<?xml version="1.0" encoding="UTF-8" standalone="yes"?><?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
 
<!-- Title: US_Realm_Header_Template -->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3"
	xmlns:cda="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc">
	<!-- ******************************************************** CDA Header 
		******************************************************** -->
	<realmCode code="US"/>
	<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
	<!-- US General Header Template -->
	<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
	<!-- *** Note: The next templateId, code and title will differ depending 
		on what type of document is being sent. *** -->
	<!-- conforms to the document specific requirements -->
	<templateId root="2.16.840.1.113883.10.20.22.1.2"/>
	<id extension="TT988" root="2.16.840.1.113883.19.5.99999.1"/>
	<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9"
		displayName="Summarization of Episode Note"/>
	<title>Community Health and Hospitals: Health Summary</title>
	<effectiveTime value="201209150000-0400"/>
	<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
	<languageCode code="en-US"/>
	<setId extension="sTT988" root="2.16.840.1.113883.19.5.99999.19"/>
	<versionNumber value="1"/>
	<recordTarget>
		<patientRole>
			<id extension="998991" root="2.16.840.1.113883.19.5.99999.2"/>
			<!-- Fake ID using HL7 example OID. -->
			<id extension="111-00-2330" root="2.16.840.1.113883.4.1"/>
			<!-- Fake Social Security Number using the actual SSN OID. -->
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>1357 Amber Drive</streetAddressLine>
				<city>Beaverton</city>
				<state>OR</state>
				<postalCode>97867</postalCode>
				<country>US</country>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
			</addr>
			<telecom value="tel:(816)276-6909" use="HP"/>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<patient>
				<name use="L">
					<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
					<given>Isabella</given>
					<given>Isa</given>
					<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
					<family>Jones</family>
				</name>
				<administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"
					displayName="Female"/>
				<birthTime value="19750501"/>
				<maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2"
					codeSystemName="MaritalStatusCode"/>
				<religiousAffiliationCode code="1013"
					displayName="Christian (non-Catholic, non-specific)"
					codeSystemName="HL7 Religious Affiliation" codeSystem="2.16.840.1.113883.5.1076"/>
				<!-- CDC Race and Ethnicity code set contains the minimum race and ethnicity categories defined by OMB Standards for Race and Ethnicity -->
				<raceCode nullFlavor='NA'/>
				<ethnicGroupCode nullFlavor='ASKU'/>
				<guardian>
					<code code="PRN" displayName="Parent" codeSystem="2.16.840.1.113883.5.111"
						codeSystemName="HL7 Role code"/>
					<addr use="HP">
						<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
						<streetAddressLine>1357 Amber Drive</streetAddressLine>
						<city>Beaverton</city>
						<state>OR</state>
						<postalCode>97867</postalCode>
						<country>US</country>
						<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
					</addr>
					<telecom value="tel:(816)276-6909" use="HP"/>
					<guardianPerson>
						<name>
							<given>Ralph</given>
							<family>Jones</family>
						</name>
					</guardianPerson>
				</guardian>
				<birthplace>
					<place>
						<addr>
							<city>Beaverton</city>
							<state>OR</state>
							<postalCode>97867</postalCode>
							<country>US</country>
						</addr>
					</place>
				</birthplace>
				<languageCommunication>
					<languageCode code="en"/>
					<!-- EN is "English" as in the IG -->
					<modeCode code="ESP" displayName="Expressed spoken"
						codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
					<proficiencyLevelCode code="G" displayName="Good"
						codeSystem="2.16.840.1.113883.5.61"
						codeSystemName="LanguageAbilityProficiency"/>
					<preferenceInd value="true"/>
				</languageCommunication>
			</patient>
			<providerOrganization>
				<id root="2.16.840.1.113883.4.6"/>
				<name>Community Health and Hospitals</name>
				<telecom use="WP" value="tel: 555-555-5000"/>
				<addr>
					<streetAddressLine>1001 Village Avenue</streetAddressLine>
					<city>Portland</city>
					<state>OR</state>
					<postalCode>99123</postalCode>
					<country>US</country>
				</addr>
			</providerOrganization>
		</patientRole>
	</recordTarget>
	<author>
		<time value="20050329224411+0500"/>
		<assignedAuthor>
			<id extension="99999999" root="2.16.840.1.113883.4.6"/>
			<code code="200000000X" codeSystem="2.16.840.1.113883.6.101"
				displayName="Allopathic &amp; Osteopathic Physicians"/>
			<addr>
				<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>99123</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:555-555-1002"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedAuthor>
	</author>
	<dataEnterer>
		<assignedEntity>
			<id root="2.16.840.1.113883.4.6" extension="999999943252"/>
			<addr>
				<streetAddressLine>1001 Village Avenue</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>99123</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:555-555-1002"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</dataEnterer>
	<informant>
		<assignedEntity>
			<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
			<addr>
				<streetAddressLine>1001 Village Avenue</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>99123</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:555-555-1002"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</informant>
	<informant>
		<relatedEntity classCode="PRS">
			<!-- classCode PRS represents a person with personal relationship with 
				the patient. -->
			<code code="SPS" displayName="SPOUSE" codeSystem="2.16.840.1.113883.1.11.19563"
				codeSystemName="Personal Relationship Role Type Value Set"/>
			<relatedPerson>
				<name>
					<given>Frank</given>
					<family>Jones</family>
				</name>
			</relatedPerson>
		</relatedEntity>
	</informant>
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<id extension="99999999" root="2.16.840.1.113883.4.6"/>
				<name>Community Health and Hospitals</name>
				<telecom value="tel: 555-555-1002" use="WP"/>
				<addr use="WP">
					<streetAddressLine>1002 Healthcare Drive </streetAddressLine>
					<city>Portland</city>
					<state>OR</state>
					<postalCode>99123</postalCode>
					<country>US</country>
				</addr>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<informationRecipient>
		<intendedRecipient>
			<informationRecipient>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</informationRecipient>
			<receivedOrganization>
				<name>Community Health and Hospitals</name>
			</receivedOrganization>
		</intendedRecipient>
	</informationRecipient>
	<legalAuthenticator>
		<time value="20090227130000+0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="999999999" root="2.16.840.1.113883.4.6"/>
			<addr>
				<streetAddressLine>1001 Village Avenue</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>99123</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:555-555-1002"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</legalAuthenticator>
	<authenticator>
		<time value="20090227130000+0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="999999999" root="2.16.840.1.113883.4.6"/>
			<addr>
				<streetAddressLine>1001 Village Avenue</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>99123</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:555-555-1002"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</authenticator>
	<documentationOf>
		<serviceEvent classCode="PCPR">
			<code code="73761001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
				displayName="Colonoscopy"/>
			<effectiveTime>
				<low value="201209081245-0400"/>
				<high value="20150723175100"/>
			</effectiveTime>
			<performer typeCode="PRF">
				<functionCode code="PP" displayName="Primary Performer"
					codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
					<originalText>Primary Care Provider</originalText>
				</functionCode>
				<assignedEntity>
					<!-- Provider NPI "PseudoMD-1" -->
					<id extension="PseudoMD-1" root="2.16.840.1.113883.4.6"/>
					<code code="207RG0100X" displayName="Gastroenterologist"
						codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
					<addr>
						<streetAddressLine>1001 Village Avenue</streetAddressLine>
						<city>Portland</city>
						<state>OR</state>
						<postalCode>99123</postalCode>
						<country>US</country>
					</addr>
					<telecom value="tel:+1-555-555-5000" use="HP"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Henry</given>
							<family>Seven</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<id root="2.16.840.1.113883.19.5.9999.1393"/>
						<name>Community Health and Hospitals</name>
						<telecom value="tel:+1-555-555-5000" use="HP"/>
						<addr>
							<streetAddressLine>1001 Village Avenue</streetAddressLine>
							<city>Portland</city>
							<state>OR</state>
							<postalCode>99123</postalCode>
							<country>US</country>
						</addr>
					</representedOrganization>
				</assignedEntity>
			</performer>
		</serviceEvent>
	</documentationOf>
	<!-- ******************************************************** CDA Body ******************************************************** -->
	<component>
		<structuredBody>

			<!-- **************************** RESULTS **************************************** -->
			<component>
				<section>
					<!-- conforms to Results section with entries optional -->
					<templateId root="2.16.840.1.113883.10.20.22.2.3"/>
					<!-- Results section with entries required -->
					<templateId root="2.16.840.1.113883.10.20.22.2.3.1"/>
					<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
						displayName="RESULTS"/>
					<title>RESULTS</title>
					<text>
						<table>
							<tbody>
								<tr>
									<td colspan="2">LABORATORY INFORMATION</td>
								</tr>
								<tr>
									<td colspan="2">Chemistries and drug levels</td>
								</tr>
								<tr>
									<td>
										<content ID="result1">HGB (M 13-18 g/dl; F 12-16
											g/dl)</content>
									</td>
									<td>13.2</td>
								</tr>
								<tr>
									<td>
										<content ID="result2">WBC (4.3-10.8 10+3/ul)</content>
									</td>
									<td>6.7</td>
								</tr>
								<tr>
									<td>
										<content ID="result3">PLT (135-145 meq/l)</content>
									</td>
									<td>123 (L)</td>
								</tr>
								<tr>
									<td colspan="2">Liver Functions and Other Laboratory Values</td>
								</tr>
								<tr>
									<td>ALT (SGPT)</td>
									<td>31.0</td>
								</tr>
								<tr>
									<td>AST (SGOT)</td>
									<td>18.0</td>
								</tr>
								<tr>
									<td>GGT</td>
									<td>28.0 Alk</td>
								</tr>
								<tr>
									<td>Phos</td>
									<td>86.0</td>
								</tr>
								<tr>
									<td>Total Bili</td>
									<td>0.1</td>
								</tr>
								<tr>
									<td>Albumin</td>
									<td>3.2</td>
								</tr>
								<tr>
									<td colspan="2">Blood Count</td>
								</tr>
								<tr>
									<td>White Count</td>
									<td>7.7</td>
								</tr>
								<tr>
									<td>Platelets</td>
									<td>187.0</td>
								</tr>
								<tr>
									<td>Hematocrit</td>
									<td>23.7</td>
								</tr>
								<tr>
									<td>Hemoglobin</td>
									<td>8.1</td>
								</tr>
								<tr>
									<td colspan="2">ELECTROCARDIOGRAM (EKG) INFORMATION</td>
								</tr>
								<tr>
									<td>EKG</td>
									<td>Sinus rhythm without acute changes</td>
								</tr>
							</tbody>
						</table>
					</text>
					<entry typeCode="DRIV">
						<organizer classCode="BATTERY" moodCode="EVN">
							<!-- ** Result organizer ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.1"/>
							<id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
							<code code="43789009" displayName="CBC WO DIFFERENTIAL"
								codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
							<statusCode code="completed"/>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ** Result observation ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
									<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
									<code code="30313-1" displayName="HGB"
										codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
									<text>
										<reference value="#result1"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime value="200003231430"/>
									<value xsi:type="PQ" value="13.2" unit="g/dl"/>
									<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
									<referenceRange>
										<observationRange>
											<text>M 13-18 g/dl; F 12-16 g/dl</text>
										</observationRange>
									</referenceRange>
								</observation>
							</component>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ** Result observation ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
									<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
									<code code="33765-9" displayName="WBC"
										codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
									<text>
										<reference value="#result2"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime value="200003231430"/>
									<value xsi:type="PQ" value="6.7" unit="10+3/ul"/>
									<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
									<referenceRange>
										<observationRange>
											<value xsi:type="IVL_PQ">
												<low value="4.3" unit="10+3/ul"/>
												<high value="10.8" unit="10+3/ul"/>
											</value>
										</observationRange>
									</referenceRange>
								</observation>
							</component>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ** Result observation ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
									<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
									<code code="26515-7" displayName="PLT"
										codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
									<text>
										<reference value="#result3"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime value="200003231430"/>
									<value xsi:type="PQ" value="123" unit="10+3/ul"/>
									<interpretationCode code="L" codeSystem="2.16.840.1.113883.5.83"/>
									<referenceRange>
										<observationRange>
											<value xsi:type="IVL_PQ">
												<low value="150" unit="10+3/ul"/>
												<high value="350" unit="10+3/ul"/>
											</value>
										</observationRange>
									</referenceRange>
								</observation>
							</component>
						</organizer>
					</entry>
				</section>
			</component>			




			<!-- ***************************** PLAN OF CARE ******************************** -->
			<component>
				<section>
					<!-- Plan of care section -->
					<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
					<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
						displayName="Treatment plan"/>
					<title>PLAN OF CARE</title>
					<text>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>Planned Activity</th>
									<th>Planned Date</th>
								</tr>
							</thead>
							<tbody>
								<tr>
									<td>Colonoscopy</td>
									<td>20120512</td>
								</tr>
							</tbody>
						</table>
					</text>
					<!-- Examples of the same planned activity are shown in different plan of care entries -->
					<entry typeCode="DRIV">
						<observation classCode="OBS" moodCode="RQO">
							<!-- ** Plan of care activity observation ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.44"/>
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4a"/>
							<code code="73761001" codeSystem="2.16.840.1.113883.6.96"
								codeSystemName="SNOMED CT" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20120512"/>
							</effectiveTime>
						</observation>
					</entry>
					<entry>
						<act moodCode="RQO" classCode="ACT">
							<!-- ** Plan of care activity act ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.39"/>
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/>
							<code code="73761001" codeSystem="2.16.840.1.113883.6.96"
								codeSystemName="SNOMED CT" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20120512"/>
							</effectiveTime>
						</act>
					</entry>
					<entry>
						<encounter moodCode="INT" classCode="ENC">
							<!-- ** Plan of care activity encounter ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.40"/>
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4d"/>
							<code code="73761001" codeSystem="2.16.840.1.113883.6.96"
								codeSystemName="SNOMED CT" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20120512"/>
							</effectiveTime>
						</encounter>
					</entry>
					<entry>
						<procedure moodCode="RQO" classCode="PROC">
							<!-- ** Plan of care activity procedure ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.41"/>
							<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
							<code code="73761001" codeSystem="2.16.840.1.113883.6.96"
								codeSystemName="SNOMED CT" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20120512"/>
							</effectiveTime>
						</procedure>
					</entry>
					<entry>
						<act classCode="ACT" moodCode="INT">
						<templateId root="2.16.840.1.113883.10.20.22.4.20"/>
						<!-- ** Instructions Template ** -->
						<code code="171044003" codeSystem="2.16.840.1.113883.6.96"
						displayName="immunization education" />
						<text>
						<reference value="#immunSect" />
						Possible flu-like symptoms for three days.
						</text>
						<statusCode code="completed" />
						</act>						
					</entry>
				</section>
			</component>
			<!-- ******************** REASON FOR REFERRAL ****************************************** -->
			<component>
				<section>
				 <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.1"/>
				 <!-- ** Reason for Referral Section Template ** -->
				 <code codeSystem="2.16.840.1.113883.6.1"
				 codeSystemName="LOINC" code="42349-1"
				 displayName="REASON FOR REFERRAL"/>
				 <title>REASON FOR REFERRAL</title>
				 <text>
				 <paragraph>Lumbar spinal stenosis with radiculopathy.</paragraph>
				 </text>
				</section>
			</component>
			<!-- ******************** HOSPITAL DISCHARGE INSTRUCTIONS ****************************************** -->
			<component>
				<section>
				 <templateId root="2.16.840.1.113883.10.20.22.2.41"/>
				 <code code="8653-8" codeSystem="2.16.840.1.113883.6.1"
				 codeSystemName="LOINC"
				 displayName="HOSPITAL DISCHARGE INSTRUCTIONS"/>
				 <title>HOSPITAL DISCHARGE INSTRUCTIONS</title>
				 <text>
				 <list listType="ordered">
				 <item>Take all of your prescription medication as directed.</item>
				 <item>Make an appointment with your doctor to be seen two weeks
				from the
				 date of your procedure.</item>
				 <item>You may feel slightly bloated after the procedure because of
				air
				 that was introduced during the examination.</item>
				 <item>Call your physician if you notice:<br/>
				 Bleeding or black stools.<br/>
				 Abdominal pain.<br/>
				 Fever or chills.<br/>
				 Nausea or vomiting.<br/>
				 Any unusual pain or problem.<br/>
				 Pain or redness at the site where the intravenous needle was
				 placed.<br/>
				 </item>
				 <item>Do not drink alcohol for 24 hours. Alcohol amplifies the
				effect of
				 the sedatives given.</item>
				 <item>Do not drive or operate machinery for 24 hours.</item>
				 </list>
				 </text>
				</section>				
			</component>


		</structuredBody>
	</component>
</ClinicalDocument>
