<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--

	Title: US_Realm_Header_Template
	Original Filename: US_Realm_Header_Template.xml
	Version: 1.0
	Revision History:
	01/31/2011 bam created
    07/29/2011 RWM modified

-->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
 xsi:schemaLocation="urn:hl7-org:v3 http://xreg2.nist.gov:8080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd"
 xmlns="urn:hl7-org:v3"
 xmlns:mif="urn:hl7-org:v3/mif">
	<!--

********************************************************

  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="2.16.840.1.113883.10.20.22.1.7"/>
	<id extension="999021" root="2.16.840.1.113883.19"/>
	<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="11504-8" displayName="Surgical Operation Note"/>
	<title>Good Health Clinic Operative Note</title>
	<effectiveTime value="20050329171504+0500"/>
	<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
	<languageCode code="en-US"/>
	<setId extension="111199021" root="2.16.840.1.113883.19"/>
	<versionNumber value="1"/>
	<recordTarget>
		<patientRole>
			<id extension="12345" root="2.16.840.1.113883.19"/>
			<!-- Fake ID using HL7 example OID. -->
			<id extension="111-00-1234" 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>17 Daws Rd.</streetAddressLine>
				<city>Blue Bell</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>US</country>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
			</addr>
			<telecom value="tel:(781)555-1212" 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 -->
					<prefix>Mr.</prefix>
					<given>Adam</given>
					<given qualifier="CL">Frankie</given>
					<!-- CL is "Call me" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
					<family>Everyman</family>
				</name>
				<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
				<birthTime value="19541125"/>
				<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="2.16.840.1.113883.1.11.19185"/>
				<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC"/>
				<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC"/>
				<guardian>
					<code code="GRFTH" displayName="Grandfather" 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>17 Daws Rd.</streetAddressLine>
						<city>Blue Bell</city>
						<state>MA</state>
						<postalCode>02368</postalCode>
						<country>US</country>
						<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
					</addr>
					<telecom value="tel:(781)555-1212" use="HP"/>
					<guardianPerson>
						<name>
							<given>Ralph</given>
							<family>Relative</family>
						</name>
					</guardianPerson>
				</guardian>
				<birthplace>
					<place>
						<addr>
							<state>MA</state>
							<postalCode>02368</postalCode>
							<country>USA</country>
						</addr>
					</place>
				</birthplace>
				<languageCommunication>
					<languageCode code="fr-CN"/>
					<modeCode code="RWR" displayName="Recieve Written" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
					<preferenceInd value="true"/>
				</languageCommunication>
			</patient>
			<providerOrganization>
				<id root="2.16.840.1.113883.19"/>
				<name>Good Health Clinic</name>
				<telecom use="WP" value="tel:(781)555-1212"/>
				<addr>
					<streetAddressLine>21 North Ave</streetAddressLine>
					<city>Burlington</city>
					<state>MA</state>
					<postalCode>02368</postalCode>
					<country>USA</country>
				</addr>
			</providerOrganization>
		</patientRole>
	</recordTarget>
	<author>
		<time value="20050329224411+0500"/>
		<assignedAuthor>
			<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
			<addr>
				<streetAddressLine>21 North Ave.</streetAddressLine>
				<city>Burlington</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>USA</country>
			</addr>
			<telecom use="WP" value="tel:(555)555-1003"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedAuthor>
	</author>
	<dataEnterer>
		<assignedEntity>
			<id root="2.16.840.1.113883.19.5" extension="43252"/>
			<addr>
				<streetAddressLine>21 North Ave.</streetAddressLine>
				<city>Burlington</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>USA</country>
			</addr>
			<telecom use="WP" value="tel:(555)555-1003"/>
			<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>21 North Ave.</streetAddressLine>
				<city>Burlington</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>USA</country>
			</addr>
			<telecom value="tel:(555)555-1003"/>
			<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>Rose</given>
					<family>Everyman</family>
				</name>
			</relatedPerson>
		</relatedEntity>
	</informant>
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<id root="2.16.840.1.113883.19.5"/>
				<name>Good Health Clinic</name>
				<telecom value="tel:(555)555-1212" use="WP"/>
				<addr use="WP">
					<streetAddressLine>17 Daws Rd.</streetAddressLine>
					<city>Blue Bell</city>
					<state>MA</state>
					<postalCode>02368</postalCode>
					<country>USA</country>
				</addr>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<informationRecipient>
		<intendedRecipient>
			<informationRecipient>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</informationRecipient>
			<receivedOrganization>
				<name>Good Health Clinic</name>
			</receivedOrganization>
		</intendedRecipient>
	</informationRecipient>
	<legalAuthenticator>
		<time value="20050329224411+0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="KP00017" root="2.16.840.1.113883.19"/>
			<addr>
				<streetAddressLine>21 North Ave.</streetAddressLine>
				<city>Burlington</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>USA</country>
			</addr>
			<telecom use="WP" value="tel:(555)555-1003"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</legalAuthenticator>
	<authenticator>
		<time value="20050329224411+0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="KP00017" root="2.16.840.1.113883.19"/>
			<addr>
				<streetAddressLine>21 North Ave.</streetAddressLine>
				<city>Burlington</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>USA</country>
			</addr>
			<telecom use="WP" value="tel:(555)555-1003"/>
			<assignedPerson>
				<name>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</authenticator>
	<documentationOf typeCode="DOC">
		<serviceEvent classCode="PCPR">
			<effectiveTime>
				<low value="20100601"/>
				<high value="20100915"/>
			</effectiveTime>
			<performer typeCode="PRF">
				<functionCode code="PP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
					<originalText>Primary Care Provider</originalText>
				</functionCode>
				<time>
					<low value="20020716"/>
					<high value="20070915"/>
				</time>
				<assignedEntity>
					<id extension="PseudoMD-1" root="2.16.840.1.113883.19"/>
					<code code="200000000X" displayName="Allopathic and Osteopathic Physicians" codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
					<addr/>
					<telecom value="tel:+1-301-975-3251" use="HP"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Pseudo</given>
							<family>Physician-1</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<id root="2.16.840.1.113883.3.72.5"/>
						<name>NIST HL7 Test Laboratory</name>
						<telecom/>
						<addr/>
					</representedOrganization>
				</assignedEntity>
			</performer>
			<performer typeCode="PRF">
				<functionCode code="PP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.12.443" codeSystemName="Provider Role">
					<originalText>Primary Care Provider</originalText>
				</functionCode>
				<time>
					<low value="20020716"/>
					<high value="20070915"/>
				</time>
				<assignedEntity>
					<id extension="PseudoMD-3" root="2.16.840.1.113883.19"/>
					<code code="200000000X" displayName="Allopathic and Osteopathic Physicians" codeSystemName="Provider Codes" codeSystem="2.16.840.1.113883.6.101"/>
					<addr/>
					<telecom value="tel:+1-301-975-3251" use="HP"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Pseudo</given>
							<family>Physician-3</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<id root="2.16.840.1.113883.19.123"/>
						<name>HL7 Test Laboratory</name>
						<telecom/>
						<addr/>
					</representedOrganization>
				</assignedEntity>
			</performer>
		</serviceEvent>
	</documentationOf>
	<authorization typeCode="AUTH">
		<consent classCode="CONS" moodCode="EVN">
			<id extension="99370125" root="2.16.840.1.113883.19"/>
			<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="CONSP-X" displayName="Consent for Surgical Procedure"/>
			<statusCode code="completed"/>
		</consent>
	</authorization>
	<!--

***********************************

***********************************

-->
	<!-- ********************************************************

     CDA Body

     ******************************************************** -->
	<component>
		<structuredBody>
			<!--

********************************************************

ANESTHESIA

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.25"/>
					<code code="59774-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE ANESTHESIA"/>
					<title>Procedure Anesthesia</title>
					<text>
						<content ID="Med1">Conscious sedation with propofol 200 mg IV </content>
					</text>
					<entry>
						<procedure classCode="PROC" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
							<!-- ***** Procedure  Activity Procedure Template ***** -->
							<id root="d68b7e32-7810-4f5b-9cc2-acd54b0fd85d"/>
							<code code="274025005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonic polypectomy">
								<originalText>
									<reference value="#Proc1"/>
								</originalText>
							</code>
							<statusCode code="completed"/>
							<effectiveTime value="20110215"/>
							<methodCode nullFlavor="UNK"/>
							<specimen typeCode="SPC">
								<specimenRole classCode="SPEC">
									<id root="c2ee9ee9-ae31-4628-a919-fec1cbb58683"/>
									<specimenPlayingEntity>
										<code code="309226005" codeSystem="2.16.840.1.113883.6.96" displayName="colonic polyp sample"/>
									</specimenPlayingEntity>
								</specimenRole>
							</specimen>
							<performer>
								<assignedEntity>
									<id root="c2ee9ee9-ae31-4628-a919-fec1cbb58687"/>
									<addr>
										<streetAddressLine>17 Daws Rd.</streetAddressLine>
										<city>Blue Bell</city>
										<state>MA</state>
										<postalCode>02368</postalCode>
										<country>US</country>
									</addr>
									<telecom use="WP" value="(555)555-555-1234"/>
									<representedOrganization>
										<id root="c2ee9ee9-ae31-4628-a919-fec1cbb58686"/>
										<name>Good Health Clinic</name>
										<telecom use="WP" value="(555)555-555-1234"/>
										<addr>
											<streetAddressLine>17 Daws Rd.</streetAddressLine>
											<city>Blue Bell</city>
											<state>MA</state>
											<postalCode>02368</postalCode>
											<country>US</country>
										</addr>
									</representedOrganization>
								</assignedEntity>
							</performer>
							<participant typeCode="LOC">
								<participantRole classCode="MANU">
									<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
									<!--   Product instance template   -->
									<id root="eb936010-7b17-11db-9fe1-0800200c9a68"/>
									<playingDevice>
										<code code="90412006" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscope"/>
									</playingDevice>
									<scopingEntity>
										<id root="eb936010-7b17-11db-9fe1-0800200c9b65"/>
									</scopingEntity>
								</participantRole>
							</participant>
						</procedure>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
							<!-- ** MEDICATION ACTIVITY -->
							<id root="cdbd33f0-6cde-11db-9fe1-0800200c9a66"/>
							<text>
								<reference value="#Med1"/>Propofol 20mg/mL injection emulsion 50mL vial

							</text>
							<statusCode code="completed"/>
							<effectiveTime xsi:type="IVL_TS">
								<low value="20110301"/>
								<high value="20120301"/>
							</effectiveTime>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A">
								<period value="1" unit="h"/>
							</effectiveTime>
							<routeCode code="C38276" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" displayName="INTRAVENOUS"/>
							<doseQuantity value="1"/>
							<rateQuantity value="2" unit="ml/min"/>
							<maxDoseQuantity nullFlavor="UNK">
								<numerator nullFlavor="UNK"/>
								<denominator nullFlavor="UNK"/>
							</maxDoseQuantity>
							<administrationUnitCode code="C38276" displayName="INTRAVENOUS" codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus"/>
							<consumable>
								<manufacturedProduct>
									<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
									<id/>
									<manufacturedMaterial>
										<code code="153475" codeSystem="2.16.840.1.113883.6.88" displayName="Propofol 20 MG/ML Injectable Suspension">

										</code>
									</manufacturedMaterial>
									<manufacturerOrganization/>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
				</section>
			</component>
			<!--

********************************************************

COMPLICATIONS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.37"/>
					<code code="55109-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Complications"/>
					<title>Complications</title>
					<text>Asthmatic symptoms while under general anesthesia.</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<!-- Problem observation template -->
							<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
							<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
							<code code="409586006" codeSystem="2.16.840.1.113883.6.96" displayName="Complaint"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<low value="199803"/>
							</effectiveTime>
							<value xsi:type="CD" code="233604007" codeSystem="2.16.840.1.113883.6.96" displayName="Pneumonia"/>
							<entryRelationship typeCode="REFR">
								<observation classCode="OBS" moodCode="EVN">
									<!-- Problem status observation template -->
									<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
									<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNOMED CT"/>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="SUBJ" inversionInd="true">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
									<!--    Age observation template   -->
									<code code="397659008" codeSystem="2.16.840.1.113883.6.96" displayName="Age"/>
									<statusCode code="completed"/>
									<value xsi:type="PQ" value="57" unit="a"/>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="REFR">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.5"/>
									<!-- Health status observation template -->
									<code code="11323-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Health status"/>
									<statusCode code="completed"/>
									<value xsi:type="CE" code="413322009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Resolved"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
				</section>
			</component>
			<!--

********************************************************

OPERATIVE NOTE FLUIDS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.7.12"/>
					<code code="10216-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGICAL OPERATION NOTE FLUIDS"/>
					<title>Operative Note Fluids</title>
					<text>250 ML Ringers Lactate</text>
				</section>
			</component>
			<!--

********************************************************

OPERATIVE NOTE SURGICAL PROCEDURE

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.7.14"/>
					<code code="10223-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGICAL OPERATION NOTE SURGICAL PROCEDURE"/>
					<title>Surgical Procedure</title>
					<text>Laparoscopic Appendectomy</text>
				</section>
			</component>
			<!--

********************************************************

PLAN OF CARE

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
					<!--  **** Plan of Care section template  **** -->
					<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>April 21, 2000</td>
								</tr>
							</tbody>
						</table>
					</text>
					<entry typeCode="DRIV">
						<observation classCode="OBS" moodCode="RQO">
							<templateId root="2.16.840.1.113883.10.20.22.4.44"/>
							<!--   Plan of Care Activity Observation template   -->
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4a"/>
							<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20000421"/>
							</effectiveTime>
						</observation>
					</entry>
					<entry>
						<act moodCode="RQO" classCode="ACT">
							<templateId root="2.16.840.1.113883.10.20.22.4.39"/>
							<!--  ****  Plan of Care Activity Act template   **** -->
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/>
							<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20000421"/>
							</effectiveTime>
						</act>
					</entry>
					<entry>
						<encounter moodCode="INT" classCode="ENC">
							<templateId root="2.16.840.1.113883.10.20.22.4.40"/>
							<!--  ****  Plan of Care Activity Encounter template  **** -->
							<id root="9a6d1bac-17d3-4195-89a4-1121bc809b4d"/>
						</encounter>
					</entry>
					<entry>
						<procedure moodCode="RQO" classCode="PROC">
							<templateId root="2.16.840.1.113883.10.20.22.4.41"/>
							<!-- ** Plan of Care Activity Procedure template ** -->
							<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
							<code code="310634005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonoscopy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20000421"/>
							</effectiveTime>
						</procedure>
					</entry>
				</section>
			</component>
			<!--

********************************************************

PLANNED PROCEDURE

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.30"/>
					<!--  ******** Planned Procedure Section template  ******** -->
					<code code="59772-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Planned Procedure"/>
					<title>Planned Procedure</title>
					<text>Colonoscopy</text>
					<entry>
						<procedure moodCode="RQO" classCode="PROC">
							<templateId root="2.16.840.1.113883.10.20.22.4.41"/>
							<!-- ** Plan of Care Activity Procedure template ** -->
							<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
							<code code="274025005" codeSystem="2.16.840.1.113883.6.96" displayName="Colonic polypectomy"/>
							<statusCode code="new"/>
							<effectiveTime>
								<center value="20000421"/>
							</effectiveTime>
						</procedure>
					</entry>
				</section>
			</component>
			<!--

********************************************************

POSTOPERATIVE DIAGNOSIS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.35"/>
					<code code="10218-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="POSTOPERATIVE DIAGNOSIS"/>
					<title>Postoperative Diagnosis</title>
					<text>Appendicitis with periappendiceal abscess</text>
				</section>
			</component>
			<!--

********************************************************

PREOPERATIVE DIAGNOSIS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.34"/>
					<code code="10219-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGICAL OPERATION NOTE PREOPERATIVE DX"/>
					<title>Preoperative Diagnosis</title>
					<text>Appendicitis</text>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE DESCRIPTION

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.27"/>
					<code code="29554-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE DESCRIPTION"/>
					<title>Procedure Description</title>
					<text>The patient was brought to the operating room, placed in the supine position, and general  anesthesia was induced.  A detailed technical narrative of a laparoscopic appendectomy from initial incision to placement of any dressings follows.</text>
				</section>
			</component>
			<!-- ***********************************

     PROCEDURE DISPOSITION

     *********************************** -->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.18.2.12"/>
					<code code="59775-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE DISPOSITION"/>
					<title>Procedure Disposition</title>
					<text>The patient was taken to the Endoscopy Recovery Unit in stable

						condition.</text>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE ESTIMATED BLOOD LOSS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.18.2.9"/>
					<code code="59770-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE ESTIMATED BLOOD LOSS"/>
					<title>Procedure Estimated Blood Loss</title>
					<text>Minimal</text>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE FINDINGS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.28"/>
					<code code="59776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE FINDINGS"/>
					<title>Procedure Findings</title>
					<text>A 6 mm sessile polyp was found in the ascending colon and removed by

            snare, no cautery. Bleeding was controlled. Moderate diverticulosis

            and hemorrhoids were incidentally noted.</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<!-- Problem observation template -->
							<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
							<id root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
							<code code="409586006" codeSystem="2.16.840.1.113883.6.96" displayName="Complaint"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<low value="199803"/>
							</effectiveTime>
							<value xsi:type="CD" code="233604007" codeSystem="2.16.840.1.113883.6.96" displayName="Pneumonia"/>
							<entryRelationship typeCode="REFR">
								<observation classCode="OBS" moodCode="EVN">
									<!-- Problem status observation template -->
									<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
									<code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" codeSystemName="SNOMED CT"/>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="SUBJ" inversionInd="true">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
									<!--    Age observation template   -->
									<code code="397659008" codeSystem="2.16.840.1.113883.6.96" displayName="Age"/>
									<statusCode code="completed"/>
									<value xsi:type="PQ" value="57" unit="a"/>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="REFR">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.5"/>
									<!-- Health status observation template -->
									<code code="11323-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Health status"/>
									<statusCode code="completed"/>
									<value xsi:type="CE" code="413322009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Resolved"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE IMPLANTS

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.40"/>
					<code code="59771-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE IMPLANTS"/>
					<title>Procedure Implants</title>
					<text>No implants were placed.</text>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE INDICATIONS

***********************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.29"/>
					<code code="59768-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE INDICATIONS"/>
					<title>Procedure Indications</title>
					<text>The procedure is performed for screening in a low risk individual.

   </text>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
							<id root="db734647-fc99-424c-a864-7e3cda82e703" extension="45665"/>
							<code code="404684003" displayName="Finding" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
							<statusCode code="completed"/>
							<value xsi:type="CE" code="414992000" displayName="Painless rectal bleeding" codeSystem="2.16.840.1.113883.6.96"/>
						</observation>
					</entry>
				</section>
			</component>
			<!--

********************************************************

PROCEDURE SPECIMENS TAKEN

********************************************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.31"/>
					<code code="59773-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURE SPECIMENS TAKEN"/>
					<title>Procedure Specimens Taken</title>
					<text>Ascending colon polyp</text>
				</section>
			</component>
			<!--

********************************************************

SURGICAL DRAINS

***********************************

-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.7.13"/>
					<code code="11537-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="SURGICAL DRAINS"/>
					<title>Surgical Drains</title>
					<text>Penrose drain placed</text>
				</section>
			</component>
			<!--

**Required Sections

Anesthesia

Complications

Post Operative Diagnosis

Pre Operative Diagnosis

Procedure Estimated Blood Loss

Procedure Findings

Procedure Specimens Taken

Procedure Description







**Optional Sections

Procedure Implants

Operative Note Fluids

Operative Note Surgical Procedure

Plan of Care

Planned Procedure

Procedure Disposition

Procedure Indications

Surgical Drains









* wherever referenced, intent is that either

"Assessment and Plan" is present or both "Assessment" and "Plan of Care".

Only these combinations should be used.



*** wherever referenced, intent is that either "Chief Complaint/Reason for Visit" is present

or  "Chief Complaint", and/or "Reason for Visit".

Only these combinations should be used.



-->
		</structuredBody>
	</component>
</ClinicalDocument>
