | <given> | |
| 1550 | D | |
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| 1553 | Mr | |
| 1554 | </prefix> | |
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| 1557 | > | |
| 1558 | PhD | |
| 1559 | </suffix> | |
| 1560 | </name> | |
| 1561 | ||
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| 1564 | <represent edOrganiza tion> | |
| 1565 | ||
| 1566 | <id | |
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| 1568 | extension= "LAB1" | |
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| 1570 | ||
| 1571 | <name> | |
| 1572 | Lab 1 | |
| 1573 | </name> | |
| 1574 | ||
| 1575 | <telecom | |
| 1576 | nullFlavor ="UNK" | |
| 1577 | /> | |
| 1578 | ||
| 1579 | <addr> | |
| 1580 | <country> | |
| 1581 | US | |
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| 1583 | </addr> | |
| 1584 | ||
| 1585 | </represen tedOrganiz ation> | |
| 1586 | ||
| 1587 | </assigned Entity> | |
| 1588 | ||
| 1589 | </performe r> | |
| 1590 | ||
| 1591 | </serviceE vent> | |
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| 1596 | ||
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| 1599 | <component > | |
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| 1603 | <templateI d | |
| 1604 | root="2.16 .840.1.113 883.3.248. 999.980" | |
| 1605 | /> | |
| 1606 | ||
| 1607 | <title> | |
| 1608 | Document S ource Info rmation | |
| 1609 | </title> | |
| 1610 | ||
| 1611 | <text> | |
| 1612 | This docum ent contai ns data fr om the fol lowing sou rces: | |
| 1613 | <br/> | |
| 1614 | Lab 2 | |
| 1615 | <br/> | |
| 1616 | Palomar He alth | |
| 1617 | <br/> | |
| 1618 | UCSD | |
| 1619 | <br/> | |
| 1620 | muxendpoin t1 | |
| 1621 | <br/> | |
| 1622 | sdbeaconte stedge | |
| 1623 | <br/> | |
| 1624 | <br/> | |
| 1625 | Federated endpoints queried: | |
| 1626 | <br/> | |
| 1627 | Kaiser Per manente (K P) STAGE G WVAL03 | |
| 1628 | <br/> | |
| 1629 | Palomar | |
| 1630 | <br/> | |
| 1631 | RCHSD | |
| 1632 | <br/> | |
| 1633 | SHARP XDS via MC | |
| 1634 | <br/> | |
| 1635 | SharpTest | |
| 1636 | <br/> | |
| 1637 | UCSD | |
| 1638 | <br/> | |
| 1639 | muxendpoin t1 | |
| 1640 | <br/> | |
| 1641 | muxendpoin t2 | |
| 1642 | <br/> | |
| 1643 | <br/> | |
| 1644 | Data retri eved from: | |
| 1645 | <br/> | |
| 1646 | None | |
| 1647 | </text> | |
| 1648 | ||
| 1649 | </section> | |
| 1650 | ||
| 1651 | </componen t> | |
| 1652 | ||
| 1653 | <component > | |
| 1654 | ||
| 1655 | <section> | |
| 1656 | ||
| 1657 | <templateI d | |
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| 1660 | ||
| 1661 | <templateI d | |
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| 1663 | /> | |
| 1664 | ||
| 1665 | <templateI d | |
| 1666 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.3.13" | |
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| 1673 | displayNam e="Allergi es, advers e reaction s, alerts" | |
| 1674 | /> | |
| 1675 | ||
| 1676 | <title> | |
| 1677 | Allergies and Advers e Reaction s | |
| 1678 | </title> | |
| 1679 | ||
| 1680 | <text> | |
| 1681 | <table | |
| 1682 | border="1" | |
| 1683 | width="100 %" | |
| 1684 | > | |
| 1685 | <thead> | |
| 1686 | <tr> | |
| 1687 | <th> | |
| 1688 | Type | |
| 1689 | </th> | |
| 1690 | <th> | |
| 1691 | Descriptio n | |
| 1692 | </th> | |
| 1693 | <th> | |
| 1694 | Substance | |
| 1695 | </th> | |
| 1696 | <th> | |
| 1697 | Reaction | |
| 1698 | </th> | |
| 1699 | <th> | |
| 1700 | Status | |
| 1701 | </th> | |
| 1702 | <th> | |
| 1703 | Data Sourc e(s) | |
| 1704 | </th> | |
| 1705 | </tr> | |
| 1706 | </thead> | |
| 1707 | <tbody> | |
| 1708 | <tr> | |
| 1709 | <td> | |
| 1710 | <content> | |
| 1711 | Food aller gy | |
| 1712 | </content> | |
| 1713 | </td> | |
| 1714 | <td> | |
| 1715 | <content | |
| 1716 | ID="allerg y-descript ion-allerg y-1" | |
| 1717 | > | |
| 1718 | Food aller gy | |
| 1719 | </content> | |
| 1720 | </td> | |
| 1721 | <td> | |
| 1722 | <content | |
| 1723 | ID="allerg y-substanc e-allergy- 1" | |
| 1724 | > | |
| 1725 | Compazine | |
| 1726 | </content> | |
| 1727 | </td> | |
| 1728 | <td> | |
| 1729 | <content | |
| 1730 | ID="Allerg y-reaction -allergy-1 -1" | |
| 1731 | > | |
| 1732 | Dystonia | |
| 1733 | </content> | |
| 1734 | <content | |
| 1735 | ID="Allerg y-severity -allergy-1 -1" | |
| 1736 | > | |
| 1737 | moderate | |
| 1738 | </content> | |
| 1739 | </td> | |
| 1740 | <td/> | |
| 1741 | <td> | |
| 1742 | <content> | |
| 1743 | Lab 2 | |
| 1744 | </content> | |
| 1745 | </td> | |
| 1746 | </tr> | |
| 1747 | </tbody> | |
| 1748 | </table> | |
| 1749 | </text> | |
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| 1752 | ||
| 1753 | <act | |
| 1754 | classCode= "ACT" | |
| 1755 | moodCode=" EVN" | |
| 1756 | > | |
| 1757 | ||
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| 1773 | ||
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| 1782 | ||
| 1783 | <code | |
| 1784 | nullFlavor ="NA" | |
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| 1786 | ||
| 1787 | <statusCod e | |
| 1788 | code="comp leted" | |
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| 1790 | ||
| 1791 | <effective Time> | |
| 1792 | ||
| 1793 | <low | |
| 1794 | value="201 2101100000 0-0700" | |
| 1795 | /> | |
| 1796 | ||
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| 1799 | /> | |
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| 1806 | value="201 2101100000 0-0700" | |
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| 1814 | /> | |
| 1815 | ||
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| 1817 | root="2.16 .840.1.113 883.4.6" | |
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| 1819 | assigningA uthorityNa me="Nation al Plan an d Provider Enumerati on System" | |
| 1820 | /> | |
| 1821 | ||
| 1822 | <addr> | |
| 1823 | <streetAdd ressLine> | |
| 1824 | 1234 Hospi tal Place | |
| 1825 | </streetAd dressLine> | |
| 1826 | <city> | |
| 1827 | Irvine | |
| 1828 | </city> | |
| 1829 | <state> | |
| 1830 | CA | |
| 1831 | </state> | |
| 1832 | <postalCod e> | |
| 1833 | 92617 | |
| 1834 | </postalCo de> | |
| 1835 | <country> | |
| 1836 | US | |
| 1837 | </country> | |
| 1838 | </addr> | |
| 1839 | ||
| 1840 | <telecom | |
| 1841 | value="tel :1-111-222 -5556" | |
| 1842 | /> | |
| 1843 | ||
| 1844 | <telecom | |
| 1845 | value="fax :1-222-333 -4455" | |
| 1846 | /> | |
| 1847 | ||
| 1848 | <telecom | |
| 1849 | value="mai lto:Sam@mi rthcorp.co m" | |
| 1850 | /> | |
| 1851 | ||
| 1852 | <assignedP erson> | |
| 1853 | ||
| 1854 | <name> | |
| 1855 | <family> | |
| 1856 | Phelps | |
| 1857 | </family> | |
| 1858 | <given> | |
| 1859 | Sam | |
| 1860 | </given> | |
| 1861 | <given> | |
| 1862 | D | |
| 1863 | </given> | |
| 1864 | <prefix> | |
| 1865 | Mr | |
| 1866 | </prefix> | |
| 1867 | <suffix | |
| 1868 | qualifier= "TITLE" | |
| 1869 | > | |
| 1870 | PhD | |
| 1871 | </suffix> | |
| 1872 | </name> | |
| 1873 | ||
| 1874 | </assigned Person> | |
| 1875 | ||
| 1876 | <represent edOrganiza tion> | |
| 1877 | ||
| 1878 | <id | |
| 1879 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 1880 | extension= "LAB2" | |
| 1881 | /> | |
| 1882 | ||
| 1883 | <name> | |
| 1884 | Lab 2 | |
| 1885 | </name> | |
| 1886 | ||
| 1887 | <telecom | |
| 1888 | nullFlavor ="UNK" | |
| 1889 | /> | |
| 1890 | ||
| 1891 | <addr | |
| 1892 | nullFlavor ="UNK" | |
| 1893 | /> | |
| 1894 | ||
| 1895 | </represen tedOrganiz ation> | |
| 1896 | ||
| 1897 | </assigned Author> | |
| 1898 | ||
| 1899 | </author> | |
| 1900 | ||
| 1901 | <author> | |
| 1902 | ||
| 1903 | <time | |
| 1904 | nullFlavor ="UNK" | |
| 1905 | /> | |
| 1906 | ||
| 1907 | <assignedA uthor> | |
| 1908 | ||
| 1909 | <id | |
| 1910 | nullFlavor ="UNK" | |
| 1911 | /> | |
| 1912 | ||
| 1913 | <addr | |
| 1914 | nullFlavor ="UNK" | |
| 1915 | /> | |
| 1916 | ||
| 1917 | <telecom | |
| 1918 | nullFlavor ="UNK" | |
| 1919 | /> | |
| 1920 | ||
| 1921 | <assignedP erson> | |
| 1922 | ||
| 1923 | <name | |
| 1924 | nullFlavor ="NA" | |
| 1925 | /> | |
| 1926 | ||
| 1927 | </assigned Person> | |
| 1928 | ||
| 1929 | </assigned Author> | |
| 1930 | ||
| 1931 | </author> | |
| 1932 | ||
| 1933 | <informant > | |
| 1934 | ||
| 1935 | <assignedE ntity> | |
| 1936 | ||
| 1937 | <id | |
| 1938 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 1939 | extension= "2.16.840. 1.113883.1 7.8.4.9.8" | |
| 1940 | /> | |
| 1941 | ||
| 1942 | <addr | |
| 1943 | nullFlavor ="UNK" | |
| 1944 | /> | |
| 1945 | ||
| 1946 | <telecom | |
| 1947 | nullFlavor ="UNK" | |
| 1948 | /> | |
| 1949 | ||
| 1950 | <assignedP erson> | |
| 1951 | ||
| 1952 | <name> | |
| 1953 | <given> | |
| 1954 | Lab 2 | |
| 1955 | </given> | |
| 1956 | </name> | |
| 1957 | ||
| 1958 | </assigned Person> | |
| 1959 | ||
| 1960 | <represent edOrganiza tion> | |
| 1961 | ||
| 1962 | <id | |
| 1963 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 1964 | extension= "LAB2" | |
| 1965 | /> | |
| 1966 | ||
| 1967 | <name> | |
| 1968 | Lab 2 | |
| 1969 | </name> | |
| 1970 | ||
| 1971 | <telecom | |
| 1972 | nullFlavor ="UNK" | |
| 1973 | /> | |
| 1974 | ||
| 1975 | <addr | |
| 1976 | nullFlavor ="UNK" | |
| 1977 | /> | |
| 1978 | ||
| 1979 | </represen tedOrganiz ation> | |
| 1980 | ||
| 1981 | </assigned Entity> | |
| 1982 | ||
| 1983 | </informan t> | |
| 1984 | ||
| 1985 | <entryRela tionship | |
| 1986 | typeCode=" SUBJ" | |
| 1987 | inversionI nd="false" | |
| 1988 | > | |
| 1989 | ||
| 1990 | <observati on | |
| 1991 | classCode= "OBS" | |
| 1992 | moodCode=" EVN" | |
| 1993 | > | |
| 1994 | ||
| 1995 | <templateI d | |
| 1996 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5" | |
| 1997 | /> | |
| 1998 | ||
| 1999 | <templateI d | |
| 2000 | root="2.16 .840.1.113 883. IP " | |
| 2001 | /> | |
| 2002 | ||
| 2003 | <templateI d | |
| 2004 | root="2.16 .840.1.113 883. IP " | |
| 2005 | /> | |
| 2006 | ||
| 2007 | <templateI d | |
| 2008 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.6" | |
| 2009 | /> | |
| 2010 | ||
| 2011 | <id | |
| 2012 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2013 | extension= "1234567-2 -al1" | |
| 2014 | /> | |
| 2015 | ||
| 2016 | <code | |
| 2017 | code="4142 85001" | |
| 2018 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 2019 | codeSystem Name="SNOM ED CT" | |
| 2020 | displayNam e="Food al lergy" | |
| 2021 | /> | |
| 2022 | ||
| 2023 | <text> | |
| 2024 | <reference | |
| 2025 | value="#al lergy-desc ription-al lergy-1" | |
| 2026 | /> | |
| 2027 | </text> | |
| 2028 | ||
| 2029 | <statusCod e | |
| 2030 | code="comp leted" | |
| 2031 | /> | |
| 2032 | ||
| 2033 | <effective Time> | |
| 2034 | ||
| 2035 | <low | |
| 2036 | value="201 2101100000 0-0700" | |
| 2037 | /> | |
| 2038 | ||
| 2039 | <high | |
| 2040 | value="201 2102000000 0-0700" | |
| 2041 | /> | |
| 2042 | ||
| 2043 | </effectiv eTime> | |
| 2044 | ||
| 2045 | <value | |
| 2046 | xsi:type=" CD" | |
| 2047 | code="N000 0005824_(P rochlorper azine)" | |
| 2048 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 2049 | codeSystem Name="SNOM ED CT" | |
| 2050 | displayNam e="Compazi ne" | |
| 2051 | > | |
| 2052 | ||
| 2053 | <originalT ext> | |
| 2054 | Compazine | |
| 2055 | </original Text> | |
| 2056 | ||
| 2057 | </value> | |
| 2058 | ||
| 2059 | <participa nt | |
| 2060 | typeCode=" CSM" | |
| 2061 | > | |
| 2062 | ||
| 2063 | <participa ntRole | |
| 2064 | classCode= "MANU" | |
| 2065 | > | |
| 2066 | ||
| 2067 | <addr | |
| 2068 | nullFlavor ="UNK" | |
| 2069 | /> | |
| 2070 | ||
| 2071 | <telecom | |
| 2072 | nullFlavor ="UNK" | |
| 2073 | /> | |
| 2074 | ||
| 2075 | <playingEn tity | |
| 2076 | classCode= "MMAT" | |
| 2077 | > | |
| 2078 | ||
| 2079 | <code | |
| 2080 | code="N000 0005824_(P rochlorper azine)" | |
| 2081 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 2082 | codeSystem Name="SNOM ED CT" | |
| 2083 | displayNam e="Compazi ne" | |
| 2084 | > | |
| 2085 | ||
| 2086 | <originalT ext> | |
| 2087 | Compazine | |
| 2088 | <reference | |
| 2089 | value="#al lergy-subs tance-alle rgy-1" | |
| 2090 | /> | |
| 2091 | </original Text> | |
| 2092 | ||
| 2093 | </code> | |
| 2094 | ||
| 2095 | <name> | |
| 2096 | </name> | |
| 2097 | ||
| 2098 | </playingE ntity> | |
| 2099 | ||
| 2100 | </particip antRole> | |
| 2101 | ||
| 2102 | </particip ant> | |
| 2103 | ||
| 2104 | <entryRela tionship | |
| 2105 | typeCode=" MFST" | |
| 2106 | inversionI nd="true" | |
| 2107 | > | |
| 2108 | ||
| 2109 | <observati on | |
| 2110 | classCode= "OBS" | |
| 2111 | moodCode=" EVN" | |
| 2112 | > | |
| 2113 | ||
| 2114 | <templateI d | |
| 2115 | root="2.16 .840.1.113 883. IP " | |
| 2116 | /> | |
| 2117 | ||
| 2118 | <code | |
| 2119 | code="ASSE RTION" | |
| 2120 | codeSystem ="2.16.840 .1.113883. 5.4" | |
| 2121 | /> | |
| 2122 | ||
| 2123 | <text> | |
| 2124 | <reference | |
| 2125 | value="#Al lergy-reac tion-aller gy-1-1" | |
| 2126 | /> | |
| 2127 | </text> | |
| 2128 | ||
| 2129 | <statusCod e | |
| 2130 | code="comp leted" | |
| 2131 | /> | |
| 2132 | ||
| 2133 | <value | |
| 2134 | xsi:type=" CD" | |
| 2135 | code="1580 2004" | |
| 2136 | displayNam e="Dystoni a" | |
| 2137 | /> | |
| 2138 | ||
| 2139 | <entryRela tionship | |
| 2140 | typeCode=" SUBJ" | |
| 2141 | inversionI nd="true" | |
| 2142 | > | |
| 2143 | ||
| 2144 | <observati on | |
| 2145 | classCode= "OBS" | |
| 2146 | moodCode=" EVN" | |
| 2147 | > | |
| 2148 | ||
| 2149 | <templateI d | |
| 2150 | root="2.16 .840.1.113 883. IP " | |
| 2151 | /> | |
| 2152 | ||
| 2153 | <templateI d | |
| 2154 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.1" | |
| 2155 | /> | |
| 2156 | ||
| 2157 | <code | |
| 2158 | code="SEV" | |
| 2159 | codeSystem ="2.16.840 .1.113883. 5.4" | |
| 2160 | codeSystem Name="HL7A ctCode" | |
| 2161 | displayNam e="Severit y observat ion" | |
| 2162 | /> | |
| 2163 | ||
| 2164 | <text> | |
| 2165 | <reference | |
| 2166 | value="#Al lergy-seve rity-aller gy-1-1" | |
| 2167 | /> | |
| 2168 | </text> | |
| 2169 | ||
| 2170 | <statusCod e | |
| 2171 | code="comp leted" | |
| 2172 | /> | |
| 2173 | ||
| 2174 | <value | |
| 2175 | xsi:type=" CD" | |
| 2176 | code="6736 007" | |
| 2177 | displayNam e="moderat e" | |
| 2178 | /> | |
| 2179 | ||
| 2180 | </observat ion> | |
| 2181 | ||
| 2182 | </entryRel ationship> | |
| 2183 | ||
| 2184 | </observat ion> | |
| 2185 | ||
| 2186 | </entryRel ationship> | |
| 2187 | ||
| 2188 | </observat ion> | |
| 2189 | ||
| 2190 | </entryRel ationship> | |
| 2191 | ||
| 2192 | </act> | |
| 2193 | ||
| 2194 | </entry> | |
| 2195 | ||
| 2196 | </section> | |
| 2197 | ||
| 2198 | </componen t> | |
| 2199 | ||
| 2200 | <component > | |
| 2201 | ||
| 2202 | <section> | |
| 2203 | ||
| 2204 | <templateI d | |
| 2205 | root="2.16 .840.1.113 883.3.88.1 1.83.127" | |
| 2206 | /> | |
| 2207 | ||
| 2208 | <templateI d | |
| 2209 | root="2.16 .840.1.113 883. IP " | |
| 2210 | /> | |
| 2211 | ||
| 2212 | <templateI d | |
| 2213 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.1.5.3.3" | |
| 2214 | /> | |
| 2215 | ||
| 2216 | <code | |
| 2217 | code="4624 0-8" | |
| 2218 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2219 | codeSystem Name="LOIN C" | |
| 2220 | displayNam e="History of encoun ters" | |
| 2221 | /> | |
| 2222 | ||
| 2223 | <title> | |
| 2224 | Encounters | |
| 2225 | </title> | |
| 2226 | ||
| 2227 | <text> | |
| 2228 | <table | |
| 2229 | border="1" | |
| 2230 | width="100 %" | |
| 2231 | > | |
| 2232 | <thead> | |
| 2233 | <tr> | |
| 2234 | <th> | |
| 2235 | Encounter | |
| 2236 | </th> | |
| 2237 | <th> | |
| 2238 | Providers | |
| 2239 | </th> | |
| 2240 | <th> | |
| 2241 | Location | |
| 2242 | </th> | |
| 2243 | <th> | |
| 2244 | Date | |
| 2245 | </th> | |
| 2246 | <th> | |
| 2247 | Indication s | |
| 2248 | </th> | |
| 2249 | <th> | |
| 2250 | Data Sourc e(s) | |
| 2251 | </th> | |
| 2252 | </tr> | |
| 2253 | </thead> | |
| 2254 | <tbody> | |
| 2255 | <tr> | |
| 2256 | <td> | |
| 2257 | <content | |
| 2258 | ID="Encoun ter-encoun ter-1" | |
| 2259 | > | |
| 2260 | UNK | |
| 2261 | Encounter with Sam D . Phelps. - vital ch eck | |
| 2262 | </content> | |
| 2263 | </td> | |
| 2264 | <td> | |
| 2265 | <content> | |
| 2266 | Attender: Mr Sam Phe lps PhD | |
| 2267 | </content> | |
| 2268 | </td> | |
| 2269 | <td/> | |
| 2270 | <td> | |
| 2271 | <content> | |
| 2272 | 10/11/2012 12:00:00 AM PDT - 1 0/20/2012 12:00:00 A M PDT | |
| 2273 | </content> | |
| 2274 | </td> | |
| 2275 | <td/> | |
| 2276 | <td> | |
| 2277 | <content> | |
| 2278 | Lab 2 | |
| 2279 | </content> | |
| 2280 | </td> | |
| 2281 | </tr> | |
| 2282 | <tr> | |
| 2283 | <td | |
| 2284 | ID="encoun ter-encoun ter-1-note s" | |
| 2285 | colspan="1 00%" | |
| 2286 | > | |
| 2287 | This is an encounter note/comm ent for Sa m D. Phelp s | |
| 2288 | </td> | |
| 2289 | </tr> | |
| 2290 | </tbody> | |
| 2291 | </table> | |
| 2292 | </text> | |
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| 2294 | <entry> | |
| 2295 | ||
| 2296 | <encounter | |
| 2297 | classCode= "ENC" | |
| 2298 | moodCode=" EVN" | |
| 2299 | > | |
| 2300 | ||
| 2301 | <templateI d | |
| 2302 | root="2.16 .840.1.113 883. IP " | |
| 2303 | /> | |
| 2304 | ||
| 2305 | <templateI d | |
| 2306 | root="2.16 .840.1.113 883.3.88.1 1.83.16" | |
| 2307 | /> | |
| 2308 | ||
| 2309 | <templateI d | |
| 2310 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.14" | |
| 2311 | /> | |
| 2312 | ||
| 2313 | <id | |
| 2314 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2315 | extension= "56735432- 2-enc-1" | |
| 2316 | /> | |
| 2317 | ||
| 2318 | <code | |
| 2319 | nullFlavor ="UNK" | |
| 2320 | > | |
| 2321 | ||
| 2322 | <originalT ext> | |
| 2323 | UNK | |
| 2324 | Encounter with Sam D . Phelps. - vital ch eck | |
| 2325 | <reference | |
| 2326 | value="#En counter-en counter-1" | |
| 2327 | /> | |
| 2328 | </original Text> | |
| 2329 | ||
| 2330 | </code> | |
| 2331 | ||
| 2332 | <text> | |
| 2333 | UNK | |
| 2334 | Encounter with Sam D . Phelps. - vital ch eck | |
| 2335 | <reference | |
| 2336 | value="#En counter-en counter-1" | |
| 2337 | /> | |
| 2338 | </text> | |
| 2339 | ||
| 2340 | <effective Time> | |
| 2341 | ||
| 2342 | <low | |
| 2343 | value="201 2101100000 0-0700" | |
| 2344 | /> | |
| 2345 | ||
| 2346 | <high | |
| 2347 | value="201 2102000000 0-0700" | |
| 2348 | /> | |
| 2349 | ||
| 2350 | </effectiv eTime> | |
| 2351 | ||
| 2352 | <priorityC ode | |
| 2353 | code="E" | |
| 2354 | displayNam e="Emergen cy" | |
| 2355 | /> | |
| 2356 | ||
| 2357 | <performer | |
| 2358 | typeCode=" PRF" | |
| 2359 | > | |
| 2360 | ||
| 2361 | <time> | |
| 2362 | ||
| 2363 | <low | |
| 2364 | nullFlavor ="UNK" | |
| 2365 | /> | |
| 2366 | ||
| 2367 | <high | |
| 2368 | nullFlavor ="UNK" | |
| 2369 | /> | |
| 2370 | ||
| 2371 | </time> | |
| 2372 | ||
| 2373 | <assignedE ntity> | |
| 2374 | ||
| 2375 | <id | |
| 2376 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2377 | extension= "956768532 " | |
| 2378 | assigningA uthorityNa me="Lab 2" | |
| 2379 | /> | |
| 2380 | ||
| 2381 | <id | |
| 2382 | root="2.16 .840.1.113 883.4.6" | |
| 2383 | extension= "112524837 35432424" | |
| 2384 | assigningA uthorityNa me="Nation al Plan an d Provider Enumerati on System" | |
| 2385 | /> | |
| 2386 | ||
| 2387 | <code | |
| 2388 | code="ATND " | |
| 2389 | displayNam e="Attende r" | |
| 2390 | /> | |
| 2391 | ||
| 2392 | <addr> | |
| 2393 | <streetAdd ressLine> | |
| 2394 | 1234 Hospi tal Place | |
| 2395 | </streetAd dressLine> | |
| 2396 | <city> | |
| 2397 | Irvine | |
| 2398 | </city> | |
| 2399 | <state> | |
| 2400 | CA | |
| 2401 | </state> | |
| 2402 | <postalCod e> | |
| 2403 | 92617 | |
| 2404 | </postalCo de> | |
| 2405 | <country> | |
| 2406 | US | |
| 2407 | </country> | |
| 2408 | </addr> | |
| 2409 | ||
| 2410 | <telecom | |
| 2411 | value="tel :1-111-222 -5556" | |
| 2412 | /> | |
| 2413 | ||
| 2414 | <telecom | |
| 2415 | value="fax :1-222-333 -4455" | |
| 2416 | /> | |
| 2417 | ||
| 2418 | <telecom | |
| 2419 | value="mai lto:Sam@mi rthcorp.co m" | |
| 2420 | /> | |
| 2421 | ||
| 2422 | <assignedP erson> | |
| 2423 | ||
| 2424 | <name> | |
| 2425 | <family> | |
| 2426 | Phelps | |
| 2427 | </family> | |
| 2428 | <given> | |
| 2429 | Sam | |
| 2430 | </given> | |
| 2431 | <given> | |
| 2432 | D | |
| 2433 | </given> | |
| 2434 | <prefix> | |
| 2435 | Mr | |
| 2436 | </prefix> | |
| 2437 | <suffix | |
| 2438 | qualifier= "TITLE" | |
| 2439 | > | |
| 2440 | PhD | |
| 2441 | </suffix> | |
| 2442 | </name> | |
| 2443 | ||
| 2444 | </assigned Person> | |
| 2445 | ||
| 2446 | <represent edOrganiza tion> | |
| 2447 | ||
| 2448 | <id | |
| 2449 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2450 | extension= "LAB2" | |
| 2451 | /> | |
| 2452 | ||
| 2453 | <name> | |
| 2454 | Lab 2 | |
| 2455 | </name> | |
| 2456 | ||
| 2457 | <telecom | |
| 2458 | nullFlavor ="UNK" | |
| 2459 | /> | |
| 2460 | ||
| 2461 | <addr | |
| 2462 | nullFlavor ="UNK" | |
| 2463 | /> | |
| 2464 | ||
| 2465 | </represen tedOrganiz ation> | |
| 2466 | ||
| 2467 | </assigned Entity> | |
| 2468 | ||
| 2469 | </performe r> | |
| 2470 | ||
| 2471 | <author> | |
| 2472 | ||
| 2473 | <time | |
| 2474 | nullFlavor ="UNK" | |
| 2475 | /> | |
| 2476 | ||
| 2477 | <assignedA uthor> | |
| 2478 | ||
| 2479 | <id | |
| 2480 | nullFlavor ="UNK" | |
| 2481 | /> | |
| 2482 | ||
| 2483 | <addr | |
| 2484 | nullFlavor ="UNK" | |
| 2485 | /> | |
| 2486 | ||
| 2487 | <telecom | |
| 2488 | nullFlavor ="UNK" | |
| 2489 | /> | |
| 2490 | ||
| 2491 | <assignedP erson> | |
| 2492 | ||
| 2493 | <name | |
| 2494 | nullFlavor ="NA" | |
| 2495 | /> | |
| 2496 | ||
| 2497 | </assigned Person> | |
| 2498 | ||
| 2499 | </assigned Author> | |
| 2500 | ||
| 2501 | </author> | |
| 2502 | ||
| 2503 | <informant > | |
| 2504 | ||
| 2505 | <assignedE ntity> | |
| 2506 | ||
| 2507 | <id | |
| 2508 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2509 | extension= "2.16.840. 1.113883.1 7.8.4.9.8" | |
| 2510 | /> | |
| 2511 | ||
| 2512 | <addr | |
| 2513 | nullFlavor ="UNK" | |
| 2514 | /> | |
| 2515 | ||
| 2516 | <telecom | |
| 2517 | nullFlavor ="UNK" | |
| 2518 | /> | |
| 2519 | ||
| 2520 | <assignedP erson> | |
| 2521 | ||
| 2522 | <name> | |
| 2523 | <given> | |
| 2524 | Lab 2 | |
| 2525 | </given> | |
| 2526 | </name> | |
| 2527 | ||
| 2528 | </assigned Person> | |
| 2529 | ||
| 2530 | <represent edOrganiza tion> | |
| 2531 | ||
| 2532 | <id | |
| 2533 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 2534 | extension= "LAB2" | |
| 2535 | /> | |
| 2536 | ||
| 2537 | <name> | |
| 2538 | Lab 2 | |
| 2539 | </name> | |
| 2540 | ||
| 2541 | <telecom | |
| 2542 | nullFlavor ="UNK" | |
| 2543 | /> | |
| 2544 | ||
| 2545 | <addr | |
| 2546 | nullFlavor ="UNK" | |
| 2547 | /> | |
| 2548 | ||
| 2549 | </represen tedOrganiz ation> | |
| 2550 | ||
| 2551 | </assigned Entity> | |
| 2552 | ||
| 2553 | </informan t> | |
| 2554 | ||
| 2555 | <entryRela tionship | |
| 2556 | typeCode=" RSON" | |
| 2557 | > | |
| 2558 | ||
| 2559 | <act | |
| 2560 | classCode= "ACT" | |
| 2561 | moodCode=" EVN" | |
| 2562 | > | |
| 2563 | ||
| 2564 | <templateI d | |
| 2565 | root="2.16 .840.1.113 883.3.88.1 1.83.11" | |
| 2566 | /> | |
| 2567 | ||
| 2568 | <templateI d | |
| 2569 | root="2.16 .840.1.113 883. IP " | |
| 2570 | /> | |
| 2571 | ||
| 2572 | <templateI d | |
| 2573 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.2" | |
| 2574 | /> | |
| 2575 | ||
| 2576 | <code | |
| 2577 | code="4876 7-8" | |
| 2578 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2579 | codeSystem Name="LOIN C" | |
| 2580 | displayNam e="Annotat ion commen t" | |
| 2581 | /> | |
| 2582 | ||
| 2583 | <text> | |
| 2584 | <reference | |
| 2585 | value="#en counter-en counter-1- notes" | |
| 2586 | /> | |
| 2587 | </text> | |
| 2588 | ||
| 2589 | <statusCod e | |
| 2590 | code="comp leted" | |
| 2591 | /> | |
| 2592 | ||
| 2593 | </act> | |
| 2594 | ||
| 2595 | </entryRel ationship> | |
| 2596 | ||
| 2597 | </encounte r> | |
| 2598 | ||
| 2599 | </entry> | |
| 2600 | ||
| 2601 | </section> | |
| 2602 | ||
| 2603 | </componen t> | |
| 2604 | ||
| 2605 | <component > | |
| 2606 | ||
| 2607 | <section> | |
| 2608 | ||
| 2609 | <templateI d | |
| 2610 | root="2.16 .840.1.113 883. IP " | |
| 2611 | /> | |
| 2612 | ||
| 2613 | <code | |
| 2614 | code="4876 8-6" | |
| 2615 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2616 | codeSystem Name="LOIN C" | |
| 2617 | displayNam e="Payment sources" | |
| 2618 | /> | |
| 2619 | ||
| 2620 | <title> | |
| 2621 | Insurance Providers | |
| 2622 | </title> | |
| 2623 | ||
| 2624 | <text> | |
| 2625 | <table | |
| 2626 | border="1" | |
| 2627 | width="100 %" | |
| 2628 | > | |
| 2629 | <thead> | |
| 2630 | <tr> | |
| 2631 | <th> | |
| 2632 | Payer name | |
| 2633 | </th> | |
| 2634 | <th> | |
| 2635 | Policy typ e / Covera ge type | |
| 2636 | </th> | |
| 2637 | <th> | |
| 2638 | Policy ID | |
| 2639 | </th> | |
| 2640 | <th> | |
| 2641 | Covered pa rty ID | |
| 2642 | </th> | |
| 2643 | <th> | |
| 2644 | Covered pa rty's rela tionship t o holder | |
| 2645 | </th> | |
| 2646 | <th> | |
| 2647 | Policy Hol der | |
| 2648 | </th> | |
| 2649 | <th> | |
| 2650 | Plan Infor mation | |
| 2651 | </th> | |
| 2652 | </tr> | |
| 2653 | </thead> | |
| 2654 | <tbody> | |
| 2655 | <tr> | |
| 2656 | <td> | |
| 2657 | <content/> | |
| 2658 | </td> | |
| 2659 | <td> | |
| 2660 | <content> | |
| 2661 | extended h ealthcare | |
| 2662 | </content> | |
| 2663 | </td> | |
| 2664 | <td> | |
| 2665 | <content> | |
| 2666 | 100901 | |
| 2667 | </content> | |
| 2668 | </td> | |
| 2669 | <td/> | |
| 2670 | <td/> | |
| 2671 | <td/> | |
| 2672 | <td> | |
| 2673 | <content | |
| 2674 | ID="Plan-N ame-payer- 1" | |
| 2675 | > | |
| 2676 | 100901 | |
| 2677 | </content> | |
| 2678 | </td> | |
| 2679 | </tr> | |
| 2680 | <tr> | |
| 2681 | <td> | |
| 2682 | <content> | |
| 2683 | BLUE SHIEL D | |
| 2684 | </content> | |
| 2685 | </td> | |
| 2686 | <td> | |
| 2687 | <content/> | |
| 2688 | </td> | |
| 2689 | <td> | |
| 2690 | <content> | |
| 2691 | 63546313 | |
| 2692 | </content> | |
| 2693 | </td> | |
| 2694 | <td/> | |
| 2695 | <td> | |
| 2696 | <content> | |
| 2697 | Child | |
| 2698 | </content> | |
| 2699 | </td> | |
| 2700 | <td/> | |
| 2701 | <td> | |
| 2702 | <content | |
| 2703 | ID="Plan-N ame-payer- 2" | |
| 2704 | > | |
| 2705 | 63546313 | |
| 2706 | </content> | |
| 2707 | </td> | |
| 2708 | </tr> | |
| 2709 | </tbody> | |
| 2710 | </table> | |
| 2711 | </text> | |
| 2712 | ||
| 2713 | <entry | |
| 2714 | typeCode=" DRIV" | |
| 2715 | > | |
| 2716 | ||
| 2717 | <act | |
| 2718 | classCode= "ACT" | |
| 2719 | moodCode=" DEF" | |
| 2720 | > | |
| 2721 | ||
| 2722 | <templateI d | |
| 2723 | root="2.16 .840.1.113 883. IP " | |
| 2724 | /> | |
| 2725 | ||
| 2726 | <id | |
| 2727 | root="2.16 .840.1.113 883.17.8.1 " | |
| 2728 | extension= "100901" | |
| 2729 | /> | |
| 2730 | ||
| 2731 | <code | |
| 2732 | code="4876 8-6" | |
| 2733 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2734 | codeSystem Name="LOIN C" | |
| 2735 | displayNam e="Payment sources" | |
| 2736 | /> | |
| 2737 | ||
| 2738 | <statusCod e | |
| 2739 | code="comp leted" | |
| 2740 | /> | |
| 2741 | ||
| 2742 | <entryRela tionship | |
| 2743 | typeCode=" COMP" | |
| 2744 | > | |
| 2745 | ||
| 2746 | <act | |
| 2747 | classCode= "ACT" | |
| 2748 | moodCode=" EVN" | |
| 2749 | > | |
| 2750 | ||
| 2751 | <templateI d | |
| 2752 | root="2.16 .840.1.113 883. IP " | |
| 2753 | /> | |
| 2754 | ||
| 2755 | <id | |
| 2756 | root="2.16 .840.1.113 883.17.8.1 " | |
| 2757 | extension= "100901" | |
| 2758 | /> | |
| 2759 | ||
| 2760 | <code | |
| 2761 | code="EHCP OL" | |
| 2762 | codeSystem ="2.16.840 .1.113883. 5.4" | |
| 2763 | displayNam e="extende d healthca re" | |
| 2764 | /> | |
| 2765 | ||
| 2766 | <statusCod e | |
| 2767 | code="comp leted" | |
| 2768 | /> | |
| 2769 | ||
| 2770 | <performer | |
| 2771 | typeCode=" PRF" | |
| 2772 | > | |
| 2773 | ||
| 2774 | <time> | |
| 2775 | ||
| 2776 | <low | |
| 2777 | nullFlavor ="UNK" | |
| 2778 | /> | |
| 2779 | ||
| 2780 | <high | |
| 2781 | nullFlavor ="UNK" | |
| 2782 | /> | |
| 2783 | ||
| 2784 | </time> | |
| 2785 | ||
| 2786 | <assignedE ntity> | |
| 2787 | ||
| 2788 | <id | |
| 2789 | root="2.16 .840.1.113 883.17.8.1 " | |
| 2790 | extension= "b8a0af3b- 4ea9-4de3- 91f0-7790b 983dd88" | |
| 2791 | /> | |
| 2792 | ||
| 2793 | <code | |
| 2794 | code="PAYO R" | |
| 2795 | codeSystem ="2.16.840 .1.113883. 5.110" | |
| 2796 | /> | |
| 2797 | ||
| 2798 | <addr | |
| 2799 | nullFlavor ="UNK" | |
| 2800 | /> | |
| 2801 | ||
| 2802 | <telecom | |
| 2803 | nullFlavor ="UNK" | |
| 2804 | /> | |
| 2805 | ||
| 2806 | <represent edOrganiza tion> | |
| 2807 | ||
| 2808 | <id | |
| 2809 | nullFlavor ="UNK" | |
| 2810 | /> | |
| 2811 | ||
| 2812 | <name | |
| 2813 | nullFlavor ="UNK" | |
| 2814 | /> | |
| 2815 | ||
| 2816 | <telecom | |
| 2817 | nullFlavor ="UNK" | |
| 2818 | /> | |
| 2819 | ||
| 2820 | <addr | |
| 2821 | nullFlavor ="UNK" | |
| 2822 | /> | |
| 2823 | ||
| 2824 | </represen tedOrganiz ation> | |
| 2825 | ||
| 2826 | </assigned Entity> | |
| 2827 | ||
| 2828 | </performe r> | |
| 2829 | ||
| 2830 | <participa nt | |
| 2831 | typeCode=" COV" | |
| 2832 | > | |
| 2833 | ||
| 2834 | <time> | |
| 2835 | ||
| 2836 | <low | |
| 2837 | nullFlavor ="UNK" | |
| 2838 | /> | |
| 2839 | ||
| 2840 | <high | |
| 2841 | nullFlavor ="UNK" | |
| 2842 | /> | |
| 2843 | ||
| 2844 | </time> | |
| 2845 | ||
| 2846 | <participa ntRole | |
| 2847 | classCode= "PAT" | |
| 2848 | > | |
| 2849 | ||
| 2850 | <id | |
| 2851 | root="3213 21" | |
| 2852 | /> | |
| 2853 | ||
| 2854 | <code | |
| 2855 | nullFlavor ="UNK" | |
| 2856 | /> | |
| 2857 | ||
| 2858 | <addr | |
| 2859 | nullFlavor ="UNK" | |
| 2860 | /> | |
| 2861 | ||
| 2862 | <telecom | |
| 2863 | nullFlavor ="UNK" | |
| 2864 | /> | |
| 2865 | ||
| 2866 | <playingEn tity> | |
| 2867 | ||
| 2868 | <name | |
| 2869 | nullFlavor ="UNK" | |
| 2870 | /> | |
| 2871 | ||
| 2872 | <sdtc:birt hTime | |
| 2873 | nullFlavor ="UNK" | |
| 2874 | /> | |
| 2875 | ||
| 2876 | </playingE ntity> | |
| 2877 | ||
| 2878 | </particip antRole> | |
| 2879 | ||
| 2880 | </particip ant> | |
| 2881 | ||
| 2882 | <participa nt | |
| 2883 | typeCode=" HLD" | |
| 2884 | > | |
| 2885 | ||
| 2886 | <participa ntRole> | |
| 2887 | ||
| 2888 | <id | |
| 2889 | nullFlavor ="UNK" | |
| 2890 | /> | |
| 2891 | ||
| 2892 | <addr | |
| 2893 | nullFlavor ="UNK" | |
| 2894 | /> | |
| 2895 | ||
| 2896 | <telecom | |
| 2897 | nullFlavor ="UNK" | |
| 2898 | /> | |
| 2899 | ||
| 2900 | <playingEn tity> | |
| 2901 | ||
| 2902 | <name | |
| 2903 | nullFlavor ="UNK" | |
| 2904 | /> | |
| 2905 | ||
| 2906 | <sdtc:birt hTime | |
| 2907 | nullFlavor ="UNK" | |
| 2908 | /> | |
| 2909 | ||
| 2910 | </playingE ntity> | |
| 2911 | ||
| 2912 | </particip antRole> | |
| 2913 | ||
| 2914 | </particip ant> | |
| 2915 | ||
| 2916 | <entryRela tionship | |
| 2917 | typeCode=" REFR" | |
| 2918 | > | |
| 2919 | ||
| 2920 | <act | |
| 2921 | classCode= "ACT" | |
| 2922 | moodCode=" DEF" | |
| 2923 | > | |
| 2924 | ||
| 2925 | <id | |
| 2926 | root="EHCP OL" | |
| 2927 | extension= "extended healthcare " | |
| 2928 | /> | |
| 2929 | ||
| 2930 | <code | |
| 2931 | code="EHCP OL" | |
| 2932 | codeSystem ="2.16.840 .1.113883. 5.4" | |
| 2933 | displayNam e="extende d healthca re" | |
| 2934 | /> | |
| 2935 | ||
| 2936 | <text> | |
| 2937 | 100901 | |
| 2938 | <reference | |
| 2939 | value="Pla n-Name-pay er-1" | |
| 2940 | /> | |
| 2941 | </text> | |
| 2942 | ||
| 2943 | </act> | |
| 2944 | ||
| 2945 | </entryRel ationship> | |
| 2946 | ||
| 2947 | </act> | |
| 2948 | ||
| 2949 | </entryRel ationship> | |
| 2950 | ||
| 2951 | </act> | |
| 2952 | ||
| 2953 | </entry> | |
| 2954 | ||
| 2955 | <entry | |
| 2956 | typeCode=" DRIV" | |
| 2957 | > | |
| 2958 | ||
| 2959 | <act | |
| 2960 | classCode= "ACT" | |
| 2961 | moodCode=" DEF" | |
| 2962 | > | |
| 2963 | ||
| 2964 | <templateI d | |
| 2965 | root="2.16 .840.1.113 883. IP " | |
| 2966 | /> | |
| 2967 | ||
| 2968 | <id | |
| 2969 | root="2.16 .840.1.113 883.17.8.1 " | |
| 2970 | /> | |
| 2971 | ||
| 2972 | <code | |
| 2973 | code="4876 8-6" | |
| 2974 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 2975 | codeSystem Name="LOIN C" | |
| 2976 | displayNam e="Payment sources" | |
| 2977 | /> | |
| 2978 | ||
| 2979 | <statusCod e | |
| 2980 | code="comp leted" | |
| 2981 | /> | |
| 2982 | ||
| 2983 | <entryRela tionship | |
| 2984 | typeCode=" COMP" | |
| 2985 | > | |
| 2986 | ||
| 2987 | <act | |
| 2988 | classCode= "ACT" | |
| 2989 | moodCode=" EVN" | |
| 2990 | > | |
| 2991 | ||
| 2992 | <templateI d | |
| 2993 | root="2.16 .840.1.113 883. IP " | |
| 2994 | /> | |
| 2995 | ||
| 2996 | <id | |
| 2997 | root="2.16 .840.1.113 883.17.8.1 " | |
| 2998 | extension= "63546313" | |
| 2999 | /> | |
| 3000 | ||
| 3001 | <code | |
| 3002 | nullFlavor ="UNK" | |
| 3003 | /> | |
| 3004 | ||
| 3005 | <statusCod e | |
| 3006 | code="comp leted" | |
| 3007 | /> | |
| 3008 | ||
| 3009 | <performer | |
| 3010 | typeCode=" PRF" | |
| 3011 | > | |
| 3012 | ||
| 3013 | <time> | |
| 3014 | ||
| 3015 | <low | |
| 3016 | nullFlavor ="UNK" | |
| 3017 | /> | |
| 3018 | ||
| 3019 | <high | |
| 3020 | nullFlavor ="UNK" | |
| 3021 | /> | |
| 3022 | ||
| 3023 | </time> | |
| 3024 | ||
| 3025 | <assignedE ntity> | |
| 3026 | ||
| 3027 | <id | |
| 3028 | root="2.16 .840.1.113 883.17.8.1 " | |
| 3029 | extension= "1009" | |
| 3030 | /> | |
| 3031 | ||
| 3032 | <code | |
| 3033 | code="PAYO R" | |
| 3034 | codeSystem ="2.16.840 .1.113883. 5.110" | |
| 3035 | /> | |
| 3036 | ||
| 3037 | <addr | |
| 3038 | nullFlavor ="UNK" | |
| 3039 | /> | |
| 3040 | ||
| 3041 | <telecom | |
| 3042 | nullFlavor ="UNK" | |
| 3043 | /> | |
| 3044 | ||
| 3045 | <represent edOrganiza tion> | |
| 3046 | ||
| 3047 | <id | |
| 3048 | nullFlavor ="UNK" | |
| 3049 | /> | |
| 3050 | ||
| 3051 | <name> | |
| 3052 | BLUE SHIEL D | |
| 3053 | </name> | |
| 3054 | ||
| 3055 | <telecom | |
| 3056 | nullFlavor ="UNK" | |
| 3057 | /> | |
| 3058 | ||
| 3059 | <addr | |
| 3060 | nullFlavor ="UNK" | |
| 3061 | /> | |
| 3062 | ||
| 3063 | </represen tedOrganiz ation> | |
| 3064 | ||
| 3065 | </assigned Entity> | |
| 3066 | ||
| 3067 | </performe r> | |
| 3068 | ||
| 3069 | <participa nt | |
| 3070 | typeCode=" COV" | |
| 3071 | > | |
| 3072 | ||
| 3073 | <time> | |
| 3074 | ||
| 3075 | <low | |
| 3076 | nullFlavor ="UNK" | |
| 3077 | /> | |
| 3078 | ||
| 3079 | <high | |
| 3080 | nullFlavor ="UNK" | |
| 3081 | /> | |
| 3082 | ||
| 3083 | </time> | |
| 3084 | ||
| 3085 | <participa ntRole | |
| 3086 | classCode= "PAT" | |
| 3087 | > | |
| 3088 | ||
| 3089 | <id | |
| 3090 | nullFlavor ="UNK" | |
| 3091 | /> | |
| 3092 | ||
| 3093 | <code | |
| 3094 | code="Chil d" | |
| 3095 | displayNam e="Child" | |
| 3096 | /> | |
| 3097 | ||
| 3098 | <addr> | |
| 3099 | <country> | |
| 3100 | US | |
| 3101 | </country> | |
| 3102 | </addr> | |
| 3103 | ||
| 3104 | <telecom | |
| 3105 | nullFlavor ="UNK" | |
| 3106 | /> | |
| 3107 | ||
| 3108 | <playingEn tity> | |
| 3109 | ||
| 3110 | <name | |
| 3111 | nullFlavor ="UNK" | |
| 3112 | /> | |
| 3113 | ||
| 3114 | <sdtc:birt hTime | |
| 3115 | nullFlavor ="UNK" | |
| 3116 | /> | |
| 3117 | ||
| 3118 | </playingE ntity> | |
| 3119 | ||
| 3120 | </particip antRole> | |
| 3121 | ||
| 3122 | </particip ant> | |
| 3123 | ||
| 3124 | <participa nt | |
| 3125 | typeCode=" HLD" | |
| 3126 | > | |
| 3127 | ||
| 3128 | <participa ntRole> | |
| 3129 | ||
| 3130 | <id | |
| 3131 | nullFlavor ="UNK" | |
| 3132 | /> | |
| 3133 | ||
| 3134 | <addr | |
| 3135 | nullFlavor ="UNK" | |
| 3136 | /> | |
| 3137 | ||
| 3138 | <telecom | |
| 3139 | nullFlavor ="UNK" | |
| 3140 | /> | |
| 3141 | ||
| 3142 | <playingEn tity> | |
| 3143 | ||
| 3144 | <name | |
| 3145 | nullFlavor ="UNK" | |
| 3146 | /> | |
| 3147 | ||
| 3148 | <sdtc:birt hTime | |
| 3149 | nullFlavor ="UNK" | |
| 3150 | /> | |
| 3151 | ||
| 3152 | </playingE ntity> | |
| 3153 | ||
| 3154 | </particip antRole> | |
| 3155 | ||
| 3156 | </particip ant> | |
| 3157 | ||
| 3158 | <entryRela tionship | |
| 3159 | typeCode=" REFR" | |
| 3160 | > | |
| 3161 | ||
| 3162 | <act | |
| 3163 | classCode= "ACT" | |
| 3164 | moodCode=" DEF" | |
| 3165 | > | |
| 3166 | ||
| 3167 | <id | |
| 3168 | root="1009 01" | |
| 3169 | extension= "BLUE SHIE LD HMO" | |
| 3170 | /> | |
| 3171 | ||
| 3172 | <code | |
| 3173 | nullFlavor ="UNK" | |
| 3174 | /> | |
| 3175 | ||
| 3176 | <text> | |
| 3177 | 63546313 | |
| 3178 | <reference | |
| 3179 | value="Pla n-Name-pay er-2" | |
| 3180 | /> | |
| 3181 | </text> | |
| 3182 | ||
| 3183 | </act> | |
| 3184 | ||
| 3185 | </entryRel ationship> | |
| 3186 | ||
| 3187 | </act> | |
| 3188 | ||
| 3189 | </entryRel ationship> | |
| 3190 | ||
| 3191 | </act> | |
| 3192 | ||
| 3193 | </entry> | |
| 3194 | ||
| 3195 | </section> | |
| 3196 | ||
| 3197 | </componen t> | |
| 3198 | ||
| 3199 | <component > | |
| 3200 | ||
| 3201 | <section> | |
| 3202 | ||
| 3203 | <templateI d | |
| 3204 | root="2.16 .840.1.113 883.3.88.1 1.83.103" | |
| 3205 | /> | |
| 3206 | ||
| 3207 | <templateI d | |
| 3208 | root="2.16 .840.1.113 883. IP " | |
| 3209 | /> | |
| 3210 | ||
| 3211 | <templateI d | |
| 3212 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.3.6" | |
| 3213 | /> | |
| 3214 | ||
| 3215 | <code | |
| 3216 | code="1145 0-4" | |
| 3217 | codeSystem ="2.16.840 .1.113883. 6.1" | |
| 3218 | codeSystem Name="LOIN C" | |
| 3219 | displayNam e="Problem list" | |
| 3220 | /> | |
| 3221 | ||
| 3222 | <title> | |
| 3223 | Problems, Conditions , and Diag noses | |
| 3224 | </title> | |
| 3225 | ||
| 3226 | <text> | |
| 3227 | <table | |
| 3228 | border="1" | |
| 3229 | width="100 %" | |
| 3230 | > | |
| 3231 | <thead> | |
| 3232 | <tr> | |
| 3233 | <th> | |
| 3234 | Code | |
| 3235 | </th> | |
| 3236 | <th> | |
| 3237 | Display Na me | |
| 3238 | </th> | |
| 3239 | <th> | |
| 3240 | Descriptio n | |
| 3241 | </th> | |
| 3242 | <th> | |
| 3243 | Problem Ty pe | |
| 3244 | </th> | |
| 3245 | <th> | |
| 3246 | Effective Dates | |
| 3247 | </th> | |
| 3248 | <th> | |
| 3249 | Data Sourc e(s) | |
| 3250 | </th> | |
| 3251 | </tr> | |
| 3252 | </thead> | |
| 3253 | <tbody> | |
| 3254 | <tr> | |
| 3255 | <td> | |
| 3256 | <content> | |
| 3257 | 441456002 | |
| 3258 | </content> | |
| 3259 | </td> | |
| 3260 | <td> | |
| 3261 | <content> | |
| 3262 | Polyp | |
| 3263 | </content> | |
| 3264 | </td> | |
| 3265 | <td> | |
| 3266 | <content | |
| 3267 | ID="Condit ion-Proble m-Descript ion-proble m-1" | |
| 3268 | > | |
| 3269 | Polyp | |
| 3270 | </content> | |
| 3271 | </td> | |
| 3272 | <td> | |
| 3273 | <content> | |
| 3274 | Diagnosis | |
| 3275 | </content> | |
| 3276 | </td> | |
| 3277 | <td> | |
| 3278 | <content> | |
| 3279 | 10/11/2012 12:00:00 AM PDT - 1 0/20/2012 12:00:00 A M PDT | |
| 3280 | </content> | |
| 3281 | </td> | |
| 3282 | <td> | |
| 3283 | <content> | |
| 3284 | Lab 2 | |
| 3285 | </content> | |
| 3286 | </td> | |
| 3287 | </tr> | |
| 3288 | <tr> | |
| 3289 | <td> | |
| 3290 | <content> | |
| 3291 | 232243009 | |
| 3292 | </content> | |
| 3293 | </td> | |
| 3294 | <td> | |
| 3295 | <content> | |
| 3296 | Seborrheic otitis ex terna | |
| 3297 | </content> | |
| 3298 | </td> | |
| 3299 | <td> | |
| 3300 | <content | |
| 3301 | ID="Condit ion-Proble m-Descript ion-proble m-2" | |
| 3302 | > | |
| 3303 | Seborrheic otitis ex terna | |
| 3304 | </content> | |
| 3305 | </td> | |
| 3306 | <td> | |
| 3307 | <content> | |
| 3308 | Diagnosis | |
| 3309 | </content> | |
| 3310 | </td> | |
| 3311 | <td> | |
| 3312 | <content> | |
| 3313 | 10/11/2012 12:00:00 AM PDT - 1 0/20/2012 12:00:00 A M PDT | |
| 3314 | </content> | |
| 3315 | </td> | |
| 3316 | <td> | |
| 3317 | <content> | |
| 3318 | Lab 2 | |
| 3319 | </content> | |
| 3320 | </td> | |
| 3321 | </tr> | |
| 3322 | </tbody> | |
| 3323 | </table> | |
| 3324 | </text> | |
| 3325 | ||
| 3326 | <entry> | |
| 3327 | ||
| 3328 | <act | |
| 3329 | classCode= "ACT" | |
| 3330 | moodCode=" EVN" | |
| 3331 | negationIn d="false" | |
| 3332 | > | |
| 3333 | ||
| 3334 | <templateI d | |
| 3335 | root="2.16 .840.1.113 883.3.88.1 1.83.7" | |
| 3336 | /> | |
| 3337 | ||
| 3338 | <templateI d | |
| 3339 | root="2.16 .840.1.113 883. IP " | |
| 3340 | /> | |
| 3341 | ||
| 3342 | <templateI d | |
| 3343 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5.1" | |
| 3344 | /> | |
| 3345 | ||
| 3346 | <templateI d | |
| 3347 | root="1.3. 6.1.4.1.19 376.1.5.3. 1.4.5.2" | |
| 3348 | /> | |
| 3349 | ||
| 3350 | <id | |
| 3351 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 3352 | extension= "7654321-2 -diag1" | |
| 3353 | /> | |
| 3354 | ||
| 3355 | <code | |
| 3356 | nullFlavor ="NA" | |
| 3357 | /> | |
| 3358 | ||
| 3359 | <text/> | |
| 3360 | ||
| 3361 | <statusCod e | |
| 3362 | nullFlavor ="UNK" | |
| 3363 | /> | |
| 3364 | ||
| 3365 | <effective Time> | |
| 3366 | ||
| 3367 | <low | |
| 3368 | nullFlavor ="NA" | |
| 3369 | /> | |
| 3370 | ||
| 3371 | </effectiv eTime> | |
| 3372 | ||
| 3373 | <performer | |
| 3374 | typeCode=" PRF" | |
| 3375 | > | |
| 3376 | ||
| 3377 | <time> | |
| 3378 | ||
| 3379 | <low | |
| 3380 | nullFlavor ="UNK" | |
| 3381 | /> | |
| 3382 | ||
| 3383 | <high | |
| 3384 | nullFlavor ="UNK" | |
| 3385 | /> | |
| 3386 | ||
| 3387 | </time> | |
| 3388 | ||
| 3389 | <assignedE ntity> | |
| 3390 | ||
| 3391 | <id | |
| 3392 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 3393 | extension= "956768532 " | |
| 3394 | assigningA uthorityNa me="Lab 2" | |
| 3395 | /> | |
| 3396 | ||
| 3397 | <id | |
| 3398 | root="2.16 .840.1.113 883.4.6" | |
| 3399 | extension= "112524837 35432424" | |
| 3400 | assigningA uthorityNa me="Nation al Plan an d Provider Enumerati on System" | |
| 3401 | /> | |
| 3402 | ||
| 3403 | <code | |
| 3404 | nullFlavor ="UNK" | |
| 3405 | /> | |
| 3406 | ||
| 3407 | <addr> | |
| 3408 | <streetAdd ressLine> | |
| 3409 | 1234 Hospi tal Place | |
| 3410 | </streetAd dressLine> | |
| 3411 | <city> | |
| 3412 | Irvine | |
| 3413 | </city> | |
| 3414 | <state> | |
| 3415 | CA | |
| 3416 | </state> | |
| 3417 | <postalCod e> | |
| 3418 | 92617 | |
| 3419 | </postalCo de> | |
| 3420 | <country> | |
| 3421 | US | |
| 3422 | </country> | |
| 3423 | </addr> | |
| 3424 | ||
| 3425 | <telecom | |
| 3426 | value="tel :1-111-222 -5556" | |
| 3427 | /> | |
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| 4126 | root="2.16 .840.1.113 883. IP " | |
| 4127 | /> | |
| 4128 | ||
| 4129 | <id | |
| 4130 | root="2.16 .840.1.113 883.17.8.4 .9.8" | |
| 4131 | extension= "7654321-2 -diag2" | |
| 4132 | /> | |
| 4133 | ||
| 4134 | <code | |
| 4135 | code="2822 91009" | |
| 4136 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 4137 | codeSystem Name="SNOM ED CT" | |
| 4138 | displayNam e="Diagnos is" | |
| 4139 | /> | |
| 4140 | ||
| 4141 | <text> | |
| 4142 | Seborrheic otitis ex terna | |
| 4143 | <reference | |
| 4144 | value="#Co ndition-Pr oblem-Desc ription-pr oblem-2" | |
| 4145 | /> | |
| 4146 | </text> | |
| 4147 | ||
| 4148 | <statusCod e | |
| 4149 | code="comp leted" | |
| 4150 | /> | |
| 4151 | ||
| 4152 | <effective Time> | |
| 4153 | ||
| 4154 | <low | |
| 4155 | value="201 2101100000 0-0700" | |
| 4156 | /> | |
| 4157 | ||
| 4158 | <high | |
| 4159 | value="201 2102000000 0-0700" | |
| 4160 | /> | |
| 4161 | ||
| 4162 | </effectiv eTime> | |
| 4163 | ||
| 4164 | <value | |
| 4165 | xsi:type=" CD" | |
| 4166 | code="2322 43009" | |
| 4167 | codeSystem ="2.16.840 .1.113883. 6.96" | |
| 4168 | codeSystem Name="SNOM ED" | |
| 4169 | displayNam e="Seborrh eic otitis externa" | |
| 4170 | /> | |
| 4171 | ||
| 4172 | </observat ion> | |
| 4173 | ||
| 4174 | </entryRel ationship> | |
| 4175 | ||
| 4176 | </act> | |
| 4177 | ||
| 4178 | </entry> | |
| 4179 | ||
| 4180 | </section> | |
| 4181 | ||
| 4182 | </componen t> | |
| 4183 | ||
| 4184 | </structur edBody> | |
| 4185 | ||
| 4186 | </componen t> | |
| 4187 | </Clinical Document> |
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