External Document Reference

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 7/13/2017
  • SDWG: 10/5/2017

C-CDA 2.1 Example:

  • 2.16.840.1.113883.10.20.22.2.6.1:2015-08-01

  • Problem Section: 2.16.840.1.113883.10.20.22.2.5.1:2015-08-01

  • Problem Act: 2.16.840.1.113883.10.20.22.4.3:2015-08-01
  • Problem Observation: 2.16.840.1.113883.10.20.22.4.4:2015-08-01

  • External Document Reference: 2.16.840.1.113883.10.20.22.4.115:2014-06-09

Reference to full CDA sample: PROBLEMSinEmptyC-CDA2.1 (in git repo at same location as this snippet)

Validation location

  • https://sitenv.org/sandbox-ccda/ccda-validator

Comments

  • This demonstrates how an individual entry may refer to an external document where information was originally provided (e.g. a problem in this example). In addition, how to also link back to the original observation using externalObservation is also shown. While these elements are optional, they help create a chain of data provenance.

Custodian

  • John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)

Keywords

  • externalDocument, externalObservation, reference

Permalink

Links

 

Example: External Document Reference QRDA Template (C-CDAR2.1).xml download example view on GitHub

<!-- This example illustrates how parts of a specific entry may refer to an external document and/or act, observation, procedure 
	 The use case would be where information from a prior document have been imported and 
	 other information may be available in the newly created clinical document. 
	 It uses the QRDA template for external document reference 2.16.840.1.113883.10.20.22.4.115:2014-06-09 
	 It references the approved active problem example http://cdasearch.hl7.org/examples/view/b6f23e38249108eb5bc47905c949e9bb59fc33b4 -->
<section>
	<templateId root="2.16.840.1.113883.10.20.22.2.5.1"/>
	<templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01"/>
	<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" displayName="Problem List"/>
	<title>Problem List</title>
	<text>
		<table>
			<thead>
				<tr>
					<th>Name</th>
					<th>Dates</th>
					<th>Status</th>
					<th>Author</th>
					<th>Author Time</th>
				</tr>
			</thead>
			<tbody>
				<tr ID="Problem1">
					<td ID="Problem1Value">Community Acquired Pneumonia</td>
					<td>Onset: February 27 2014</td>
					<td>Active</td>
					<td>Heartly Sixer, MD (NPI: 66666)</td>
					<td>Mar 2, 2014</td>
					<!-- Additional information linking to source document may be appropriate based on use case -->
				</tr>
			</tbody>
		</table>
	</text>
	<entry>
		<act classCode="ACT" moodCode="EVN">
			<templateId root="2.16.840.1.113883.10.20.22.4.3" />
			<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01"/>
			<!-- Since this represents an element which has been imported from the original document 
			but may vary from original act, a different GUID is used to idenitfy  -->
			<!-- Some systems may also include the original id here. This example did 
			not since the externalObservation is more appropriate -->
			<id root="11526f79-94a3-4682-a969-0f3d039db732"/>
			<code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
			<statusCode code="active"/>
			<effectiveTime>
				<low value="20140302124536+0500"/>
			</effectiveTime>
			<entryRelationship typeCode="SUBJ">
				<observation classCode="OBS" moodCode="EVN">
					<templateId root="2.16.840.1.113883.10.20.22.4.4" />
					<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
					<!-- Since this represents an element which has been imported from the original document 
					but may vary from original observation, a different GUID is used to idenitfy  -->
					<!-- Some systems may also include the original id here. This example did 
					not since the externalObservation is more appropriate -->
					<id root="35e97377-b63b-4e6a-a53e-9cfb016bea0b"/>
					<code code="55607006" displayName="Problem"
						codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
						<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1"
							codeSystemName="LOINC" displayName="Problem"/>
					</code>
					<text>
						<reference value="#Problem1"/>
					</text>
					<statusCode code="completed"/>
					<effectiveTime>
						<low value="20140227"/>
					</effectiveTime>
					<value xsi:type="CD" code="385093006" codeSystem="2.16.840.1.113883.6.96"
						codeSystemName="SNOMED CT" displayName="Community Acquired Pneumonia">
						<originalText>
							<reference value="#Problem1Value" />
						</originalText>
					</value>
					<!-- Since no changes were made to the observation, the orginal author is included here -->
					<author>
						<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
						<time value="20140302124536"/>
						<assignedAuthor>
							<id extension="66666" root="2.16.840.1.113883.4.6"/>
							<code code="207RC0000X" codeSystem="2.16.840.1.113883.6.101"
								codeSystemName="NUCC" displayName="Cardiovascular Disease"/>
							<addr>
								<streetAddressLine>6666 StreetName St.</streetAddressLine>
								<city>Silver Spring</city>
								<state>MD</state>
								<postalCode>20901</postalCode>
								<country>US</country>
							</addr>
							<telecom value="tel:+1(301)666-6666" use="WP"/>
							<assignedPerson>
								<name>
									<given>Heartly</given>
									<family>Sixer</family>
									<suffix>MD</suffix>
								</name>
							</assignedPerson>
						</assignedAuthor>
					</author>
					<!-- This reference refers to the external document where the problem was documented -->
					<!-- It uses a template for externalDocument from the QRDA 1 3.1 Implementation Guide-->
					<reference typeCode="REFR">
						<externalDocument classCode="DOCCLIN" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.115" extension="2014-06-09" />
							<!-- This refers to the ClinicalDocument/id of the original document -->
							<id extension="TT661" root="2.16.840.1.113883.19.5.99999.1"/>							
							<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9" displayName="Summary of episode note" />
							<!-- While not required, there is a benefit of using <setId> and <versionNumber> as a secondary key on documents.   
							If the flow from a document source system or repository to a destination system is infrequent or  not able to guarantee 
							sequential transmission of  document revisions.  The setId and versionNumber pair are actually better for detecting which 
							new document revises a previous older version of that document.  -->
							<!-- If setId and versionNumber are not available or applicable, they may be omitted -->
							<!-- This refers to the ClinicalDocument/setId and versionNumber of the original document -->
							<setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
							<versionNumber value="1"/>
						</externalDocument>
					</reference>
					<!-- This reference refers to the observation within external document the where the problem was documented -->
					<!-- Other options are the use of reference/externalAct or reference/externalProcedures -->
					<reference typeCode="REFR">
						<externalObservation classCode="OBS" moodCode="EVN">
							<!-- This refers to the observation/id of the original observation -->
							<!-- If there are multiple id elements, all should be included -->
							<id extension="10241104348" root="1.3.6.1.4.1.22812.4.111.0.4.1.2.1"/>
							<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
								<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
							</code>
						</externalObservation>
					</reference>
				</observation>
			</entryRelationship>
		</act>
	</entry>
</section>

Example: PROBLEMS_in_Empty_C-CDA_2.1 (C-CDAR2.1).xml download example view on GitHub

<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
 Title:        Continuity of Care Document (CCD)
 
 This file was based on MU testing file named: 170.315_b1_toc_gold_sample2_v2.xml
 All component/section wihtin structuredBody have been emptied to provide a template for testing specific entries
 
 ********************************************************
 Disclaimer: This sample file contains representative data elements to represent a Continuity of Care Document (CCD). 
 The file depicts a fictional character's health data. Any resemblance to a real person is coincidental. 
 To illustrate as many data elements as possible, the clinical scenario may not be plausible. 
 The data in this sample file is not intended to represent real patients, people or clinical events. 
 This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide.
 ********************************************************
 -->
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="C:\XML\CDA_SDTC_Schema\infrastructure\cda\CDA_SDTC.xsd"
	xmlns:voc="urn:hl7-org:v3/voc" xmlns:sdtc="urn:hl7-org:sdtc">
	<realmCode code="US"/>
	<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
	<!-- US Realm Header ID-->
	<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
	<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
	<!-- CCD template ID-->
	<templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2015-08-01"/>
	<templateId root="2.16.840.1.113883.10.20.22.1.2"/>
	<!-- Globally unique identifier for the document  -->
	<id extension="TT662" root="2.16.840.1.113883.19.5.99999.1"/>
	<code code="34133-9" displayName="Summarization of Episode Note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
	<!-- Title of this document -->
	<title>170.315_b1_toc_gold_sample2 test data</title>

	<effectiveTime value="20150722180000-0500" />

	<confidentialityCode code="N" displayName="normal" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality"/>
	<languageCode code="en-US"/>
	<setId extension="sTT662" root="2.16.840.1.113883.19.5.99999.19"/>
	<!-- Version of this document -->
	<versionNumber value="1"/>
	<recordTarget>
		<patientRole>
			<id extension="414122222" root="2.16.840.1.113883.4.1"/>
			<!-- Example Social Security Number using the actual SSN OID. -->
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>1357 Amber Dr</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:+1(555)-777-1234" use="MC"/>
			<telecom value="tel:+1(555)-723-1544" use="HP"/>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<patient>
				<name use="L">
					<given>Richard</given>
					<family>Maur</family>
					<suffix>jr</suffix>
				</name>
				<administrativeGenderCode code="M" displayName="Male" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender"/>
				<!-- Date of birth need only be precise to the day -->
				<birthTime value="19800801"/>
				<maritalStatusCode nullFlavor="NI"/>
				<religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation"/>
				<raceCode nullFlavor="UNK"/>
				<sdtc:raceCode nullFlavor="UNK"/>
				<ethnicGroupCode nullFlavor="UNK"/>
				<languageCommunication>
					<languageCode code="en"/>
					<modeCode code="ESP" displayName="Expressed spoken"
						codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
					<preferenceInd value="true"/>
				</languageCommunication>
			</patient>
			<providerOrganization>
				<id extension="99999999" root="2.16.840.1.113883.4.6"/>
				<name>Community Health and Hospitals</name>
				<telecom use="WP" value="tel:+1(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>
	<!-- The author represents the person who provides the content in the document -->
	<author>
		<time value="20150722"/>
		<assignedAuthor>
			<id extension="111111" root="2.16.840.1.113883.4.6"/>
			<code code="281P00000X" codeSystem="2.16.840.1.113883.6.101"
				displayName="Chronic Disease Hospital"/>
			<addr>
				<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>97266</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:+1(555)-555-1002"/>
			<assignedPerson>
				<name>
					<prefix>Dr</prefix>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedAuthor>
	</author>
	<!-- The dataEnterer transferred the content created by the author into the document -->
	<dataEnterer>
		<assignedEntity>
			<id root="2.16.840.1.113883.4.6" extension="999999943252"/>
			<addr>
				<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>97266</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:+1(555)-555-1002"/>
			<assignedPerson>
				<name>
					<given>Mary</given>
					<family>McDonald</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</dataEnterer>
	<!-- The informant represents any sources of information for document content -->
	<informant>
		<assignedEntity>
			<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
			<addr>
				<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>97266</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:+1(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>Caroline</given>
					<family>Maur</family>
				</name>
			</relatedPerson>
		</relatedEntity>
	</informant>
	<!-- The custodian represents the organization charged with maintaining the original source document -->
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<id extension="99998899" root="2.16.840.1.113883.4.6"/>
				<name>Community Health and Hospitals</name>
				<telecom use="WP" value="tel:+1(555)-555-5000"/>
				<addr>
					<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
					<city>Portland</city>
					<state>OR</state>
					<postalCode>97266</postalCode>
					<country>US</country>
				</addr>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<!-- The informationRecipient represents the intended recipient of the document -->
	<informationRecipient>
		<intendedRecipient>
			<informationRecipient>
				<name>
					<prefix>Dr</prefix>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</informationRecipient>
			<receivedOrganization>
				<name>Community Health and Hospitals</name>
			</receivedOrganization>
		</intendedRecipient>
	</informationRecipient>
	<!-- The legalAuthenticator represents the individual who is responsible for the document -->
	<legalAuthenticator>
		<time value="20150722"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="999998899" root="2.16.840.1.113883.4.6"/>
			<addr>
				<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>97266</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:+1(555)-555-1002"/>
			<assignedPerson>
				<name>
					<prefix>Dr</prefix>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</legalAuthenticator>
	<!-- The authenticator represents the individual attesting to the accuracy of information in the document-->
	<authenticator>
		<time value="20150722"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="999998899" root="2.16.840.1.113883.4.6"/>
			<addr>
				<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
				<city>Portland</city>
				<state>OR</state>
				<postalCode>97266</postalCode>
				<country>US</country>
			</addr>
			<telecom use="WP" value="tel:+1(555)-555-1002"/>
			<assignedPerson>
				<name>
					<prefix>Dr</prefix>
					<given>Henry</given>
					<family>Seven</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</authenticator>
	<!-- The participant represents supporting entities -->
	<participant typeCode="IND">
		<!-- patient's grandfather -->
		<associatedEntity classCode="PRS">
			<code code="GPARNT" displayName="grandparent" 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 Dr</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:+1(555)-723-1544" use="HP"/>
			<associatedPerson>
				<name>
					<prefix>Mr.</prefix>
					<given>Issac</given>
					<family>Maur</family>
				</name>
			</associatedPerson>
		</associatedEntity>
	</participant>
	<!-- Note: Entities playing multiple roles are recorded in multiple participants -->
	<participant typeCode="IND">
		<!-- patient's spouse -->
		<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 Dr</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:+1(555)-723-1544" use="HP"/>
			<associatedPerson>
				<name>
					<prefix>Ms</prefix>
					<given>Caroline</given>
					<family>Maur</family>
				</name>
			</associatedPerson>
		</associatedEntity>
	</participant>	
	<documentationOf>
		<serviceEvent classCode="PCPR">
			<code code="423123007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"
				displayName="Burn by Fire"/>
			<effectiveTime>
				<low value="20150722180000-0500"/>
				<high value="20150722230000-5000"/>
			</effectiveTime>
			<!-- since there are two Care Team members we need two performer elements. -db -->
			<!-- Note: example of Care Team here:
			https://github.com/gecole/HL7-Task-Force-Examples/blob/master/CareTeamToC170.314b2Ambulatory.xml
			db -->
			<performer typeCode="PRF">
				<functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="Primary Care Provider">
					<originalText>Primary Care Provider</originalText>
				</functionCode>
				<assignedEntity>
					<id extension="5555555555" root="2.16.840.1.113883.4.6"/>
					<code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>
					<addr>
						<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
						<city>Portland</city>
						<state>OR</state>
						<postalCode>97266</postalCode>
						<country>US</country>
					</addr>
					<telecom use="WP" value="tel:+1(555)-555-1002"/>
					<assignedPerson>
						<name>
							<prefix qualifier="TITLE">Dr</prefix>
							<given>Henry</given>
							<family>Seven</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<id extension="99998899" root="2.16.840.1.113883.4.6"/>
						<name>Community Health and Hospitals</name>
						<telecom use="WP" value="tel:+1(555)-555-5000"/>
						<addr>
							<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
							<city>Portland</city>
							<state>OR</state>
							<postalCode>97266</postalCode>
							<country>US</country>
						</addr>
					</representedOrganization>
				</assignedEntity>
			</performer>
			<performer typeCode="PRF">
				<!-- we do not have a function code for this person since recording as RN for now -->
				<time>
					<low nullFlavor="UNK"/>
				</time>
				<assignedEntity>
					<!-- this provider has an id, but it is not an NPI  -->
					<id extension="91138" root="1.3.6.1.4.1.22812.4.99930.4"/>
					<!-- the provider is a Registered Nurse - may not be so -->
					<!-- note: we don't know what Mary is from the test data
						 but since not specified, RN should not be an issue -db -->
					<code codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC Health Care Provider Taxonomy" code="163W00000X" displayName="Registered Nurse"/>
					<addr>
						<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
						<city>Portland</city>
						<state>OR</state>
						<postalCode>97266</postalCode>
						<country>US</country>
					</addr>
					<telecom use="WP" value="tel:+1(555)-555-1002"/>
					<assignedPerson>
						<name>
							<given>Mary</given>
							<family>McDonald</family>
						</name>
					</assignedPerson>
				</assignedEntity>
			</performer>			
		</serviceEvent>
	</documentationOf>
	<!-- added componentOf to represent encounter and to represent length of stay better as per SME suggestion -db -->
	<componentOf>
		<encompassingEncounter>
			<id extension="9937012" root="2.16.840.1.113883.19"/>
			<effectiveTime>
				<!-- represents length of time spent in hospital -db -->
				<low value="20150722180000-0500"/>
				<high value="20150722230000-5000"/>
			</effectiveTime>			
		</encompassingEncounter>
	</componentOf>
	<!-- ******************************************************** CDA Body ******************************************************** -->
	<component>
		<structuredBody>

			<!-- ***************** ALLERGIES *************** -->
			<!-- No known allergies -->
			<component>
				<section>
					<!-- *** Allergies and Intolerances Section (entries required) (V3) *** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-01"/>
					<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" codeSystemName="LOINC"/>
					<title>ALLERGIES AND ADVERSE REACTIONS</title>
					<text>No Known Drug Allergies</text>
					<!-- replaced Allergy Problem Act (R1.1) with 
					Allergy Concern Act (V3) to meet R2.1 validation requirements -DB-->
					<entry typeCode="DRIV">
						<act classCode="ACT" moodCode="EVN">
							<!-- ** Allergy Concern Act (V3) ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-08-01"/>
							<!--Critical Change-->
							<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
							<id root="36e3e930-7b15-11db-9fe1-0831200c9a66"/>
							<code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
							<!-- The statusCode represents the need to continue tracking the allergy -->
							<!-- This is of ongoing concern to the provider -->
							<statusCode code="active"/>
							<effectiveTime>
								<!-- The low value represents when the allergy was first recorded in the patient's chart -->
								<low value="20150722"/>
							</effectiveTime>
							<entryRelationship typeCode="SUBJ">
								<!-- using negationInd="true" to signify that there are is NO food allergy (disorder) allergy -db -->
								<observation classCode="OBS" moodCode="EVN" negationInd="true">
									<!-- ** Allergy observation (V2) ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.7" extension="2014-06-09"/>
									<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
									<id root="4adc1020-7b16-11db-9fe1-0832200c9a66"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
									<statusCode code="completed"/>
									<effectiveTime nullFlavor="NA"/>
									<!-- using Drug allergy (disorder) along with negationInd instead -db -->
									<value xsi:type="CD" code="416098002"
										displayName="Drug allergy (disorder)"
										codeSystem="2.16.840.1.113883.6.96"
										codeSystemName="SNOMED CT">
									</value>
									<!-- In C-CDA R2 the participant is required. The SNOMED code ="105590001" displayName="Substance" could be used in the participant-->									
									<participant typeCode="CSM">
										<participantRole classCode="MANU">
											<playingEntity classCode="MMAT">
												<code nullFlavor="NA"/>
											</playingEntity>
										</participantRole>
									</participant>
								</observation>
							</entryRelationship>
						</act>
					</entry>					
				</section>
			</component>

			<!-- ******************************* MEDICATIONS ***************************** -->
			<!-- No known medications -->			
			<component>
				<section>
					<!-- *** Medications Section (entries required) (V2) *** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-09"/>
					<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>
					<text>No known Medications</text>
					<entry>
						<!-- Act.actionNegationInd -->
						<substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="true">
							<!-- ** Medication Activity (V2) ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
							<id root="cdbd33f0-6cde-11db-9fe1-0833200c9a66"/>
							<statusCode code="active"/>
							<effectiveTime nullFlavor="NA"/>
							<doseQuantity nullFlavor="NA"/>
							<consumable>
								<manufacturedProduct classCode="MANU">
									<!-- ** Medication information ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
									<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
									<manufacturedMaterial>
										<code nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.88"> 
											<translation code="410942007" displayName="drug or medication"
												codeSystem="2.16.840.1.113883.6.96"            
												codeSystemName="SNOMED CT"/>
										</code>
									</manufacturedMaterial>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
				</section>
			</component>

			<!-- ******************************* MEDICATIONS ADMINISTERED			***************************** 
				NO known medications 
			-->
			<component>
				<section>
					<!-- The section contains the medications taken by the patient prior to 
					and 
					at the time of admission to the facility. -->
					<!-- Admission Medications Section (entries optional) (V3) -->
					<templateId root="2.16.840.1.113883.10.20.22.2.44" extension="2015-08-01"/>
					<templateId root="2.16.840.1.113883.10.20.22.2.44"/>
					<code code="42346-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="MEDICATIONS ON ADMISSION"/>
					<title>Admission Medications</title>
					<text>No Medications Administered</text>
					<entry>
						<!-- Act.actionNegationInd -->
						<substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="true">
							<!-- ** Medication Activity (V2) ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
							<id root="cdbd33f0-6cde-11db-9fe1-0834200c9a66"/>
							<statusCode code="active"/>
							<effectiveTime nullFlavor="NA"/>
							<doseQuantity nullFlavor="NA"/>
							<consumable>
								<manufacturedProduct classCode="MANU">
									<!-- ** Medication information ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
									<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
									<manufacturedMaterial>
										<code nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.88"> 
											<translation code="410942007" displayName="drug or medication"
												codeSystem="2.16.840.1.113883.6.96"            
												codeSystemName="SNOMED CT"/>
										</code>
									</manufacturedMaterial>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
				</section>
			</component>	
			<!-- Added Discharge Medications Section (entries required) (V3) No known medications -->
			<component>
				<section nullFlavor="NI">
					<!-- Discharge Medications Section (entries required) (V3) -->
					<templateId root="2.16.840.1.113883.10.20.22.2.11.1" extension="2015-08-01" />
					<templateId root="2.16.840.1.113883.10.20.22.2.11.1" />
					<code code="10183-2" displayName="Hospital Discharge Medications"
												codeSystem="2.16.840.1.113883.6.1"
												codeSystemName="LOINC">
						<translation code="75311-1" displayName="Discharge Medications"
													codeSystem="2.16.840.1.113883.6.1"
													codeSystemName="LOINC"/>
					</code>
					<title>Discharge Medications</title>
					<text>No Information</text>
				</section>
			</component>			

			<!-- ***************** PROBLEM LIST *********************** -->
			<!-- Problem examples -->		
			<component>
				<!-- An example of how to use a qualifier. This example shows presence of a problem/value/translation, although it could also be used to refine the problem/value -->
				<!-- The use of qualifiers could also be used on other sections, such as qualifying a procedure -->
				<!-- An example of how to use a qualifier. This example shows presence of a problem/value/translation, although it could also be used to refine the problem/value -->
				<!-- The use of qualifiers could also be used on other sections, such as qualifying a procedure -->
				<section>
					<templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01"/>
					<code code="11450-4" codeSystem="2.16.840.1.113883.6.1" displayName="Problem List"/>
					<title>Problem List</title>
					<text>
						<table>
							<thead>
								<tr>
									<th>Name</th>
									<th>Dates</th>
									<th>Location/Qualifier</th>
									<th>Status</th>
								</tr>
							</thead>
							<tbody>
								<tr ID="Problem14">
									<td ID="ProblemDescription14">Below Knee Amputation</td>
									<td>
										<content>Onset: Apr 2 2014</content>
									</td>
									<td>Left</td>
									<td>Active</td>
								</tr>
								<tr ID="Problem1">
									<td ID="Problem1Value">Community Acquired Pneumonia</td>
									<td>Onset: February 27 2014</td>
									<td>Active</td>
								</tr>
							</tbody>
						</table>
					</text>
					<entry>
						<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01"/>
							<id root="e5fbc288-659f-4aeb-a5e1-eb7cc8fcdfaf" />
							<code code="CONC" codeSystem="2.16.840.1.113883.5.6" />
							<!-- While clinicians can track resolved problems, generally active problems will have active concern status and resolved concerns will be completed -->
							<statusCode code="active" />
							<effectiveTime>
								<!-- This represents the time that the clinician began tracking the concern. This may frequently be an EHR timestamp-->
								<low value="20140403124536+0500" />
							</effectiveTime>
							<entryRelationship typeCode="SUBJ">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
									<id root="ac416033-3cc1-4485-ab31-36ce7669f55c" />
									<code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55607006" displayName="Problem" >
										<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
									</code>
									<text>
										<reference value="#Problem14" />
									</text>
									<statusCode code="completed" />
									<effectiveTime>
										<!-- This represents the date of biological onset. This can be before the patient vistited the clinician, as illustrated in this example-->
										<low value="20140402" />
									</effectiveTime>
									<!-- This is a SNOMED code as the primary vocabulary for problem lists. It would be preferable to have a SNOMED code but no direct translation is available here. -->
									<value xsi:type="CD" nullFlavor="OTH">
										<originalText>
											<reference value="#ProblemDescription14" />
										</originalText>
										<translation xsi:type="CD" code="V49.75" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9" displayName="Below Knee Amputation Status" />
									</value>
									<targetSiteCode xsi:type="CD" code="30021000" codeSystem="2.16.840.1.113883.6.96" displayName="Lower leg structure">
										<!-- This is an example of a qualifer which would affect a quality measure (e.g. cms 123 Diabetes Foot Exam) -->
										<!-- a qualifier may be a child element to <value> or <translation>. Here we use translation since it refines an ICD-9 code-->
										<qualifier>
											<name code="272741003" codeSystem="2.16.840.1.113883.6.96" displayName="Laterality" />
											<value code="7771000" codeSystem="2.16.840.1.113883.6.96" displayName="Left"/>
										</qualifier>
									</targetSiteCode>
								</observation>
							</entryRelationship>
						</act>
					</entry>
					<entry>
						<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.3" />
							<templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01"/>
							<!-- Since this represents an element which has been imported from the original document 
			but may vary from original act, a different GUID is used to idenitfy  -->
							<id root="11526f79-94a3-4682-a969-0f3d039db732"/>
							<code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
							<statusCode code="active"/>
							<effectiveTime>
								<low value="20140302124536+0500"/>
							</effectiveTime>
							<entryRelationship typeCode="SUBJ">
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.22.4.4" />
									<templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
									<!-- Since this represents an element which has been imported from the original document 
					but may vary from original observation, a different GUID is used to idenitfy  -->
									<id root="35e97377-b63b-4e6a-a53e-9cfb016bea0b"/>
									<code code="55607006" displayName="Problem"
						codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
										<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1"
							codeSystemName="LOINC" displayName="Problem"/>
									</code>
									<text>
										<reference value="#Problem1"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime>
										<low value="20140227"/>
									</effectiveTime>
									<value xsi:type="CD" code="385093006" codeSystem="2.16.840.1.113883.6.96"
						codeSystemName="SNOMED CT" displayName="Community Acquired Pneumonia">
										<originalText>
											<reference value="#Problem1Value" />
										</originalText>
									</value>
									<author>
										<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
										<time value="20140302124536"/>
										<assignedAuthor>
											<id extension="66666" root="2.16.840.1.113883.4.6"/>
											<code code="207RC0000X" codeSystem="2.16.840.1.113883.6.101"
								codeSystemName="NUCC" displayName="Cardiovascular Disease"/>
											<addr>
												<streetAddressLine>6666 StreetName St.</streetAddressLine>
												<city>Silver Spring</city>
												<state>MD</state>
												<postalCode>20901</postalCode>
												<country>US</country>
											</addr>
											<telecom value="tel:+1(301)666-6666" use="WP"/>
											<assignedPerson>
												<name>
													<given>Heartly</given>
													<family>Sixer</family>
													<suffix>MD</suffix>
												</name>
											</assignedPerson>
										</assignedAuthor>
									</author>
									<!-- This reference refers to the external document where the problem was documented -->
									<!-- It uses a template for externalDocument from the QRDA 1 3.1 Implementation Guide-->
									<reference typeCode="REFR">
										<externalDocument classCode="DOCCLIN" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.22.4.115" extension="2014-06-09" />
											<!-- This refers to the ClinicalDocument/id of the original document -->
											<id extension="TT661" root="2.16.840.1.113883.19.5.99999.1"/>							
											<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="34133-9" displayName="Summary of episode note" />
											<!-- While not required, there is a benefit of using <setId> and <versionNumber> as a secondary key on documents.   
							If the flow from a document source system or repository to a destination system is infrequent or  not able to guarantee 
							sequential transmission of  document revisions.  The setId and versionNumber pair are actually better for detecting which 
							new document revises a previous older version of that document.  -->
											<!-- If setId and versionNumber are not available or applicable, they may be omitted -->
											<setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
											<versionNumber value="1"/>
										</externalDocument>
									</reference>
									<!-- This reference refers to the observation within external document the where the problem was documented -->
									<!-- Other options are the use of reference/externalAct or reference/externalProcedures -->
									<reference typeCode="REFR">
										<externalObservation classCode="OBS" moodCode="EVN">
											<!-- This refers to the observation/id of the original observation -->
											<id extension="10241104348" root="1.3.6.1.4.1.22812.4.111.0.4.1.2.1"/>
											<code code="55607006" displayName="Problem" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
												<translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
											</code>
										</externalObservation>
									</reference>
								</observation>
							</entryRelationship>
						</act>
					</entry>
				</section>
			</component>

			<!-- ************************ ENCOUNTERS *********************** -->
			<!-- No known encounters -->
			<component>
				<section nullFlavor="NI">
					<!-- *** Encounters section (entries required) (V3) *** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/>
					<templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>
					<code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of encounters"/>
					<title>ENCOUNTERS</title>
					<text>No Encounters</text>
				</section>
			</component>

			<!-- ************** PROCEDURES ***************** -->
			<!-- edited as per test doc - all of this data is directly relevant -db -->
			<!-- (NO) UDI section based off of 	https://github.com/brettmarquard/HL7-C-CDA-Task-Force-Examples/blob/master/No_Implanted_Devices.xml 
			-db -->
			<!-- ************** PROCEDURES and UDI ***************** -->
			<component>
				<!-- nullFlavor of NI indicates No Information.-->
				<section nullFlavor="NI">
					<templateId root="2.16.840.1.113883.10.20.22.2.7" extension="2014-06-09" />
					<!-- Procedures section template -->
					<code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURES" />
					<title>Procedures</title>
					<text>No Information</text>
				</section>
			</component>


			<!-- ************** No UDI ***************** -->
			<component>
				<section>
					<!-- Medical equipment section -->
					<templateId root="2.16.840.1.113883.10.20.22.2.23" extension="2014-06-09"/>
					<code code="46264-8" codeSystem="2.16.840.1.113883.6.1" />
					<title>MEDICAL EQUIPMENT</title>
					<!-- Alternative text: Patient has no history of procedures with implantable devices'-->
					<!-- Alternative text: Patient has no implanted devices'-->
					<text>
						<paragraph ID="Proc2">Patient has no history of implantable devices</paragraph>
					</text>				
					<entry>
						<procedure classCode="PROC" moodCode="EVN" negationInd="true">
							<!-- Procedure Activity Procedure V2-->
							<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
							<id root="d5b614bd-01ce-410d-8728-e1fd01dcc72a" />
							<code code="71388002" codeSystem="2.16.840.1.113883.6.96"   
								displayName="Procedure"/>
							<text>
								<reference value="#Proc2"/>
							</text>
							<statusCode code="completed" />
							<effectiveTime nullFlavor="NA" />
							<participant typeCode="DEV">
								<participantRole classCode="MANU">
									<templateId root="2.16.840.1.113883.10.20.22.4.37"/>
									<!-- UDI is 'not applicable' since no procedure -->
									<id nullFlavor="NA" root="2.16.840.1.113883.3.3719"/>  
									<playingDevice>
										<code code="40388003" codeSystem="2.16.840.1.113883.6.96"   
											displayName="Implant"/>
									</playingDevice>
									<scopingEntity>
										<id root="2.16.840.1.113883.3.3719"/>
									</scopingEntity>
								</participantRole>
							</participant>	
						</procedure>
					</entry>
				</section>
			</component>


			<!-- ******************** IMMUNIZATIONS ********************* -->
			<!-- No immunizations -->
			<component>
				<section>
					<!-- *** Immunizations Section (entries required) (V2) *** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2014-06-09"/>
					<templateId root="2.16.840.1.113883.10.20.22.2.2.1"/>
					<code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations"/>
					<title>IMMUNIZATIONS</title>
					<text>No immunization history</text>
					<entry typeCode="DRIV">
						<!-- using negationInd="true" to signify that there are no known immunizations -->
						<substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="true">
							<!-- ** Immunization Activity (V3) ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.52"/>
							<id root="de10790f-1496-4729-8fe6-f1b87b6219f7"/>
							<statusCode code="active"/>
							<effectiveTime nullFlavor="NA"/>
							<routeCode nullFlavor="NA"/>
							<consumable>
								<manufacturedProduct classCode="MANU">
									<!-- ** Immunization Medication Information (V2) ** -->
									<templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
									<templateId root="2.16.840.1.113883.10.20.22.4.54"/>
									<manufacturedMaterial>
										<!-- there is no generic vaccine code and no known recommended way to do this - 
										leaving generic flu for now just as an example. Not sure if it makes more sense to apply a nullFlavor? -db -->
										<code nullFlavor="OTH">
											<!-- Optional original text -->
											<originalText>Vaccination</originalText>
											<translation code="71181003" displayName="vaccine"
												codeSystem="2.16.840.1.113883.6.96"
												codeSystemName="SNOMED CT"/>
										</code>
										<!-- NA since there is no immunization data -db -->
										<lotNumberText nullFlavor="NA"/>
									</manufacturedMaterial>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
				</section>
			</component>

			<!-- ************* VITAL SIGNS *************** -->
			<!-- No vital signs  -db -->
			<component>
				<section nullFlavor="NI">
					<templateId root="2.16.840.1.113883.10.20.22.2.4.1" extension="2015-08-01" />
					<code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="VITAL SIGNS" />
					<title>VITAL SIGNS</title>
					<text>No Recorded Vital Signs</text>
				</section>
			</component>

			<!-- ******************* SOCIAL HISTORY ********************* -->
			<!-- edited as per test doc - most of this data is directly relevant -db -->
			<component>
				<section>
					<!--  ** Social History Section (V3) ** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-01"/>
					<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History"/>
					<title>SOCIAL HISTORY</title>
					<text>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>Social History Observation</th>
									<th>Description</th>
									<th>Dates Observed</th>
								</tr>
							</thead>
							<tbody>								
								<tr>
									<td>Current Smoking Status</td>
									<td>Current every day</td>
									<td>July 22, 2015</td>
								</tr>
								<tr>
									<td ID="BirthSexInfo">Birth Sex</td>
									<td>Male</td>
									<td>July 22, 2015</td>
								</tr>
							</tbody>
						</table>
					</text>					
					<!-- Current Smoking Status - July 22, 2015 -db -->
					<entry typeCode="DRIV">
						<observation classCode="OBS" moodCode="EVN">
							<!-- ** Smoking Status - Meaningful Use (V2) ** -->
							<templateId root="2.16.840.1.113883.10.20.22.4.78" extension="2014-06-09"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.78"/>
							<id extension="123456789" root="2.16.840.1.113883.19"/>
							<!-- code SHALL be 72166-2 for Smoking Status - Meaningful Use (V2) -db -->
							<code code="72166-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Tobacco smoking status NHIS"/>
							<statusCode code="completed"/>
							<!-- The effectiveTime reflects when the current smoking status was observed. -->
							<effectiveTime value="20150722"/>
							<!-- The value represents the patient's smoking status currently observed. -->
							<!-- Consol Smoking Status Meaningful Use2 SHALL contain exactly one [1..1] value (CONF:1098-14810), which SHALL be selected from ValueSet Current Smoking Status 2.16.840.1.113883.11.20.9.38 STATIC 2014-09-01 (CONF:1098-14817) -db -->
							<value xsi:type="CD" code="449868002" displayName="Current every day smoker" codeSystem="2.16.840.1.113883.6.96"/>
						</observation>
					</entry>					
					<!-- removed Social history observation (V3) entry for "Alcoholic drinks per day" -db -->
					<!-- Add Birth Sex entry -->
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.200" extension="2016-06-01"/>
							<code code="76689-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Sex Assigned At Birth"/>
							<text>
								<reference value="#BirthSexInfo"/>
							</text>
							<statusCode code="completed"/>
							<effectiveTime value="20150722"/>
							<value code="M" codeSystem="2.16.840.1.113883.5.1" xsi:type="CD" displayName="Male"/>
						</observation>
					</entry>


				</section>
			</component>	

			<!-- ******************** RESULTS ************************ -->
			<!-- edited as per test doc - all of this data is directly relevant -db -->
			<component>
				<section nullFlavor="NI">
					<!-- Results Section (entries required) (V3) -->
					<templateId root="2.16.840.1.113883.10.20.22.2.3.1" extension="2015-08-01"/>
					<templateId root="2.16.840.1.113883.10.20.22.2.3.1"/>
					<code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="RESULTS"/>
					<title>RESULTS</title>
					<text>Laboratory Test: None needed. Laboratory Values/Results: No Lab Result data</text>
				</section>
			</component>			

			<!-- removed component Advance Directives as not required by test data -db -->

			<!-- removed component Family History as not required by test data -db -->

			<!-- removed component Functional Status as not required by test data (specific to 170.315(b)(1), (b)(2)) -db -->

			<!-- removed component Medical Equipment as not required by test data -db -->

			<!-- removed component Payers as not required by test data -db -->

			<!-- added Assessment -db -->			
			<!-- 
			********************************************************
			Assessment
			********************************************************
			-->
			<!-- edited as per test doc - all of this data is directly relevant -db -->
			<component>
				<section nullFlavor="NI">
					<!-- Assessment Section -db -->
					<!-- There is no R2.1 (or 2.0) version of Assessment Section, using R1.1 templateId only -db -->
					<templateId root="2.16.840.1.113883.10.20.22.2.8"/>
					<code codeSystem="2.16.840.1.113883.6.1" 
						 codeSystemName="LOINC" code="51848-0" 
						 displayName="ASSESSMENTS"/>
					<title>ASSESSMENTS</title>
					<text>No assessment information</text>
				</section>
			</component>

			<!-- ******************* PLAN OF TREATMENT ********************** -->
			<!-- edited as per test doc - all of this data is directly relevant -db -->
			<component>
				<section>
					<!--  **** Plan of Treatment Section (V2) **** -->
					<templateId root="2.16.840.1.113883.10.20.22.2.10" extension="2014-06-09"/>
					<templateId root="2.16.840.1.113883.10.20.22.2.10"/>
					<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Treatment plan"/>
					<title>TREATMENT PLAN</title>
					<text>
						No Plan of treatment
					</text>
				</section>
			</component>

			<!-- Added Goals - original version from C-CDA_R2_Care_Plan.xml from R2.0 IG package.
			     There are no duplicated template Ids with extensions -
				 as there is only one version in existence for each section and entry listed -db -->
			<!-- 
                ********************************************************
                Goals
                ********************************************************
            -->
			<!-- edited as per test doc -db -->			
			<component>
				<section nullFlavor="NI">
					<!-- Goals Section -->
					<templateId root="2.16.840.1.113883.10.20.22.2.60"/>
					<code code="61146-7" displayName="Goals" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Goals Section</title>
					<text>No goal information</text>
				</section>
			</component>

			<!-- added Health Concerns -db -->
			<!-- Note: There is no R1.1 version of Health Concerns Section or Health Concern Act -
				 so there is only one templateId per section (they're NEW) -db -->
			<!-- updated as per ETF	https://github.com/brettmarquard/HL7-C-CDA-Task-Force-Examples/blob/master/No_Known_Health_Concerns.xml 
			-db -->
			<!-- 
			********************************************************
			Health Concerns
			********************************************************
			-->
			<!-- edited as per test doc -db -->					
			<component>
				<!-- This example records assertion of no concerns -->
				<section>
					<!-- Health Concerns Section (V2) (V1 was added as a NEW template in R2.0, V2 was updated in R2.1) -db -->
					<templateId root="2.16.840.1.113883.10.20.22.2.58" extension="2015-08-01"/>
					<code code="75310-3" displayName="Health Concerns Document"
						codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Health Concerns</title>
					<!--Including ID at text element is allowed -->
					<text ID="HealthConcern_1">No Known Health Concerns on 07/22/2015</text>
					<entry typeCode="COMP">
						<!-- negationInd=true indicates no known health concerns at the stated time-->
						<act classCode="ACT" moodCode="EVN" negationInd="true">
							<!-- There is no V1 version of this template -db -->
							<templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2015-08-01"/>
							<id root="4eab0e52-dd7d-4285-99eb-72d32ddb195d"/>
							<code code="75310-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
								displayName="Health Concern"/>
							<text>
								<reference value="#HealthConcern_1"/>
							</text>
							<!-- This Health Concern has a statusCode of concern because assertion is ongoing -->
							<statusCode code="active"/>
							<!-- The effective time is the date that the Health Concern started being followed - 
								this does not necessarily correlate to the onset date of the contained health issues-->
							<effectiveTime value="20150722"/>
							<!-- Time at which THIS “concern” began being tracked.-->
						</act>
					</entry>
				</section>
			</component>		

			<!-- 
			************************************
			HOSPITAL DISCHARGE INSTRUCTIONS
			************************************ 
			-->
			<component>
				<section>
					<!-- Hospital Discharge Instructions Section - no R2.1 version for this template -db -->
					<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>
						<list
						  listType="ordered">
							<item>Appointments: Schedule an appointment with Dr Seven after 1 week. Follow up with Outpatient facility.</item>
							<item>In case of fever, take Tylenol as advised in plan of treatment.</item>
						</list>
					</text>
				</section>
			</component>				

			<!-- removed Reason for Referral -db -->	

			<!-- added Mental Status Section (V2) (used to be NEW in R2.0) 2.16.840.1.113883.10.20.22.2.56 as required by VDT inp test data -db -->
			<!-- 
			********************************************************
			Mental Status Section
			********************************************************
			-->		
			<component>
				<section nullFlavor="NI">
					<!-- note: the IG lists the wrong templateId in its example of this section, lists ...2,14 instead of 2.56 -db -->
					<!-- There is no R1.1 version of this template -db -->
					<templateId root="2.16.840.1.113883.10.20.22.2.56" extension="2015-08-01" />
					<!-- Mental Status Section -->
					<code code="10190-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="MENTAL STATUS" />
					<title>MENTAL STATUS</title>
					<text>No information</text>
				</section>	
			</component>

			<!-- added component Functional Status as required by test data -db -->
			<!-- 
			********************************************************
			FUNCTIONAL STATUS
			********************************************************
			-->			
			<component>				
				<section nullFlavor="NI">
					<!-- Functional Status Section (V2)-->
					<templateId root="2.16.840.1.113883.10.20.22.2.14" extension="2014-06-09"/>
					<!-- Functional Status Section -->
					<templateId root="2.16.840.1.113883.10.20.22.2.14"/>
					<code code="47420-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Functional Status"/>
					<title>FUNCTIONAL STATUS</title>
					<text>No information</text>
				</section>
			</component>

			<!-- added Interventions -->
			<!-- 
			********************************************************
			INTERVENTIONS
			********************************************************
			-->

			<component>
				<section nullFlavor="NI">
					<templateId root="2.16.840.1.113883.10.20.21.2.3" extension="2015-08-01" />
					<code code="62387-6" displayName="Interventions Provided" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
					<title>Interventions Section</title>
					<text>No intervention information</text>
				</section>
			</component>

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