Blue Button+ Implementation Guide

February 4, 2013 - Developer Preview | Help edit this site

Format for Blue Button+ Health Content

An electronic health record keeps a digital record of clinical information about a particular individual. With the amount of variability among Health IT systems, it is important to have a consistent set of health information for each patient.

For Blue Button, the recommended standard for representing the patient health record is the HL7 Consolidated Clinical Document Architecture also known as the Consolidated CDA.

The Consolidated CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document.

There are a wide-range of templates that can be represented in the Consolidated CDA standard. For Blue Button we are outlining a subset of sections and fields that should be used.

Tools: NIST Validator Web App and C-CDA Scorecard

1. Sections

Blue Button adopts the requirements for sections and fields from Meaningful Use Stage 2. Meaningful Use specifies the fields and content structure of clinical data that providers will share with patients at care transitions. This same structure and consistency will aid application developers as they design and build consumer tools.

Whenever the C-CDA is generated for patients, it should have the following fields, if they exist in the dataholder’s system:

Section Description Quick Link
Header Patient information and demographics Jump to XML
Allergies, Adverse Reactions, and Alerts Includes status and severity of each. Jump to XML
Encounters Surgeries, ED visits, etc. Jump to XML
Immunizations Immunizations and vaccines Jump to XML
Medications As prescribed by the provider Jump to XML
Care Plan Planned activities and encounters Jump to XML
Discharge Medications Part of hospital discharge summary Jump to XML
Reason for Referral Written reason for referral Jump to XML
Problem List Concerns, complaints, and observations Jump to XML
Procedures History of procedures Jump to XML
Functional and Cognitive Status List of impairments Jump to XML
Results Includes laboratory tests Jump to XML
Social History Observations like smoking, drinking, etc. Jump to XML
Vital Signs Includes height, weight, blood pressure, etc. Jump to XML
Discharge Instructions Written discharge instructions Jump to XML

Link to Companion Guide to Consolidated CDA produced by ONC.

2. Codes, Dictionaries, and Vocabularies

Throughout the C-CDA a variety of codes are used to describe the values within it.

Code System Description
LOINC Database and universal standard for identifying medical laboratory observations
RxNorm Normalized names for clinical drugs
SNOMED CT Collection of clinical terms
ICD-10 Codes to classify diseases and a wide variety of signs and symptoms
ICD-9 Codes to classify diseases and a wide variety of signs and symptoms

3. Human Readable Stylesheet

If a patient or other person is the main consumer of the health record, it should include a stylesheet.

To make the C-CDA XML human readable, an XSLT stylesheet should be included. This will allow a person to easily view their information on a computer or print it.

4. Breakdown of Consolidated CDA XML

This section dissects a well-formed C-CDA. This is the entire XML file. This is another example.

Type of XML File

The XML file references the schema from HL7.

<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
 xsi:schemaLocation="urn:hl7-org:v3 ../../../CDA%20R2/cda-schemas-and-samples/infrastructure/cda/CDA.xsd"
 xmlns="urn:hl7-org:v3"
 xmlns:cda="urn:hl7-org:v3"
 xmlns:sdtc="urn:hl7-org:sdtc">
 

The CDA Header includes details about the identity of the patient, the creator of the XML document, and the reason the encounter that generated data occured.

   
   <!--
********************************************************
  CDA Header
********************************************************
	-->
   <!-- CONF 16791 -->
   <realmCode
      code="US"/>
   
   <!-- CONF 5361 -->
   <typeId
      root="2.16.840.1.113883.1.3"
      extension="POCD_HD000040"/>
   
   <!-- US General Header Template -->
   <!-- CONF 5252 -->
   <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"/>
   
   <!-- CONF 5363 -->
   <id
      extension="Test CCDA"
      root="1.1.1.1.1.1.1.1.1"/>
   
   <!-- CONF 5253 "CCD document" -->
   <code
      codeSystem="2.16.840.1.113883.6.1"
      codeSystemName="LOINC"
      code="34133-9"
      displayName="Summarization of Episode Note"/>
   
   <!-- CONF 5254 -->
   <title>Community Health and Hospitals: Health Summary</title>
   
   <!-- CONF 5256 -->
   <effectiveTime
      value="20120912000000-0000"/>
   
   <!-- 5259 -->
   <confidentialityCode
      code="N"
      codeSystem="2.16.840.1.113883.5.25"/>
   
   <!-- 5372 -->
   <languageCode
      code="en-US"/>
   
   <!-- CONF 5266 -->
   <recordTarget>
      
      <!-- CONF 5267 -->
      <patientRole>
         
         <!-- CONF 5268-->
         <id
            extension="1"
            root="2.16.840.1.113883.4.6"/>
         <!-- Fake ID using HL7 example OID. -->
         
         <!-- Patient SSN recorded as an ID -->
         <id
            extension="123-101-5230"
            root="2.16.840.1.113883.4.1"/>
         
         <!-- CONF 5271 -->
         <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>97006</postalCode>
            <country>US</country>
            <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
         </addr>
         
         <!-- CONF 5280 -->
         <telecom
            value="tel:(816)276-6909"
            use="HP"/>
         <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
         
         <!-- CONF 5283 -->
         <patient>
            
            <!-- CONF 5284 -->
            <name
               use="L">
               <!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
               <given>Myra</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="19470501"/>
            
            <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"/>
            
            <!-- Need to Fix the Race Code to be from the OMB Standards -->
            <raceCode
               code="2106-3"
               displayName="White"
               codeSystem="2.16.840.1.113883.6.238"
               codeSystemName="Race and Ethnicity - CDC"/>
            <ethnicGroupCode
               code="2186-5"
               displayName="Not Hispanic or Latino"
               codeSystem="2.16.840.1.113883.6.238"
               codeSystemName="Race and Ethnicity - CDC"/>
                 
            <guardian>
               <code
                  code="GPARNT"
                  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>1357 Amber Drive</streetAddressLine>
                  <city>Beaverton</city>
                  <state>OR</state>
                  <postalCode>97006</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>97006</postalCode>
                     <country>US</country>
                  </addr>
               </place>
            </birthplace>
            
            <!-- FIX  the Code System to be 639.2 -->
            <languageCommunication>
               <languageCode
                  code="eng"/>
               <modeCode
                  code="ESP"
                  displayName="Expressed spoken"
                  codeSystem="2.16.840.1.113883.5.60"
                  codeSystemName="LanguageAbilityMode"/>
               <preferenceInd
                  value="true"/>
            </languageCommunication>
         </patient>
         <providerOrganization>
            <id
               root="1.1.1.1.1.1.1.1.4"/>
            <name>Community Health and Hospitals</name>
            <telecom
               use="WP"
               value="tel: 555-555-5000"/>
            <addr>
               <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
               <city>Portland</city>
               <state>OR</state>
               <postalCode>97266</postalCode>
               <country>US</country>
            </addr>
         </providerOrganization>
      </patientRole>
   </recordTarget>
   
   <author>
      <time
         value="20050813000000+0500"/>
      <assignedAuthor>
         <id
            extension="111111"
            root="2.16.840.1.113883.4.6"/>
         <addr>
            <streetAddressLine>1002 Healthcare Drive </streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</postalCode>
            <country>US</country>
         </addr>
         <telecom
            use="WP"
            value="tel:555-555-1002"/>
         <assignedPerson>
            <name>
               <prefix>Dr</prefix>
               <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>1002 Healthcare Drive </streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</postalCode>
            <country>US</country>
         </addr>
         <telecom
            use="WP"
            value="tel:555-555-1002"/>
         <assignedPerson>
            <name>
               <given>Mary</given>
               <family>McDonald</family>
            </name>
         </assignedPerson>
      </assignedEntity>
   </dataEnterer>
   <informant>
      <assignedEntity>
         <id
            extension="KP00017"
            root="2.16.840.1.113883.19.5"/>
         <addr>
            <streetAddressLine>1002 Healthcare Drive </streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</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>97266</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="20120813"/>
      <signatureCode
         code="S"/>
      <assignedEntity>
         <id
            extension="999999999"
            root="2.16.840.1.113883.4.6"/>
         <addr>
            <streetAddressLine>1002 Healthcare Drive </streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</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="20120813"/>
      <signatureCode
         code="S"/>
      <assignedEntity>
         <id
            extension="999999999"
            root="2.16.840.1.113883.4.6"/>
         <addr>
            <streetAddressLine>1002 Healthcare Drive </streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</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>
   <participant typeCode="IND">
      <associatedEntity classCode="PRS">
         <code
            code="GPARNT"
            displayName="Grand Parent"
            codeSystem="2.16.840.1.113883.1.11.19563"
            codeSystemName="Personal Relationship Role Type Value Set"/>
         <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>97006</postalCode>
            <country>US</country>
            <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
         </addr>
         <telecom value='tel:(555)555-2006' use='WP'/>
         <associatedPerson>
            <name>
               <prefix>Mr.</prefix>
               <given>Ralph</given>
               <family>Jones</family>
            </name>
         </associatedPerson>
      </associatedEntity>
   </participant>
   <participant typeCode="IND">
      <associatedEntity classCode="PRS">
         <code
            code="SPS"
            displayName="SPOUSE"
            codeSystem="2.16.840.1.113883.1.11.19563"
            codeSystemName="Personal Relationship Role Type Value Set"/>
         <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>97006</postalCode>
            <country>US</country>
            <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
         </addr>
         <telecom value='tel:(555)555-2006' use='WP'/>
         <associatedPerson>
            <name>
               <prefix>Mr.</prefix>
               <given>Frank</given>
               <family>Jones</family>
            </name>
         </associatedPerson>
      </associatedEntity>
   </participant>
   <documentationOf
      typeCode="DOC">
      <serviceEvent
         classCode="PCPR">
         <code
            code="233604007"
            codeSystem="2.16.840.1.113883.6.96"
            codeSystemName="SNOMED-CT"
            displayName="Pnuemonia"/>
         <effectiveTime>
            <low
               value="20120806"/>
            <high
               value="20120813"/>
            
         </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="20120806"/>
               <high
                  value="20120813"/>
            </time>
            <assignedEntity>
               <id
                  extension="PseudoMD-1"
                  root="2.16.840.1.113883.4.6"/>
               <code
                  code="208D00000X"
                  displayName="General Practice"
                  codeSystemName="Provider Codes"
                  codeSystem="2.16.840.1.113883.6.101"/>
               <addr>
                  <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                  <city>Portland</city>
                  <state>OR</state>
                  <postalCode>97266</postalCode>
                  <country>US</country>
               </addr>
               <telecom
                  value="tel:+1-555-555-5000"
                  use="WP"/>
               <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="WP"/>
                  <addr>
                     <streetAddressLine>1002 Healthcare Drive </streetAddressLine>
                     <city>Portland</city>
                     <state>OR</state>
                     <postalCode>97266</postalCode>
                     <country>US</country>
                  </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="20120806"/>
               <high
                  value="20120813"/>
            </time>
            <assignedEntity>
               <id
                  extension="PseudoMD-3"
                  root="2.16.840.1.113883.4.6"/>
               <code
                  code="208D00000X"
                  displayName="General Practice"
                  codeSystemName="Provider Codes"
                  codeSystem="2.16.840.1.113883.6.101"/>
               <addr>
                  <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                  <city>Portland</city>
                  <state>OR</state>
                  <postalCode>97266</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>1002 Healthcare Drive </streetAddressLine>
                     <city>Portland</city>
                     <state>OR</state>
                     <postalCode>97266</postalCode>
                     <country>US</country>
                  </addr>
               </representedOrganization>
            </assignedEntity>
         </performer>
      </serviceEvent>
   </documentationOf>
   
   <componentOf>
      <encompassingEncounter>
         <id extension="1" root="2.16.840.1.113883.4.6"/>
         <code
            code="233604007"
            codeSystem="2.16.840.1.113883.6.96"
            codeSystemName="SNOMED-CT"
            displayName="Pnuemonia"/>
         <effectiveTime>
            <low
               value="20120806"/>
            <high
               value="20120813"/>
         </effectiveTime>
         <responsibleParty>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6"/>
               <assignedPerson>
                  <name>
                     <prefix>Dr</prefix>
                     <given>Henry</given>
                     <family>Seven</family>
                  </name>
               </assignedPerson>
            </assignedEntity>
         </responsibleParty>
         <encounterParticipant typeCode="ATND">
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6"/>
               <assignedPerson>
                  <name>
                     <prefix>Dr</prefix>
                     <given>Henry</given>
                     <family>Seven</family>
                  </name>
               </assignedPerson>
            </assignedEntity>
         </encounterParticipant>
         <location>
            <healthCareFacility>
               <id root="2.16.840.1.113883.4.6"/>
            </healthCareFacility>
         </location>
      </encompassingEncounter>
   </componentOf>

Body

This is the start of the CDA Body which contains all the sections in the health record.

   <!-- ********************************************************
     CDA Body
     ******************************************************** -->
   <component>
      <structuredBody>
         <!-- *********************** -->

Allergies, Adverse Reactions, and Alerts

This Alerts section contains a description of allergies, reactions, and alerts for the particular patient.

         <!--
********************************************************
Allergies, Adverse Reactions, Alerts
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.6.1"/>
               <!-- Alerts section template -->
               <code
                  code="48765-2"
                  codeSystem="2.16.840.1.113883.6.1"/>
               <title>ALLERGIES, ADVERSE REACTIONS, ALERTS</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Substance</th>
                           <th>Reaction</th>
                           <th>Severity</th>
                           <th>Status</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>Penicillin G benzathine</td>
                           <td><content
                                 ID="reaction1">Hives</content></td>
                           <td><content
                                 ID="severity1">Moderate to severe</content></td>
                           <td>Inactive</td>
                        </tr>
                        <tr>
                           <td>Codeine</td>
                           <td><content
                                 ID="reaction2">Shortness of Breath</content></td>
                           <td><content
                                 ID="severity2">Moderate</content></td>
                           <td>Active</td>
                        </tr>
                        <tr>
                           <td>Aspirin</td>
                           <td><content
                                 ID="reaction3">Hives</content></td>
                           <td><content
                                 ID="severity3">Mild to moderate</content></td>
                           <td>Active</td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.30"/>
                     <!-- ** Allergy problem act ** -->
                     <id
                        root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
                     <code
                        code="48765-2"
                        codeSystem="2.16.840.1.113883.6.1"
                        codeSystemName="LOINC"
                        displayName="Allergies, adverse reactions, alerts"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        value="20070501">
                        <low
                           value="20070501"/>
                        <high
                           value="20120806"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <!-- allergy observation template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.7"/>
                           <id
                              root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
                           <code
                              code="ASSERTION"
                              codeSystem="2.16.840.1.113883.5.4"/>
                           <statusCode
                              code="completed"/>
                           <effectiveTime>
                              <low nullFlavor="UNK"/>
                              <high  value="20120806"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="419511003"
                              displayName="Propensity to adverse reaction to drug"
                              codeSystem="2.16.840.1.113883.6.96"
                              codeSystemName="SNOMED CT">
                              <originalText>
                                 <reference
                                    value="#reaction1"/>
                              </originalText>
                           </value>
                           <participant
                              typeCode="CSM">
                              <participantRole
                                 classCode="MANU">
                                 <playingEntity
                                    classCode="MMAT">
                                    <code
                                       code="7982"
                                       displayName="Penicillin G benzathine"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       codeSystemName="RxNorm">
                                       <originalText>
                                          <reference
                                             value="#reaction1"/>
                                       </originalText>
                                    </code>
                                 </playingEntity>
                              </participantRole>
                           </participant>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.28"/>
                                 <!-- Allergy status observation template -->
                                 <code
                                    code="33999-4"
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC"
                                    displayName="Status"/>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CE"
                                    code="73425007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Inactive"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="MFST"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.9"/>
                                 <!-- Reaction observation template -->
                                 <id
                                    root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
                                 <code
                                    nullFlavor="NA"/>
                                 <text>
                                    <reference
                                       value="#reaction1"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <effectiveTime>
                                    <low
                                       value="20070501"/>
                                 </effectiveTime>
                                 <value
                                    xsi:type="CD"
                                    code="247472004"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Hives"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.8"/>
                                 <!-- ** Severity observation template ** -->
                                 <code xsi:type="CE"
                                    code="SEV"
                                    displayName="Severity Observation"
                                    codeSystem="2.16.840.1.113883.5.4"
                                    codeSystemName="ActCode"/>
                                 <text>
                                    <reference
                                       value="#severity1"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CD"
                                    code="371924009"
                                    displayName="Moderate to severe"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"/>
                              </observation>
                           </entryRelationship>
                        </observation>
                     </entryRelationship>
                  </act>
               </entry>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.30"/>
                     <!-- ** Allergy problem act ** -->
                     <id
                        root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
                     <code
                        code="48765-2"
                        codeSystem="2.16.840.1.113883.6.1"
                        codeSystemName="LOINC"
                        displayName="Allergies, adverse reactions, alerts"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        value="20060501">
                        <low
                           value="20060501"/>
                        <high
                           value="20120806"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <!-- allergy observation template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.7"/>
                           <id
                              root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
                           <code
                              code="ASSERTION"
                              codeSystem="2.16.840.1.113883.5.4"/>
                           <statusCode
                              code="completed"/>
                           <effectiveTime>
                              <low
                                 value="20060501"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="419511003"
                              displayName="Propensity to adverse reaction to drug"
                              codeSystem="2.16.840.1.113883.6.96"
                              codeSystemName="SNOMED CT">
                              <originalText>
                                 <reference
                                    value="#reaction2"/>
                              </originalText>
                           </value>
                           <participant
                              typeCode="CSM">
                              <participantRole
                                 classCode="MANU">
                                 <playingEntity
                                    classCode="MMAT">
                                    <code
                                       code="2670"
                                       displayName="Codeine"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       codeSystemName="RxNorm">
                                       <originalText>
                                          <reference
                                             value="#reaction2"/>
                                       </originalText>
                                    </code>
                                 </playingEntity>
                              </participantRole>
                           </participant>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.28"/>
                                 <!-- Allergy status observation template -->
                                 <code
                                    code="33999-4"
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC"
                                    displayName="Status"/>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CE"
                                    code="55561003"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Active"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="MFST"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.9"/>
                                 <!-- Reaction observation template -->
                                 <id
                                    root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
                                 <code
                                    nullFlavor="NA"/>
                                 <text>
                                    <reference
                                       value="#reaction2"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <effectiveTime>
                                    <low
                                       value="20060501"/>
                                 </effectiveTime>
                                 <value
                                    xsi:type="CD"
                                    code="267036007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Shortness of Breath"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.8"/>
                                 <!-- ** Severity observation template ** -->
                                 <code xsi:type="CE"
                                    code="SEV"
                                    displayName="Severity Observation"
                                    codeSystem="2.16.840.1.113883.5.4"
                                    codeSystemName="ActCode"/>
                                 <text>
                                    <reference
                                       value="#severity2"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CD"
                                    code="6736007"
                                    displayName="Moderate"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"/>
                              </observation>
                           </entryRelationship>
                        </observation>
                     </entryRelationship>
                  </act>
               </entry>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.30"/>
                     <!-- ** Allergy problem act ** -->
                     <id
                        root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
                     <code
                        code="48765-2"
                        codeSystem="2.16.840.1.113883.6.1"
                        codeSystemName="LOINC"
                        displayName="Allergies, adverse reactions, alerts"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        value="20080501">
                        <low
                           value="20080501"/>
                        <high
                           value="20120806"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <!-- allergy observation template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.7"/>
                           <id
                              root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
                           <code
                              code="ASSERTION"
                              codeSystem="2.16.840.1.113883.5.4"/>
                           <statusCode
                              code="completed"/>
                           <effectiveTime>
                              <low
                                 value="20080501"/>
                              <high value="20120806"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="419511003"
                              displayName="Propensity to adverse reaction to drug"
                              codeSystem="2.16.840.1.113883.6.96"
                              codeSystemName="SNOMED CT">
                              <originalText>
                                 <reference
                                    value="#reaction3"/>
                              </originalText>
                           </value>
                           <participant
                              typeCode="CSM">
                              <participantRole
                                 classCode="MANU">
                                 <playingEntity
                                    classCode="MMAT">
                                    <code
                                       code="1191"
                                       displayName="Aspirin"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       codeSystemName="RxNorm">
                                       <originalText>
                                          <reference
                                             value="#reaction3"/>
                                       </originalText>
                                    </code>
                                 </playingEntity>
                              </participantRole>
                           </participant>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.28"/>
                                 <!-- Allergy status observation template -->
                                 <code
                                    code="33999-4"
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC"
                                    displayName="Status"/>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CE"
                                    code="55561003"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Active"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="MFST"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.9"/>
                                 <!-- Reaction observation template -->
                                 <id
                                    root="4adc1020-7b14-11db-9fe1-0800200c9a64"/>
                                 <code
                                    nullFlavor="NA"/>
                                 <text>
                                    <reference
                                       value="#reaction3"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <effectiveTime>
                                    <low
                                       value="20080501"/>
                                 </effectiveTime>
                                 <value
                                    xsi:type="CD"
                                    code="247472004"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Hives"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <observation
                                 classCode="OBS"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.8"/>
                                 <!-- ** Severity observation template ** -->
                                 <code xsi:type="CE"
                                    code="SEV"
                                    displayName="Severity Observation"
                                    codeSystem="2.16.840.1.113883.5.4"
                                    codeSystemName="ActCode"/>
                                 <text>
                                    <reference
                                       value="#severity3"/>
                                 </text>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CD"
                                    code="371923003"
                                    displayName="Mild to moderate"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"/>
                              </observation>
                           </entryRelationship>
                        </observation>
                     </entryRelationship>
                  </act>
               </entry>
            </section>
         </component>

Encounters

This Encounters section includes all the office visits, emergency room visits, surgeries, etc.

         <!--
********************************************************
ENCOUNTERS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.22.1"/>
               <!-- Encounters Section - required entries -->
               <code
                  code="46240-8"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="History of encounters"/>
               <title>ENCOUNTERS</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Encounter</th>
                           <th>Performer</th>
                           <th>Location</th>
                           <th>Date</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>
                              <content
                                 ID="Encounter1"/> Pnuemonia</td>
                           <td>Dr Henry Seven</td>
                           <td>Community Health and Hospitals</td>
                           <td>20120806</td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <encounter
                     classCode="ENC"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.49"/>
                     <!-- Encounter Activities -->
                     <!--  ********  Encounter activity template   ******** -->
                     <id
                        root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
                     <code
                        code="99222"
                        displayName="InPatient Admission"
                        codeSystemName="CPT"
                        codeSystem="2.16.840.1.113883.6.12"
                        codeSystemVersion="4">
                        <originalText>Mild Fever<reference
                              value="#Encounter1"/>
                        </originalText>
                     </code>
                     <effectiveTime
                        value="20120806"/>
                     <performer>
                        <assignedEntity>
                           <id
                              root="2a620155-9d11-439e-92a3-5d9815ff4de8"/>
                           <code
                              code="59058001"
                              codeSystem="2.16.840.1.113883.6.96"
                              codeSystemName="SNOMED CT"
                              displayName="General Physician"/>
                        </assignedEntity>
                     </performer>
                     <participant
                        typeCode="LOC">
                        <participantRole
                           classCode="SDLOC">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.32"/>
                           <!-- Service Delivery Location template -->
                           <code
                              code="1160-1"
                              codeSystem="2.16.840.1.113883.6.259"
                              codeSystemName="HealthcareServiceLocation"
                              displayName="Urgent Care Center"/>
                           <addr>
                              <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                              <city>Portland</city>
                              <state>OR</state>
                              <postalCode>97266</postalCode>
                              <country>US</country>
                           </addr>
                           <telecom
                              nullFlavor="UNK"/>
                           <playingEntity
                              classCode="PLC">
                              <name>Community Health and Hospitals</name>
                           </playingEntity>
                        </participantRole>
                     </participant>
                     <entryRelationship
                        typeCode="RSON">
                        <observation
                           classCode="OBS"
                           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"/>
                           <effectiveTime>
                              <low
                                 value="20120806"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="233604007"
                              displayName="Pneumonia"
                              codeSystem="2.16.840.1.113883.6.96"/>
                        </observation>
                     </entryRelationship>
                     <entryRelationship
                        typeCode="SUBJ" inversionInd="false">
                        <act classCode="ACT" moodCode="EVN">
                           
                           <!--Encounter diagnosis act -->
                           <templateId root="2.16.840.1.113883.10.20.22.4.80"/>
                           
                           <id root="5a784260-6856-4f38-9638-80c751aff2fb"/>
                           <code xsi:type="CE" 
                              code="29308-4"
                              codeSystem="2.16.840.1.113883.6.1" 
                              codeSystemName="LOINC"
                              displayName="ENCOUNTER DIAGNOSIS"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20120806"/>
                           </effectiveTime>
                           <entryRelationship typeCode="SUBJ" inversionInd="false">
                              <observation classCode="OBS" moodCode="EVN" negationInd="false">
                                 <templateId root="2.16.840.1.113883.10.20.22.4.4"/>
                                 <!-- Problem Observation -->
                                 <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="20120806"/>
                                 </effectiveTime>
                                 <value
                                    xsi:type="CD"
                                    code="233604007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Pneumonia"/>
                              </observation>
                           </entryRelationship>
                        </act>
                     </entryRelationship>
                  </encounter>
               </entry>
            </section>
         </component>

Immunizations

This Immunizations section includes all the vaccines an individual has been administered.

         <!--
********************************************************
IMMUNIZATIONS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.2.1"/>
               <!-- Entries Required -->
               <!--  ********  Immunizations section template   ******** -->
               <code
                  code="11369-6"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="History of immunizations"/>
               <title>IMMUNIZATIONS</title>
               <!-- Unstructured text field -->
               <text><content
                     ID="immunSect"/>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Vaccine</th>
                           <th>Date</th>
                           <th>Status</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td><content
                                 ID="immun2"/>Influenza virus vaccine, IM</td>
                           <td>May 2012</td>
                           <td>Completed</td>
                        </tr>
                        <tr>
                           <td><content
                                 ID="immun4"/>Tetanus and diphtheria toxoids, IM</td>
                           <td>Aor 2012</td>
                           <td>Completed</td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               
               <entry
                  typeCode="DRIV">
                  <substanceAdministration
                     classCode="SBADM"
                     moodCode="EVN"
                     negationInd="false">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.52"/>
                     <!--  ********   Immunization activity template    ******** -->
                     <id
                        root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
                     <text>
                        <reference
                           value="#immun2"/>
                     </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        xsi:type="IVL_TS"
                        value="20120510"/>
                     <routeCode
                        code="C28161"
                        codeSystem="2.16.840.1.113883.3.26.1.1"
                        codeSystemName="National Cancer Institute (NCI) Thesaurus"
                        displayName="Intramuscular injection"/>
                     <doseQuantity
                        value="50"
                        unit="mcg"/>
                     <consumable>
                        <manufacturedProduct
                           classCode="MANU">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.54"/>
                           <!--  ********   Immunization Medication Information    ******** -->
                           <manufacturedMaterial>
                              <code
                                 code="88"
                                 codeSystem="2.16.840.1.113883.6.59"
                                 displayName="Influenza virus vaccine"
                                 codeSystemName="CVX">
                                 <originalText>Influenza virus vaccine</originalText>
                                 <translation
                                    code="111"
                                    displayName="influenza, live, intranasal"
                                    codeSystemName="CVX"
                                    codeSystem="2.16.840.1.113883.6.59"/>
                              </code>
                           </manufacturedMaterial>
                           <manufacturerOrganization>
                              <name>Health LS - Immuno Inc.</name>
                           </manufacturerOrganization>
                        </manufacturedProduct>
                     </consumable>
                     <entryRelationship
                        typeCode="SUBJ" inversionInd="true">
                        <act
                           classCode="ACT"
                           moodCode="INT">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.20"/>
                           <!-- ** Instructions Template ** -->
                           <code xsi:type="CE"
                              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>
                     </entryRelationship>
                  </substanceAdministration>
               </entry>
               <entry
                  typeCode="DRIV">
                  <substanceAdministration
                     classCode="SBADM"
                     moodCode="EVN"
                     negationInd="false">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.52"/>
                     <!--  ********   Immunization activity template    ******** -->
                     <id
                        root="e6f1ba43-c0ed-4b9b-9f12-f435d8ad8f92"/>
                     <text>
                        <reference
                           value="#immun4"/>
                     </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        xsi:type="IVL_TS"
                        value="20120401"/>
                     <routeCode
                        code="C28161"
                        codeSystem="2.16.840.1.113883.3.26.1.1"
                        codeSystemName="National Cancer Institute (NCI) Thesaurus"
                        displayName="Intramuscular injection"/>
                     <doseQuantity
                        value="50"
                        unit="mcg"/>
                     <consumable>
                        <manufacturedProduct
                           classCode="MANU">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.54"/>
                           <!--  ********   Immunization Medication Information    ******** -->
                           <manufacturedMaterial>
                              <code
                                 code="103"
                                 codeSystem="2.16.840.1.113883.6.59"
                                 displayName="Tetanus and diphtheria toxoids - preservative free"
                                 codeSystemName="CVX">
                                 <originalText>Tetanus and diphtheria toxoids - preservative free</originalText>
                                 <translation
                                    code="09"
                                    displayName="Tetanus and diphtheria toxoids - preservative free"
                                    codeSystemName="CVX"
                                    codeSystem="2.16.840.1.113883.6.59"/>
                              </code>
                           </manufacturedMaterial>
                           <manufacturerOrganization>
                              <name>Health LS - Immuno Inc.</name>
                           </manufacturerOrganization>
                        </manufacturedProduct>
                     </consumable>
                     <entryRelationship
                        typeCode="SUBJ"
                        inversionInd="true">
                        <act
                           classCode="ACT"
                           moodCode="INT">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.20"/>
                           <!-- ** Instructions Template ** -->
                           <code xsi:type="CE"
                              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>
                     </entryRelationship>
                  </substanceAdministration>
               </entry>
            </section>
         </component>

Medications

This section includes all the Medications prescribed to an individual. It includes the type of medication, start date, instructions, and why it was prescribed.

         <!--
********************************************************
MEDICATIONS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.1.1"/>
               <code
                  code="10160-0"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="HISTORY OF MEDICATION USE"/>
               <title>Medications</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Medication</th>
                           <th>Directions</th>
                           <th>Start Date</th>
                           <th>Status</th>
                           <th>Indications</th>
                           <th>Fill Instructions</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td><content
                                 ID="Med1">Albuterol 0.09 MG/ACTUAT inhalant solution</content></td>
                           <td>0.09 MG/ACTUAT inhalant solution, 2 puffs once</td>
                           <td>20120806</td>
                           <td>Active</td>
                           <td>Pneumonia (233604007 SNOMED CT)</td>
                           <td><content ID="FillIns">Generic Substitition Allowed</content></td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <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"/>0.09 MG/ACTUAT inhalant solution, 2 puffs </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        xsi:type="IVL_TS">
                        <low
                           value="20120806"/>
                        <high
                           value="20120813"/>
                     </effectiveTime>
                     <effectiveTime
                        xsi:type="PIVL_TS"
                        institutionSpecified="true"
                        operator="A">
                        <period
                           value="12"
                           unit="h"/>
                     </effectiveTime>
                     <routeCode
                        code="C38216"
                        codeSystem="2.16.840.1.113883.3.26.1.1"
                        codeSystemName="NCI Thesaurus"
                        displayName="RESPIRATORY (INHALATION)"/>
                     <doseQuantity
                        value="0.09"
                        unit="mg/actuat"/>
                     <rateQuantity
                        value="90"
                        unit="ml/min"/>
                     <administrationUnitCode
                        code="C42944"
                        displayName="INHALANT"
                        codeSystem="2.16.840.1.113883.3.26.1.1"
                        codeSystemName="NCI Thesaurus"/>
                     <consumable>
                        <manufacturedProduct
                           classCode="MANU">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.23"/>
                           <id
                              root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
                           <manufacturedMaterial>
                              <code
                                 code="573621"
                                 codeSystem="2.16.840.1.113883.6.88"
                                 displayName="Albuterol 0.09 MG/ACTUAT inhalant solution">
                                 <originalText><reference
                                       value="#Med1"/></originalText>
                                 <translation
                                    code="573621"
                                    displayName="Proventil 0.09 MG/ACTUAT inhalant solution"
                                    codeSystem="2.16.840.1.113883.6.88"
                                    codeSystemName="RxNorm"/>
                              </code>
                           </manufacturedMaterial>
                           <manufacturerOrganization>
                              <name>Medication Factory Inc.</name>
                           </manufacturerOrganization>
                        </manufacturedProduct>
                     </consumable>
                     <performer>
                        <assignedEntity>
                           <id
                              nullFlavor="NI"/>
                           <addr
                              nullFlavor="UNK"/>
                           <telecom
                              nullFlavor="UNK"/>
                           <representedOrganization>
                              <id
                                 root="2.16.840.1.113883.19.5.9999.1393"/>
                              <name>Community Health and Hospitals</name>
                              <telecom
                                 nullFlavor="UNK"/>
                              <addr
                                 nullFlavor="UNK"/>
                           </representedOrganization>
                        </assignedEntity>
                     </performer>
                     <participant
                        typeCode="CSM">
                        <participantRole
                           classCode="MANU">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.24"/>
                           <code
                              code="412307009"
                              displayName="drug vehicle"
                              codeSystem="2.16.840.1.113883.6.96"/>
                           <playingEntity
                              classCode="MMAT">
                              <code
                                 code="324049"
                                 displayName="Aerosol"
                                 codeSystem="2.16.840.1.113883.6.88"
                                 codeSystemName="RxNorm"/>
                              <name>Aerosol</name>
                           </playingEntity>
                        </participantRole>
                     </participant>
                     <entryRelationship
                        typeCode="RSON">
                        <observation
                           classCode="OBS"
                           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"/>
                           <effectiveTime>
                              <low nullFlavor="UNK" />
                              <high value="20120813"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="233604007"
                              displayName="Pneumonia"
                              codeSystem="2.16.840.1.113883.6.96"/>
                        </observation>
                     </entryRelationship>
                     <entryRelationship
                        typeCode="REFR">
                        <supply
                           classCode="SPLY"
                           moodCode="INT">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.17"/>
                           <id
                              nullFlavor="NI"/>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              xsi:type="IVL_TS">
                              <low
                                 value="20120806"/>
                              <high
                                 value="20120813"/>
                           </effectiveTime>
                           <repeatNumber
                              value="1"/>
                           <quantity
                              value="75"/>
                           <product>
                              <manufacturedProduct
                                 classCode="MANU">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.23"/>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
                                 <manufacturedMaterial>
                                    <code
                                       code="573621"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       displayName="Albuterol 0.09 MG/ACTUAT inhalant solution">
                                       <originalText><reference
                                             value="#Med1"/></originalText>
                                       <translation
                                          code="573621"
                                          displayName="Albuterol 0.09 MG/ACTUAT inhalant solution"
                                          codeSystem="2.16.840.1.113883.6.88"
                                          codeSystemName="RxNorm"/>
                                    </code>
                                 </manufacturedMaterial>
                                 <manufacturerOrganization>
                                    <name>Medication Factory Inc.</name>
                                 </manufacturerOrganization>
                              </manufacturedProduct>
                           </product>
                           <performer>
                              <assignedEntity>
                                 <id
                                    extension="2981823"
                                    root="2.16.840.1.113883.19.5.9999.456"/>
                                 <addr>
                                    <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                    <city>Portland</city>
                                    <state>OR</state>
                                    <postalCode>97266</postalCode>
                                    <country>US</country>
                                 </addr>
                              </assignedEntity>
                           </performer>
                           <author>
                              <time
                                 nullFlavor="UNK"/>
                              <assignedAuthor>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9815fe4de8"/>
                                 <addr
                                    nullFlavor="UNK"/>
                                 <telecom
                                    nullFlavor="UNK"/>
                                 <assignedPerson>
                                    <name>
                                       <prefix>Dr.</prefix>
                                       <given>Henry</given>
                                       <family>Seven</family>
                                    </name>
                                 </assignedPerson>
                              </assignedAuthor>
                           </author>
                           <entryRelationship
                              typeCode="SUBJ"
                              inversionInd="true">
                              <act
                                 classCode="ACT"
                                 moodCode="INT">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.20"/>
                                 <!-- ** Instructions Template ** -->
                                 <code xsi:type="CE"
                                    code="409073007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="instruction"/>
                                 <text><reference
                                       value="#FillIns"/>label in spanish</text>
                                 <statusCode
                                    code="completed"/>
                              </act>
                           </entryRelationship>
                        </supply>
                     </entryRelationship>
                     <entryRelationship
                        typeCode="REFR">
                        <supply
                           classCode="SPLY"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.18"/>
                           <!-- ** Medication Dispense Template ** -->
                           <id
                              root="1.2.3.4.56789.1"
                              extension="cb734647-fc99-424c-a864-7e3cda82e704"/>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120806"/>
                           <repeatNumber
                              value="1"/>
                           <product>
                              <manufacturedProduct
                                 classCode="MANU">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.23"/>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
                                 <manufacturedMaterial>
                                    <code
                                       code="573621"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       displayName="Albuterol 0.09 MG/ACTUAT inhalant solution">
                                       <originalText><reference
                                             value="#Med1"/></originalText>
                                       <translation
                                          code="573621"
                                          displayName="Albuterol 0.09 MG/ACTUAT inhalant solution"
                                          codeSystem="2.16.840.1.113883.6.88"
                                          codeSystemName="RxNorm"/>
                                    </code>
                                 </manufacturedMaterial>
                                 <manufacturerOrganization>
                                    <name>Medication Factory Inc.</name>
                                 </manufacturerOrganization>
                              </manufacturedProduct>
                           </product>
                           <performer>
                              <time
                                 nullFlavor="UNK"/>
                              <assignedEntity>
                                 <id
                                    root="2.16.840.1.113883.19.5.9999.456"
                                    extension="2981823"/>
                                 <addr>
                                    <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                    <city>Portland</city>
                                    <state>OR</state>
                                    <postalCode>97266</postalCode>
                                    <country>US</country>
                                 </addr>
                                 <telecom
                                    nullFlavor="UNK"/>
                                 <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
                                       nullFlavor="UNK"/>
                                    <addr
                                       nullFlavor="UNK"/>
                                 </representedOrganization>
                              </assignedEntity>
                           </performer>
                        </supply>
                     </entryRelationship>
                     <precondition
                        typeCode="PRCN">
                        <templateId
                           root="2.16.840.1.113883.10.20.22.4.25"/>
                        <criterion>
                           <code
                              code="ASSERTION"
                              codeSystem="2.16.840.1.113883.5.4"/>
                           <value
                              xsi:type="CE"
                              code="56018004"
                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="Wheezing"/>
                        </criterion>
                     </precondition>
                  </substanceAdministration>
               </entry>
            </section>
         </component>

Care Plan

This Care Plan section lists all the planned activities and encounters recorded in the system.

         <!--
********************************************************
CARE PLAN
********************************************************
-->
         <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>CARE PLAN</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Planned Activity</th>
                           <th>Planned Date</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>Consultation with Dr George Potomac for Asthma</td>
                           <td>20120820</td>
                        </tr>
                        <tr>
                           <td>Chest X-ray</td>
                           <td>20120826</td>
                        </tr>
                        <tr>
                           <td>Sputum Culture</td>
                           <td>20120820</td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <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"/>
                     <code
                        code="99241"
                        displayName="Office consultation - 15 minutes"
                        codeSystemName="CPT"
                        codeSystem="2.16.840.1.113883.6.12"/>
                     <effectiveTime>
                        <center value="20120820"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ" inversionInd="true">
                        <act
                           classCode="ACT"
                           moodCode="INT">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.20"/>
                           <!-- ** Instructions Template ** -->
                           <code xsi:type="CE"
                              code="409073007"
                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="instruction"/>
                           <text>Follow up with Dr George Potomac for Asthma</text>
                           <statusCode
                              code="completed"/>
                        </act>
                     </entryRelationship>
                  </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="168731009"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Chest X-Ray"
                        codeSystemName="SNOMED-CT"/>
                     <statusCode
                        code="new"/>
                     <effectiveTime>
                        <center
                           value="20120826"/>
                     </effectiveTime>
                  </procedure>
               </entry>
               <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="624-7"
                        codeSystem="2.16.840.1.113883.6.1"
                        displayName="Sputum Culture"/>
                     <statusCode
                        code="new"/>
                     <effectiveTime>
                        <center
                           value="20120820"/>
                     </effectiveTime>
                  </observation>
               </entry>
            </section>
         </component>

Discharge Medications

This Hospital Discharge Summary section captures the medication prescribed at discharge.

  <!--
********************************************************
HOSPITAL DISCHARGE MEDICATIONS
********************************************************
			-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.11.1"/>
               <!-- Entries Required -->
               <!-- Hospital Discharge Summary templateId -->
               <code
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  code="10183-2"
                  displayName=" HOSPITAL DISCHARGE MEDICATIONS "/>
               <title>HOSPITAL DISCHARGE MEDICATIONS</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Medication</th>
                           <th>Directions</th>
                           <th>Start Date</th>
                           <th>Status</th>
                           <th>Indications</th>
                           <th>Fill Instructions</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td><content ID="DM">120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler</content></td>
                           <td><content ID="DM1">0.11 MG/ACTUAT Metered Dose Once Daily</content></td>
                           <td>20120813</td>
                           <td>Active</td>
                           <td>Bronchitis (32398004 SNOMED CT)</td>
                           <td><content ID="FillIns_DM">Generic Substitition Allowed</content></td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <!-- Discharge Medication Entry -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.35"/>
                     <id
                        root="5a784260-6856-4f38-9638-80c751aff2fb"/>
                     <code
                        code="10183-2"
                        codeSystem="2.16.840.1.113883.6.1"
                        codeSystemName="LOINC"
                        displayName="Discharge medication"/>
                     <statusCode
                        code="active"/>
                     <effectiveTime>
                        <low value="20120813"/>
                        <high value="20120813"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <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="#DM1"/>0.11 MG/ACTUAT Metered Dose Once Daily </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              xsi:type="IVL_TS">
                              <low value="20120813"/>
                              <high value="20120813"/>
                           </effectiveTime>
                           <effectiveTime
                              xsi:type="PIVL_TS"
                              institutionSpecified="true"
                              operator="A">
                              <period
                                 value="24"
                                 unit="h"/>
                           </effectiveTime>
                           <routeCode
                              code="C38216"
                              codeSystem="2.16.840.1.113883.3.26.1.1"
                              codeSystemName="NCI Thesaurus"
                              displayName="RESPIRATORY (INHALATION)"/>
                           <doseQuantity
                              value="1"
                              unit="mg/actuat"/>
                           <rateQuantity
                              value="110"
                              unit="ml/min"/>
                           <maxDoseQuantity
                              nullFlavor="UNK">
                              <numerator
                                 nullFlavor="UNK"/>
                              <denominator
                                 nullFlavor="UNK"/>
                           </maxDoseQuantity>
                           <administrationUnitCode
                              code="C42944"
                              displayName="INHALANT"
                              codeSystem="2.16.840.1.113883.3.26.1.1"
                              codeSystemName="NCI Thesaurus"/>
                           <consumable>
                              <manufacturedProduct
                                 classCode="MANU">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.23"/>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
                                 <manufacturedMaterial>
                                    <code
                                       code="896001"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler">
                                       <originalText><reference
                                             value="#DM"/></originalText>
                                       <translation
                                          code="896001"
                                          displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler"
                                          codeSystem="2.16.840.1.113883.6.88"
                                          codeSystemName="RxNorm"/>
                                    </code>
                                 </manufacturedMaterial>
                                 <manufacturerOrganization>
                                    <name>Medication Factory Inc.</name>
                                 </manufacturerOrganization>
                              </manufacturedProduct>
                           </consumable>
                           <performer>
                              <assignedEntity>
                                 <id
                                    nullFlavor="NI"/>
                                 <addr
                                    nullFlavor="UNK"/>
                                 <telecom
                                    nullFlavor="UNK"/>
                                 <representedOrganization>
                                    <id
                                       root="2.16.840.1.113883.19.5.9999.1395"/>
                                    <name>Community Health and Hospitals</name>
                                    <telecom
                                       nullFlavor="UNK"/>
                                    <addr
                                       nullFlavor="UNK"/>
                                 </representedOrganization>
                              </assignedEntity>
                           </performer>
                           <participant
                              typeCode="CSM">
                              <participantRole
                                 classCode="MANU">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.24"/>
                                 <code
                                    code="412307009"
                                    displayName="drug vehicle"
                                    codeSystem="2.16.840.1.113883.6.96"/>
                                 <playingEntity
                                    classCode="MMAT">
                                    <code
                                       code="324049"
                                       displayName="Aerosol"
                                       codeSystem="2.16.840.1.113883.6.88"
                                       codeSystemName="RxNorm"/>
                                    <name>Aerosol</name>
                                 </playingEntity>
                              </participantRole>
                           </participant>
                           <entryRelationship
                              typeCode="RSON">
                              <observation
                                 classCode="OBS"
                                 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"/>
                                 <effectiveTime>
                                    <low
                                       value="20110113"/>
                                 </effectiveTime>
                                 <value
                                    xsi:type="CD"
                                    code="32398004"
                                    displayName="Bronchitis"
                                    codeSystem="2.16.840.1.113883.6.96"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="REFR">
                              <supply
                                 classCode="SPLY"
                                 moodCode="INT">
                                 <templateId
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                                 <id
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                                 <statusCode
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                                 <effectiveTime
                                    xsi:type="IVL_TS">
                                    <low
                                       value="20120813"/>
                                    <high
                                       nullFlavor="UNK"/>
                                 </effectiveTime>
                                 <repeatNumber
                                    value="1"/>
                                 <quantity
                                    value="75"/>
                                 <product>
                                    <manufacturedProduct
                                       classCode="MANU">
                                       <templateId
                                          root="2.16.840.1.113883.10.20.22.4.23"/>
                                       <id
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                                       <manufacturedMaterial>
                                          <code
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                                             displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler">
                                             <originalText><reference
                                                   value="#DM"/></originalText>
                                             <translation
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                                                displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler"
                                                codeSystem="2.16.840.1.113883.6.88"
                                                codeSystemName="RxNorm"/>
                                          </code>
                                       </manufacturedMaterial>
                                       <manufacturerOrganization>
                                          <name>Medication Factory Inc.</name>
                                       </manufacturerOrganization>
                                    </manufacturedProduct>
                                 </product>
                                 <performer>
                                    <assignedEntity>
                                       <id
                                          extension="2981825"
                                          root="2.16.840.1.113883.19.5.9999.456"/>
                                       <addr>
                                          <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                          <city>Portland</city>
                                          <state>OR</state>
                                          <postalCode>97266</postalCode>
                                          <country>US</country>
                                       </addr>
                                    </assignedEntity>
                                 </performer>
                                 <author>
                                    <time
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                                          root="2a620155-9d11-439e-92b3-5d9815fe4de8"/>
                                       <addr
                                          nullFlavor="UNK"/>
                                       <telecom
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                                       <assignedPerson>
                                          <name>
                                             <prefix>Dr.</prefix>
                                             <given>Henry</given>
                                             <family>Seven</family>
                                          </name>
                                       </assignedPerson>
                                    </assignedAuthor>
                                 </author>
                                 <entryRelationship
                                    typeCode="SUBJ"
                                    inversionInd="true">
                                    <act
                                       classCode="ACT"
                                       moodCode="INT">
                                       <templateId
                                          root="2.16.840.1.113883.10.20.22.4.20"/>
                                       <!-- ** Instructions Template ** -->
                                       <code xsi:type="CE"
                                          code="409073007"
                                          codeSystem="2.16.840.1.113883.6.96"
                                          displayName="instruction"/>
                                       <text><reference
                                          value="#FillIns_DM"/>Generic Substitution Allowed</text>
                                       <statusCode
                                          code="completed"/>
                                    </act>
                                 </entryRelationship>
                              </supply>
                           </entryRelationship>
                           <entryRelationship
                              typeCode="REFR">
                              <supply
                                 classCode="SPLY"
                                 moodCode="EVN">
                                 <templateId
                                    root="2.16.840.1.113883.10.20.22.4.18"/>
                                 <!-- ** Medication Dispense Template ** -->
                                 <id
                                    root="1.2.3.4.56789.1"
                                    extension="cb734647-fc99-424c-a864-7e3cda82e704"/>
                                 <statusCode
                                    code="completed"/>
                                 <effectiveTime
                                    value="20120813"/>
                                 <repeatNumber
                                    value="1"/>
                                 <quantity
                                    value="75"/>
                                 <product>
                                    <manufacturedProduct
                                       classCode="MANU">
                                       <templateId
                                          root="2.16.840.1.113883.10.20.22.4.23"/>
                                       <id
                                          root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
                                       <manufacturedMaterial>
                                          <code
                                             code="896001"
                                             codeSystem="2.16.840.1.113883.6.88"
                                             displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler">
                                             <originalText><reference
                                                   value="#DM"/></originalText>
                                             <translation
                                                code="896001"
                                                displayName="120 ACTUAT Fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler"
                                                codeSystem="2.16.840.1.113883.6.88"
                                                codeSystemName="RxNorm"/>
                                          </code>
                                       </manufacturedMaterial>
                                       <manufacturerOrganization>
                                          <name>Medication Factory Inc.</name>
                                       </manufacturerOrganization>
                                    </manufacturedProduct>
                                 </product>
                                 <performer>
                                    <time
                                       nullFlavor="UNK"/>
                                    <assignedEntity>
                                       <id
                                          root="2.16.840.1.113883.19.5.9999.456"
                                          extension="2981825"/>
                                       <addr>
                                          <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                          <city>Portland</city>
                                          <state>OR</state>
                                          <postalCode>97266</postalCode>
                                          <country>US</country>
                                       </addr>
                                       <telecom
                                          nullFlavor="UNK"/>
                                       <assignedPerson>
                                          <name>
                                             <prefix>Dr.</prefix>
                                             <given>Henry</given>
                                             <family>Seven</family>
                                          </name>
                                       </assignedPerson>
                                       <representedOrganization>
                                          <id
                                             root="2.16.840.1.113883.19.5.9999.1395"/>
                                          <name>Community Health and Hospitals</name>
                                          <telecom
                                             nullFlavor="UNK"/>
                                          <addr
                                             nullFlavor="UNK"/>
                                       </representedOrganization>
                                    </assignedEntity>
                                 </performer>
                              </supply>
                           </entryRelationship>
                           <precondition
                              typeCode="PRCN">
                              <templateId
                                 root="2.16.840.1.113883.10.20.22.4.25"/>
                              <criterion>
                                 <code
                                    code="ASSERTION"
                                    codeSystem="2.16.840.1.113883.5.4"/>
                                 <value
                                    xsi:type="CE"
                                    code="56018004"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Wheezing"/>
                              </criterion>
                           </precondition>
                        </substanceAdministration>
                     </entryRelationship>
                  </act>
               </entry>
            </section>
         </component>

Reason for Referral

This Referral section is a free text field that captures the reason for the referral.

         <!--
********************************************************
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>
               <!-- Unstructured text field -->
               <text>
                  <paragraph>Follow up with Dr George Potomac for Asthma</paragraph>
               </text>
            </section>
         </component>

Problem List

The Problem List section includes all concerns, complaints, and observations; with their corresponding status.

         <!--
********************************************************
PROBLEM LIST
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.5.1"/>
               <code
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                  codeSystemName="LOINC"
                  displayName="PROBLEM LIST"/>
               <title>PROBLEMS</title>
               <!-- Unstructured text field -->
               <text><content
                     ID="problems"/>
                  <list
                     listType="ordered">
                     <item><content
                           ID="problem1">Pneumonia : Status - Resolved</content></item>
                     <item><content
                           ID="problem2">Asthma : Status - Active</content></item>
                  </list>
               </text>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <!-- Problem act template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.3"/>
                     <id
                        root="ec8a6ff8-ed4b-4f7e-82c3-e98e58b45de7"/>
                     <code
                        code="CONC"
                        codeSystem="2.16.840.1.113883.5.6"
                        displayName="Concern"/>
                     <statusCode
                        code="active"/>
                     <effectiveTime>
                        <low
                           value="20120806"/>
                        <high
                           value="20120813"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <!-- Problem observation template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.4"/>
                           <id
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                           <code
                              code="409586006"
                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="Complaint"/>
                           <text>
                              <reference
                                 value="#problem1"/>
                           </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime>
                              <low value="20120806"/>
                              <high value="20120813"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="233604007"
                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="Pneumonia"/>
                           <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="445518008"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Age At Onset"/>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="PQ"
                                    value="65"
                                    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 xsi:type="CE"
                                    code="11323-3"
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC"
                                    displayName="Health status"/>
                                 <text><reference
                                       value="#problems"/></text>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CD"
                                    code="162467007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"
                                    displayName="Symptom Free"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship typeCode="REFR">
                              <observation classCode="OBS" moodCode="EVN">
                                 <!-- Status observation template -->
                                 <templateId root="2.16.840.1.113883.10.20.22.4.6"/>
                                 <code xsi:type="CE" 
                                    code="33999-4" 
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC" 
                                    displayName="Status"/>
                                 <text><reference
                                    value="#problem2"/></text>
                                 <statusCode code="completed"/>
                                 <value xsi:type="CD" 
                                    code="413322009"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT" 
                                    displayName="Resolved"/>
                              </observation>
                           </entryRelationship>
                        </observation>
                     </entryRelationship>
                  </act>
               </entry>
               <entry
                  typeCode="DRIV">
                  <act
                     classCode="ACT"
                     moodCode="EVN">
                     <!-- Problem act template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.3"/>
                     <id
                        root="ec8a6ff8-ed4b-4f7e-82c3-e98e58b45de7"/>
                     <code
                        code="CONC"
                        codeSystem="2.16.840.1.113883.5.6"
                        displayName="Concern"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime>
                        <low
                           value="20070103"/>
                     </effectiveTime>
                     <entryRelationship
                        typeCode="SUBJ">
                        <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
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                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="Complaint"/>
                           <text>
                              <reference
                                 value="#problem2"/>
                           </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime>
                              <low
                                 value="20070103"/>
                           </effectiveTime>
                           <value
                              xsi:type="CD"
                              code="195967001"
                              codeSystem="2.16.840.1.113883.6.96"
                              displayName="Asthma"/>
                           <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="445518008"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    displayName="Age At Onset"/>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="PQ"
                                    value="59"
                                    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 xsi:type="CE"
                                    code="11323-3"
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC"
                                    displayName="Health status"/>
                                 <text><reference
                                       value="#problems"/></text>
                                 <statusCode
                                    code="completed"/>
                                 <value
                                    xsi:type="CD"
                                    code="162467007"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT"
                                    displayName="Symptom Free"/>
                              </observation>
                           </entryRelationship>
                           <entryRelationship typeCode="REFR">
                              <observation classCode="OBS" moodCode="EVN">
                                 <!-- Status observation template -->
                                 <templateId root="2.16.840.1.113883.10.20.22.4.6"/>
                                 <code xsi:type="CE" 
                                    code="33999-4" 
                                    codeSystem="2.16.840.1.113883.6.1"
                                    codeSystemName="LOINC" 
                                    displayName="Status"/>
                                 <text><reference
                                    value="#problem2"/></text>
                                 <statusCode code="completed"/>
                                 <value xsi:type="CD" 
                                    code="55561003"
                                    codeSystem="2.16.840.1.113883.6.96"
                                    codeSystemName="SNOMED CT" 
                                    displayName="Active"/>
                              </observation>
                           </entryRelationship>
                        </observation>
                     </entryRelationship>
                  </act>
               </entry>
            </section>
         </component>

Procedures

The Procedures section details a history of procedures like x-rays.

         <!--
********************************************************
PROCEDURES
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.7.1"/>
               <!-- Procedures section template -->
               <code
                  code="47519-4"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="HISTORY OF PROCEDURES"/>
               <title>PROCEDURES</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Procedure</th>
                           <th>Date</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>
                              <content ID="Proc2">Chest X-Ray</content>
                           </td>
                           <td>8/7/2012</td>
                        </tr>
                     </tbody>
                  </table>
               </text>             
               <entry
                     typeCode="DRIV">
                     <procedure
                        classCode="PROC"
                        moodCode="EVN">
                        <templateId
                           root="2.16.840.1.113883.10.20.22.4.14"/>
                        <!-- Procedure Activity Observation -->
                        <id
                           extension="123456789"
                           root="2.16.840.1.113883.19"/>
                        <code
                           code="168731009"
                           codeSystem="2.16.840.1.113883.6.96"
                           displayName="Chest X-Ray"
                           codeSystemName="SNOMED-CT">
                           <originalText>
                              <reference
                                 value="#Proc2"/>
                           </originalText>
                        </code>
                        <statusCode
                           code="completed"/>
                        <effectiveTime
                           value="20120807"/>
                        <priorityCode
                           code="CR"
                           codeSystem="2.16.840.1.113883.5.7"
                           codeSystemName="ActPriority"
                           displayName="Callback results"/>
                        <methodCode
                           nullFlavor="UNK"/>
                        <targetSiteCode
                           code="82094008"
                           codeSystem="2.16.840.1.113883.6.96"
                           codeSystemName="SNOMED CT"
                           displayName="Lower Respiratory Tract Structure"/>
                        <performer>
                           <assignedEntity>
                              <id
                                 root="2.16.840.1.113883.19.5"
                                 extension="1234"/>
                              <addr>
                                 <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                 <city>Portland</city>
                                 <state>OR</state>
                                 <postalCode>97266</postalCode>
                                 <country>US</country>
                              </addr>
                              <telecom
                                 use="WP"
                                 value="(555)555-555-1234"/>
                              <representedOrganization>
                                 <id
                                    root="2.16.840.1.113883.19.5"/>
                                 <name>Community Health and Hospitals</name>
                                 <telecom
                                    nullFlavor="UNK"/>
                                 <addr
                                    nullFlavor="UNK"/>
                              </representedOrganization>
                           </assignedEntity>
                        </performer>
                        <participant
                           typeCode="LOC">
                           <participantRole
                              classCode="SDLOC">
                              <templateId
                                 root="2.16.840.1.113883.10.20.22.4.32"/>
                              <!-- Service Delivery Location template -->
                              <code
                                 code="1160-1"
                                 codeSystem="2.16.840.1.113883.6.259"
                                 codeSystemName="HealthcareServiceLocation"
                                 displayName="Urgent Care Center"/>
                              <addr>
                                 <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
                                 <city>Portland</city>
                                 <state>OR</state>
                                 <postalCode>97266</postalCode>
                                 <country>US</country>
                              </addr>
                              <telecom
                                 nullFlavor="UNK"/>
                              <playingEntity
                                 classCode="PLC">
                                 <name>Community Health and Hospitals</name>
                              </playingEntity>
                           </participantRole>
                        </participant>
                     </procedure>
                  </entry>
            </section>
         </component>

Functional and Cognitive Status

This Functional Status section details the different functional and cognitive impairments.

         <!--
********************************************************
FUNCTIONAL and COGNITIVE STATUS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.14"/>
               <!--  ******** Functional status section template   ******** -->
               <code
                  code="47420-5"
                  codeSystem="2.16.840.1.113883.6.1"/>
               <title>FUNCTIONAL STATUS</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Functional Condition</th>
                           <th>Effective Dates</th>
                           <th>Condition Status</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>
                             <content ID="fs1">Dependence on cane</content></td>
                           <td>2008</td>
                           <td>Active</td>
                        </tr>
                        <tr>
                           <td>
                              <content ID="fs2">Memory impairment</content>
                          </td>
                           <td>2008</td>
                           <td>Active</td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <observation
                     classCode="OBS"
                     moodCode="EVN">
                     <!-- Problem observation template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.68"/>
                     <id
                        root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
                     <code xsi:type="CE"
                        code="409586006"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Complaint"/>
                     <text>
                        <reference
                           value="#fs1"/>
                     </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime>
                        <low
                           value="20081101"/>
                        <high nullFlavor="UNK"/>
                     </effectiveTime>
                     <value
                        xsi:type="CD"
                        code="105504002"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Dependence on Cane"/>
                  </observation>
               </entry>
               <entry
                  typeCode="DRIV">
                  <observation
                     classCode="OBS"
                     moodCode="EVN">
                     <!-- Problem observation template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.68"/>
                     <id
                        root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
                     <code xsi:type="CE"
                        code="409586006"
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                        displayName="Complaint"/>
                     <text>
                        <reference
                           value="#fs2"/>
                     </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime>
                        <low
                           value="20081101"/>
                        <high nullFlavor="UNK" />
                         
                     </effectiveTime>
                     <value
                        xsi:type="CD"
                        code="386807006"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Memory Impairment"/>
                  </observation>
               </entry>
               <entry
                  typeCode="DRIV">
                  <observation
                     classCode="OBS"
                     moodCode="EVN">
                     <!-- Cognitive Status Problem observation template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.73"/>
                     <id
                        root="ab1791b0-5c71-11db-b0de-0800200c9a66"/>
                     <code xsi:type="CE"
                        code="373930000"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Cognitive Function Finding"/>
                     <text>
                        <reference
                           value="#fs2"/>
                     </text>
                     <statusCode
                        code="completed"/>
                     <effectiveTime>
                        <low
                           value="20081101"/>
                        <high nullFlavor="UNK"/>
                     </effectiveTime>
                     <value
                        xsi:type="CD"
                        code="48167000"
                        codeSystem="2.16.840.1.113883.6.96"
                        displayName="Amnesia"/>
                  </observation>
               </entry>
            </section>
         </component>

Results

This Results section includes all laboratory results.

         <!--
********************************************************
RESULTS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.3.1"/>
               <!-- Entries Required -->
               <code
                  code="30954-2"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="RESULTS"/>
               <title>RESULTS</title>
               <!-- Unstructured text field -->
               <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>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <organizer
                     classCode="BATTERY"
                     moodCode="EVN">
                     <!-- Result organizer template -->
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.1"/>
                     <id
                        root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
                     <code xsi:type="CE"
                        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 template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.2"/>
                           <id
                              root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           <code xsi:type="CE"
                              code="30313-1"
                              displayName="HGB"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"> </code>
                           <text>
                              <reference
                                 value="#result1"/>
                           </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120810"/>
                           <value
                              xsi:type="PQ"
                              value="10.2"
                              unit="g/dl"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                           <methodCode/>
                           <targetSiteCode/>
                           <author>
                              <time/>
                              <assignedAuthor>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9816ff4de8"/>
                              </assignedAuthor>
                           </author>
                           <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 template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.2"/>
                           <id
                              root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           <code xsi:type="CE"
                              code="33765-9"
                              displayName="WBC"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"> </code>
                           <text>
                              <reference
                                 value="#result2"/>
                           </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120810"/>
                           <value
                              xsi:type="PQ"
                              value="12.3"
                              unit="10+3/ul"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                           <methodCode/>
                           <targetSiteCode/>
                           <author>
                              <time/>
                              <assignedAuthor>
                                 <id
                                    root="2a620154-9d11-439e-92b3-5d9815ff4de8"/>
                              </assignedAuthor>
                           </author>
                           <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 template -->
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.2"/>
                           <id
                              root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
                           <code xsi:type="CE"
                              code="26515-7"
                              displayName="PLT"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"> </code>
                           <text>
                              <reference
                                 value="#result3"/>
                           </text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120810"/>
                           <value
                              xsi:type="PQ"
                              value="123"
                              unit="10+3/ul"/>
                           <interpretationCode
                              code="L"
                              codeSystem="2.16.840.1.113883.5.83"/>
                           <methodCode/>
                           <targetSiteCode/>
                           <author>
                              <time/>
                              <assignedAuthor>
                                 <id
                                    root="2a620155-9d11-439e-92b3-5d9815ff4de8"/>
                              </assignedAuthor>
                           </author>
                           <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>

Social History

This Social History section includes observations like smoking and drinking habits.

         <!--
********************************************************
SOCIAL HISTORY
********************************************************
-->
         <component>
            <!--   Social History ******** -->
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.17"/>
               <!--  ********  Social history section template   ******** -->
               <code
                  code="29762-2"
                  codeSystem="2.16.840.1.113883.6.1"
                  displayName="Social History"/>
               <title>SOCIAL HISTORY</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th>Social History Element</th>
                           <th>Description</th>
                           <th>Effective Dates</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <td>
                              <content
                                 ID="smok1"/> Former smoker (smoked from 2005-2011)
                           </td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <observation
                     classCode="OBS"
                     moodCode="EVN">
                     <!-- Smoking status observation template -->
                     <templateId
                        root="2.16.840.1.113883.10.22.4.78"/>
                     <id
                        extension="123456789"
                        root="2.16.840.1.113883.19"/>
                     <code
                        code="ASSERTION"
                        codeSystem="2.16.840.1.113883.5.4"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime>
                        <low
                           value="20050501"/>
                        <high
                           value="20110227"/>
                     </effectiveTime>
                     <value
                        xsi:type="CD"
                        code="8517006"
                        displayName="Former smoker"
                        codeSystem="2.16.840.1.113883.6.96"/>
                  </observation>
               </entry>
            </section>
         </component>

Vital Signs

The Vital Signs section captures vitals that change over time like height, weight, and blood pressure.

         <!--
********************************************************
VITAL SIGNS
********************************************************
-->
         <component>
            <section>
               <templateId
                  root="2.16.840.1.113883.10.20.22.2.4.1"/>
               <code
                  code="8716-3"
                  codeSystem="2.16.840.1.113883.6.1"
                  codeSystemName="LOINC"
                  displayName="VITAL SIGNS"/>
               <title>VITAL SIGNS</title>
               <!-- Unstructured text field -->
               <text>
                  <table
                     border="1"
                     width="100%">
                     <thead>
                        <tr>
                           <th
                              align="right">Date / Time: </th>
                           <th>Nov 1, 2011</th>
                           <th>August 6, 2012</th>
                        </tr>
                     </thead>
                     <tbody>
                        <tr>
                           <th
                              align="left">Height</th>
                           <td>
                              <content
                                 ID="vit1">69 inches</content></td>
                           <td>
                              <content
                                 ID="vit2">69 inches</content></td>
                        </tr>
                        <tr>
                           <th
                              align="left">Weight</th>
                           <td>
                              <content
                                 ID="vit3">189 lbs</content></td>
                           <td>
                              <content
                                 ID="vit4">194 lbs</content></td>
                        </tr>
                        <tr>
                           <th
                              align="left">Blood Pressure</th>
                           <td><content
                                 ID="vit5">132/86 mmHg</content></td>
                           <td><content
                                 ID="vit6">145/88 mmHg</content></td>
                        </tr>
                     </tbody>
                  </table>
               </text>
               <entry
                  typeCode="DRIV">
                  <organizer
                     classCode="CLUSTER"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.26"/>
                     <!-- Vital signs organizer template -->
                     <id
                        root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
                     <code
                        code="46680005"
                        codeSystem="2.16.840.1.113883.6.96"
                        codeSystemName="SNOMED -CT"
                        displayName="Vital signs"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        value="20111101"/>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="8302-2"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Height"/>
                           <text><reference
                                 value="#vit1"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20081101"/>
                           <value
                              xsi:type="PQ"
                              value="69"
                              unit="in"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="3141-9"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Patient Body Weight - Measured"/>
                           <text><reference
                                 value="#vit4"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20111101"/>
                           <value
                              xsi:type="PQ"
                              value="189"
                              unit="lbs"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="8480-6"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Intravascular Systolic"/>
                           <text><reference
                                 value="#vit5"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20111101"/>
                           <value
                              xsi:type="PQ"
                              value="132"
                              unit="mm[Hg]"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                  </organizer>
               </entry>
               <entry
                  typeCode="DRIV">
                  <organizer
                     classCode="CLUSTER"
                     moodCode="EVN">
                     <templateId
                        root="2.16.840.1.113883.10.20.22.4.26"/>
                     <!-- Vital signs organizer template -->
                     <id
                        root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
                     <code
                        code="46680005"
                        codeSystem="2.16.840.1.113883.6.96"
                        codeSystemName="SNOMED -CT"
                        displayName="Vital signs"/>
                     <statusCode
                        code="completed"/>
                     <effectiveTime
                        value="20120806"/>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="8302-2"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Height"/>
                           <text><reference
                                 value="#vit2"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120806"/>
                           <value
                              xsi:type="PQ"
                              value="69"
                              unit="in"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="3141-9"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Patient Body Weight - Measured"/>
                           <text><reference
                                 value="#vit4"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120806"/>
                           <value
                              xsi:type="PQ"
                              value="194"
                              unit="lbs"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                     <component>
                        <observation
                           classCode="OBS"
                           moodCode="EVN">
                           <templateId
                              root="2.16.840.1.113883.10.20.22.4.27"/>
                           <!-- Vital Sign Observation template -->
                           <id
                              root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
                           <code
                              code="8480-6"
                              codeSystem="2.16.840.1.113883.6.1"
                              codeSystemName="LOINC"
                              displayName="Intravascular Systolic"/>
                           <text><reference
                                 value="#vit6"/></text>
                           <statusCode
                              code="completed"/>
                           <effectiveTime
                              value="20120806"/>
                           <value
                              xsi:type="PQ"
                              value="145"
                              unit="mm[Hg]"/>
                           <interpretationCode
                              code="N"
                              codeSystem="2.16.840.1.113883.5.83"/>
                        </observation>
                     </component>
                  </organizer>
               </entry>
            </section>
         </component>

Discharge Instructions

The Hospital Discharge Instructions section is a free text field that captures the discharge instructions as written by the provider.

         <!-- 
************************************
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>
               <!-- Unstructured text field -->
               <text>
                  <content>
                     Ms. Jones, you have been seen by Dr. Henry Seven at Local Community Hospital from August 8th until August 13th 2012. You are currently being discharged from Local Community Hospital. Dr. Seven has provided the following instructions to you at this time; should you have any questions please contact a member of your healthcare team prior to discharge. If you have left the hospital and have questions, please contact Dr. Seven at 555-555-1002. 
                     Instructions:
                  </content>
                  <list
                     listType="ordered">
                     <item>Take all medications as prescribed.</item>
                     <item>Please monitor your peak flows. If your peak flows drop to 50% of normal, call my office immediately or return to the Emergency Room.</item>
                     <item>If you experience any of the following symptoms, call my office immediately or return to the Emergency Room:
                        <list listType="ordered">
                           <item>Shortness of Breath</item>
                           <item>Dizziness or Light-headedness</item>
                           <item>Fever, chills, or diffuse body aches</item>
                           <item>Pain or redness at the site of any previous intravenous catheter</item>
                           <item>Any other unusual problem</item>
                        </list>
                     </item>
                  </list>
               </text>
            </section>
         </component>  

End of Document

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