CCD Sample 2

<?xml-stylesheet type="text/xsl" href="cda.xsl"?><ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:cda="urn:hl7-org:v3" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" classCode="DOCCLIN" moodCode="EVN" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd"> <!--*********************************************************************** CCD Header ***********************************************************************--> <realmCode code="US"/> <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/> <!--CCD Template Root --> <!--Consolidated CCD Template v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.1.2"/> <!--Consolidated CCD Template v1.1--> <templateId root="2.16.840.1.113883.10.20.22.1.2"/> <!--US Realm Header v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.1.1"/> <!--US Realm Header v1.1--> <templateId root="2.16.840.1.113883.10.20.22.1.1"/> <id extension="CCD-Z003905-20230717160401" root="2.16.840.1.113883.17.43"/> <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Summarization of Episode Note"/> <title>Manchester Memorial Hospital Consolidated CDA Continuity of Care Document v2.1</title> <effectiveTime value="20230717160400+0500"/> <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" displayName="Normal"/> <languageCode code="en"/> <recordTarget> <patientRole> <id assigningAuthorityName="MRN" extension="Z003905" root="2.16.840.1.113883.17.43"/> <id assigningAuthorityName="EMPI" extension="Z3873" root="2.16.840.1.113883.17.43"/> <addr use="HP">

<streetAddressLine>17 BUSH LANE</streetAddressLine> <city>VERNON</city> <state>CT</state> <postalCode>06066</postalCode> <country>US</country> </addr> <telecom use="HP" value="tel:+1860-555-8989"/> <telecom nullFlavor="UNK" use="MC"/> <telecom use="HP" value="mailto:VERY.BARRY2000@YAHOO.COM"/> <patient> <name use="L"> <given>Barry</given> <family>Blue</family> </name> <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" displayName="Male"> <originalText>Male</originalText> </administrativeGenderCode> <birthTime value="20000101"/> <maritalStatusCode nullFlavor="UNK"> <originalText>SINGLE</originalText> </maritalStatusCode> <religiousAffiliationCode nullFlavor="UNK"> <originalText>NONE</originalText> </religiousAffiliationCode> <raceCode code="2131-1" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDCREC" displayName="Other Race"> <originalText>Other Race</originalText> </raceCode>

<sdtc:raceCode nullFlavor="UNK"/> <ethnicGroupCode nullFlavor="UNK"> <originalText>Unknown</originalText> </ethnicGroupCode> <sdtc:ethnicGroupCode nullFlavor="UNK"/> <languageCommunication> <languageCode code="eng"/> <modeCode nullFlavor="UNK"/> <preferenceInd value="true"/> </languageCommunication> </patient> <providerOrganization classCode="ORG" determinerCode="INSTANCE"> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </providerOrganization> </patientRole> </recordTarget> <author> <time value="202307171604+0500"/> <assignedAuthor> <id root="2.16.840.1.113883.17.43"/>

<id nullFlavor="UNK" root="2.16.840.1.113883.4.6"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1860-646-1222"/> <assignedAuthoringDevice classCode="DEV" determinerCode="INSTANCE"> <manufacturerModelName>Iatric Systems, Inc.</manufacturerModelName> <softwareName>Clinical Document Exchange (CDE) Certified v1.5</softwareName> </assignedAuthoringDevice> <representedOrganization> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </representedOrganization> </assignedAuthor> </author> <custodian> <assignedCustodian>

<representedCustodianOrganization> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </representedCustodianOrganization> </assignedCustodian> </custodian> <participant typeCode="IND"> <associatedEntity classCode="NOK"> <id extension="Z003905-NOK" root="2.16.840.1.113883.17.43"/> <code nullFlavor="UNK"> <originalText>SISTER</originalText> </code> <addr use="HP"> <streetAddressLine>*</streetAddressLine> <city>*</city> <state>CT</state> <postalCode>06118</postalCode> <country>US</country> </addr> <telecom use="HP" value="tel:+1860-555-9236"/> <telecom nullFlavor="UNK" use="WP"/>

<associatedPerson classCode="PSN"> <name> <prefix>Ms</prefix> <given>Skye</given> <family>Blue</family> </name> </associatedPerson> </associatedEntity> </participant> <participant typeCode="IND"> <associatedEntity classCode="ECON"> <id extension="Z003905-PN" root="2.16.840.1.113883.17.43"/> <code nullFlavor="UNK"> <originalText>OTHER OR FRIEND</originalText> </code> <addr use="HP"> <streetAddressLine>*</streetAddressLine> <city>*</city> <state>CT</state> <postalCode>06118</postalCode> <country>US</country> </addr> <telecom use="HP" value="tel:+1860-555-1364"/> <telecom nullFlavor="UNK" use="WP"/> <associatedPerson classCode="PSN"> <name> <given>Envi</given> <family>Greene</family> </name>

</associatedPerson> </associatedEntity> </participant> <documentationOf> <serviceEvent classCode="PCPR"> <effectiveTime> <low value="202305171339+0500"/> <high value="202305181200+0500"/> </effectiveTime> <performer typeCode="PRF"> <functionCode code="ATTPHYS" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="Attending Physician"> <originalText>Attending Physician</originalText> </functionCode> <time> <low value="202305171424"/> <high value="202305181200"/> </time> <assignedEntity> <id root="2.16.840.1.113883.4.6"/> <code nullFlavor="UNK"/> <addr nullFlavor="UNK" use="WP"> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK" use="WP"/> <assignedPerson classCode="PSN" determinerCode="INSTANCE"> <name nullFlavor="UNK"/> </assignedPerson>

<representedOrganization classCode="ORG" determinerCode="INSTANCE"> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </representedOrganization> </assignedEntity> </performer> <performer typeCode="PRF"> <functionCode code="ADMPHYS" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="Admitting Physician"> <originalText>Admitting Physician</originalText> </functionCode> <time> <low value="202305171339"/> <high value="202305181200"/> </time> <assignedEntity> <id extension="1255344123" root="2.16.840.1.113883.4.6"/> <code nullFlavor="UNK"/> <addr use="WP"> <streetAddressLine>554 Talcottville Road</streetAddressLine> <city>Vernon</city>

<state>CT</state> <postalCode>06066</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1860-875-6700"/> <assignedPerson classCode="PSN" determinerCode="INSTANCE"> <name> <prefix qualifier="TITLE">Dr.</prefix> <given>John</given> <family>Schifferdecker</family> </name> </assignedPerson> <representedOrganization classCode="ORG" determinerCode="INSTANCE"> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </representedOrganization> </assignedEntity> </performer> <performer typeCode="PRF"> <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="Primary Care Physician">

<originalText>Primary Care Physician</originalText> </functionCode> <time> <low value="202305171339"/> <high value="202305181200"/> </time> <assignedEntity> <id extension="1255344123" root="2.16.840.1.113883.4.6"/> <code nullFlavor="UNK"/> <addr use="WP"> <streetAddressLine>554 Talcottville Road</streetAddressLine> <city>Vernon</city> <state>CT</state> <postalCode>06066</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1860-875-6700"/> <assignedPerson classCode="PSN" determinerCode="INSTANCE"> <name> <prefix qualifier="TITLE">Dr.</prefix> <given>John</given> <family>Schifferdecker</family> </name> </assignedPerson> <representedOrganization classCode="ORG" determinerCode="INSTANCE"> <id root="2.16.840.1.113883.17.43"/> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP">

<streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> </representedOrganization> </assignedEntity> </performer> </serviceEvent> </documentationOf> <componentOf> <encompassingEncounter classCode="ENC" moodCode="EVN"> <id extension="Z3873-Z003905-D00008389" root="2.16.840.1.113883.17.43"/> <effectiveTime> <low value="202305171339+0500"/> <high value="202305181200+0500"/> </effectiveTime> </encompassingEncounter> </componentOf> <!--*********************************************************************** CCD Body ***********************************************************************--> <component> <structuredBody> <!--*********************************************************************** C.CDA Advance Directives ***********************************************************************--> <component contextConductionInd="true" typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Advance Directives section template -->

<!--Advance Directives Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.21.1"/> <!--Advance Directives Section v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.21.1"/> <code code="42348-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Advance Directives"/> <title>Advance Directives</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Advance Directives</th> </tr> </thead> <tbody> <tr> <td> <content>No Advance Directives Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C-CDA Results Data ***********************************************************************--> <component>

<section nullFlavor="NI"> <!-- Results Section Template --> <!--Results Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.3.1"/> <!--Results Section v1.1--> <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="Relevant diagnostic tests and/or laboratory data"/> <title>Relevant diagnostic tests and/or laboratory data</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Results</th> </tr> </thead> <tbody> <tr> <td>No Diagnostic/Lab Test or Result Information<br/> <content/> </td> </tr> </tbody> </table> <br/> <br/> <br/> </text> </section>

</component> <!--*********************************************************************** Consolidated CDA Allergies and Other Adverse Reactions Section ***********************************************************************--> <component> <section nullFlavor="NI"> <!-- Allergies and Other Adverse Reactions Section template --> <!--Allergies Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.6.1"/> <!--Allergies Section v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.6.1"/> <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <title>Allergies and Adverse Reactions</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Allergies and Adverse Reactions</th> </tr> </thead> <tbody> <tr> <td> <content>No Known Allergies<br/> </content> </td> </tr> </tbody> </table>

</text> </section> </component> <!--*********************************************************************** Consolidated CDA Conditions Data ***********************************************************************--> <component> <section> <!-- Conditions Section Template --> <!--C-CDA Problem List v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.5.1"/> <!--C-CDA Problem List v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.5.1"/> <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem List"/> <title>Problem List</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Problem List</th> </tr> </thead> <tbody> <tr> <td> <content>No known problems<br/> </content> </td> </tr>

<tr> <th colspan="1">Patient Unit Number: Z003905</th> </tr> <tr> <th colspan="5"> No Problems: </th> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <!-- Problems Template --> <!--Problem Concern Activity v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.3"/> <!--Problem Concern Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.3"/> <id extension="Z003905-55607006-CONCERN" root="2.16.840.1.113883.17.43"/> <code code="CONC" codeSystem="2.16.840.1.113883.5.6" codeSystemName="HL7ActClass" displayName="Concern"/> <statusCode code="active"/> <effectiveTime> <low value="20230517"/> </effectiveTime> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN" negationInd="true"> <!--Problem observation template --> <!--Problem Observation v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <!--Problem Observation v.1.1-->

<templateId root="2.16.840.1.113883.10.20.22.4.4"/> <id extension="Z003905-55607006-OBS" root="2.16.840.1.113883.17.43"/> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Problem"> <translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem HL7.CCDAR2"/> </code> <statusCode code="completed"/> <effectiveTime> <low value="20230517"/> </effectiveTime> <value code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Problem" xsi:type="CD"/> </observation> </entryRelationship> </act> </entry> </section> </component> <!--*********************************************************************** Consolidated CDA Vital Signs ***********************************************************************--> <component> <section nullFlavor="NI"> <!-- Vital Signs section template --> <!--Vital Signs Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.4.1"/> <!--Vital Signs Section v.1.1--> <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> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Vital Signs</th> </tr> </thead> <tbody> <tr> <td> <content>No Vital Signs Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Functional and Cognitive Status ***********************************************************************--> <component> <section nullFlavor="NI"> <!-- Cognitive and Functional Status section template --> <!--Functional Status v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.14"/> <!--Functional Status v1.1-->

<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 assessment"/> <title>Functional Status</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Functional Status</th> </tr> </thead> <tbody> <tr> <td> <content>No Functional Status Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Admission Medications v2.1**********************************************************************--> <component contextConductionInd="true" typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN"> <!-- Medication Section Template --> <!--C.CDA Admission Medications v2.1-->

<templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.44"/> <!--C.CDA Admission Medications v1.1--> <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>Medications on Admission</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Medications</th> </tr> </thead> <tbody> <tr> <td> <content>No Known Admission Medications<br/> </content> </td> </tr> </tbody> </table> </text> <entry contextConductionInd="true" typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <!--C.CDA Admission Medication Activity v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.36"/> <!--C.CDA Admission Medication Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.36"/>

<code code="42346-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medications on Admission"/> <statusCode code="completed"/> <entryRelationship typeCode="SUBJ"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="true"> <!-- Medication Activity Template --> <!--CCDA Medication Activity v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <!--CCDA Medication Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id extension="Z003905-HM-NO-MEDS" root="2.16.840.1.113883.17.43"/> <statusCode code="active"/> <effectiveTime nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable typeCode="CSM"> <manufacturedProduct classCode="MANU"> <!-- Medication Product Template --> <!--Manufactured Product v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <!--Manufactured Product v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial classCode="MMAT" determinerCode="KIND"> <code codeSystem="2.16.840.1.113883.6.88" nullFlavor="OTH"> <originalText> <reference nullFlavor="NA"/> </originalText> <translation code="410942007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="drug or medication"/>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entryRelationship> </act> </entry> </section> </component> <!--*********************************************************************** C.CDA Medications v2.1**********************************************************************-> <component contextConductionInd="true" typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN"> <!-- Medication Section Template --> <!--C-CDA Medications Section v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.1.1"/> <!--C-CDA Medications Section v1.1--> <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>History of medication use</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Medications</th> </tr> </thead>

<tbody> <tr> <td> <content>No Known Medications<br/> </content> </td> </tr> </tbody> </table> <br/> <br/> </text> <entry contextConductionInd="true" typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="true"> <!-- Medication Activity Template --> <!--CCDA Medication Activity v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <!--CCDA Medication Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id extension="Z003905-OM-NO-MEDS" root="2.16.840.1.113883.17.43"/> <statusCode code="active"/> <effectiveTime nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable typeCode="CSM"> <manufacturedProduct classCode="MANU"> <!-- Medication Product Template --> <!--Manufactured Product v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <!--Manufactured Product v1.1-->

<templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial classCode="MMAT" determinerCode="KIND"> <code codeSystem="2.16.840.1.113883.6.88" nullFlavor="OTH"> <originalText> <reference nullFlavor="NA"/> </originalText> <translation code="410942007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="drug or medication"/> </code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> </section> </component> <!--*********************************************************************** C.CDA Discharge Medications v2.1**********************************************************************--> <component contextConductionInd="true" typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN"> <!-- Medication Section Template --> <!--C.CDA Discharge Medications v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.11.1"/> <!--C.CDA Discharge Medications v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.11.1"/> <code code="10183-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Hospital Discharge medications"> <translation code="75311-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Discharge Medications"/>

</code> <title>Hospital Discharge medications</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Medications</th> </tr> </thead> <tbody> <tr> <td> <content>No Known Discharge Medications<br/> </content> </td> </tr> </tbody> </table> </text> <entry contextConductionInd="true" typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <!--C.CDA Discharge Medication Activity v2.1--> <templateId extension="2016-03-01" root="2.16.840.1.113883.10.20.22.4.35"/> <!--C.CDA Discharge Medication Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.35"/> <code code="10183-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Hospital Discharge Medication"> <translation code="75311-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Discharge Medication"/>

</code> <statusCode code="completed"/> <entryRelationship typeCode="SUBJ"> <substanceAdministration classCode="SBADM" moodCode="INT" negationInd="true"> <!-- Medication Activity Template --> <!--CCDA Medication Activity v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <!--CCDA Medication Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id extension="Z003905-DM-NO-MEDS" root="2.16.840.1.113883.17.43"/> <statusCode code="active"/> <effectiveTime nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable typeCode="CSM"> <manufacturedProduct classCode="MANU"> <!-- Medication Product Template --> <!--Manufactured Product v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <!--Manufactured Product v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial classCode="MMAT" determinerCode="KIND"> <code codeSystem="2.16.840.1.113883.6.88" nullFlavor="OTH"> <originalText> <reference nullFlavor="NA"/> </originalText> <translation code="410942007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="drug or medication"/> </code>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entryRelationship> </act> </entry> </section> </component> <!--*********************************************************************** Consolidated CDA Encounters Data ***********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN"> <!-- Encounter Section Template --> <!--Encounters Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.22.1"/> <!--Encounters Section v1.1--> <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>History Of Encounters</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="6">Encounters</th> </tr> </thead> <tbody>

<tr> <th colspan="6"> <content ID="encounter-1">Visit/Account #D00008389 (May 17, 2023 1:39pm May 18, 2023 12:00pm)</content> </th> </tr> <tr> <th colspan="1">Account Status</th> <th colspan="1">Physician Of Record</th> <th colspan="1">Reason For Visit</th> <th colspan="1">Visit Diagnosis</th> <th colspan="1">Start Date/Time</th> <th colspan="1">Stop Date/Time</th> </tr> <tr> <td> <content ID="mrn-Z003905-acct-D00008389-status-1-SDC">SDC<br/> </content> </td> <td>DR. MEDITECH<br/> </td> <td> <content ID="mrn-Z003905-acct-D00008389-status-1-SDC-reason">SURGERY<br/> </content> </td> <td> <content ID="mrn-Z003905-acct-D00008389-status-1-SDC-visit-dx-1">Not Available<br/> </content>

</td> <td>May 17, 2023 1:39pm<br/> </td> <td>May 17, 2023 1:39pm<br/> </td> </tr> <tr> <td> <content ID="mrn-Z003905-acct-D00008389-status-2-IN">IN<br/> </content> </td> <td>DR. MEDITECH<br/> </td> <td> <content ID="mrn-Z003905-acct-D00008389-status-2-IN-reason">SURGERY<br/> </content> </td> <td> <content ID="mrn-Z003905-acct-D00008389-status-2-IN-visit-dx-2">Not Available<br/> </content> </td> <td>May 17, 2023 2:24pm<br/> </td> <td>May 18, 2023 12:00pm<br/> </td> </tr> </tbody> </table>

</text> <entry typeCode="DRIV"> <encounter classCode="ENC" moodCode="EVN"> <!-- Encounter templates --> <!--Encounter Activity v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/> <!--Encounter Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.49"/> <id extension="Z003905-D00008389-SDC" root="2.16.840.1.113883.17.43"/> <code nullFlavor="OTH"> <originalText>SDC<reference value="#mrn-Z003905-acct-D00008389-status-1-SDC"/> </originalText> <translation code="SS" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7 ActEncounterCode" displayName="Short Stay"/> </code> <effectiveTime> <low value="202305171339"/> <high value="202305171339"/> </effectiveTime> <performer typeCode="PRF"> <time> <low value="202305171339"/> <high value="202305171339"/> </time> <assignedEntity classCode="ASSIGNED"> <id root="2.16.840.1.113883.4.6"/> <code nullFlavor="UNK"/> <addr nullFlavor="UNK" use="WP"/> <telecom nullFlavor="UNK" use="WP"/>

<assignedPerson classCode="PSN" determinerCode="INSTANCE"> <name nullFlavor="UNK"/> </assignedPerson> <representedOrganization classCode="ORG" determinerCode="INSTANCE"> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> </addr> </representedOrganization> </assignedEntity> </performer> <participant typeCode="LOC"> <participantRole classCode="SDLOC"> <!--Service Delivery Location v2.1--> <templateId root="2.16.840.1.113883.10.20.22.4.32"/> <code code="1060-3" codeSystem="2.16.840.1.113883.6.259" codeSystemName="HealthcareServiceLocation" displayName="Inpatient medical ward"> <originalText>MMH-MEDICAL</originalText> </code> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country>

</addr> <telecom use="WP" value="tel:+1860-646-1222"/> <playingEntity classCode="PLC" determinerCode="INSTANCE"> <name>Manchester Memorial Hospital</name> </playingEntity> </participantRole> </participant> <entryRelationship typeCode="RSON"> <observation classCode="OBS" moodCode="EVN"> <!--Indication v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.19"/> <!--Indication v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.19"/> <id extension="Z003905-D00008389-ENC-STATUS-SDC-RSON" root="2.16.840.1.113883.17.43"/> <code nullFlavor="UNK"/> <text>SURGERY<reference value="#mrn-Z003905-acct-D00008389-status-1-SDCreason"/> </text> <statusCode code="completed"/> <effectiveTime> <low value="202305171339"/> <high value="202305171339"/> </effectiveTime> <value nullFlavor="UNK" xsi:type="CD"/> </observation> </entryRelationship> <entryRelationship typeCode="SUBJ"> <act classCode="ACT" moodCode="EVN">

<!--Encounter Diagnosis Activity v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.80"/> <!--Encounter Diagnosis Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.80"/> <code code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis" xsi:type="CE"/> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <!--Problem Observation v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <!--Problem Observation v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <id extension="Z003905-D00008389-visit-dx-1" root="2.16.840.1.113883.17.43"/> <code code="404684003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Finding"> <translation code="75321-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Clinical finding HL7.CCDAR2"/> </code> <statusCode code="completed"/> <effectiveTime> <low value="202305171339"/> </effectiveTime> <value nullFlavor="NAV" xsi:type="CD"> <originalText> <reference value="#mrn-Z003905-acct-D00008389-status-1-SDC-visit-dx1"/> </originalText> </value> </observation>

</entryRelationship> </act> </entryRelationship> </encounter> </entry> <entry typeCode="DRIV"> <encounter classCode="ENC" moodCode="EVN"> <!-- Encounter templates --> <!--Encounter Activity v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/> <!--Encounter Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.49"/> <id extension="Z003905-D00008389-IN" root="2.16.840.1.113883.17.43"/> <code nullFlavor="OTH"> <originalText>IN<reference value="#mrn-Z003905-acct-D00008389-status-2-IN"/> </originalText> <translation code="IMP" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7 ActEncounterCode" displayName="Inpatient"/> </code> <effectiveTime> <low value="202305171424"/> <high value="202305181200"/> </effectiveTime> <performer typeCode="PRF"> <time> <low value="202305171424"/> <high value="202305181200"/> </time> <assignedEntity classCode="ASSIGNED">

<id root="2.16.840.1.113883.4.6"/> <code nullFlavor="UNK"/> <addr nullFlavor="UNK" use="WP"/> <telecom nullFlavor="UNK" use="WP"/> <assignedPerson classCode="PSN" determinerCode="INSTANCE"> <name nullFlavor="UNK"/> </assignedPerson> <representedOrganization classCode="ORG" determinerCode="INSTANCE"> <name>Manchester Memorial Hospital</name> <telecom use="WP" value="tel:+1860-646-1222"/> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine> <city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> </addr> </representedOrganization> </assignedEntity> </performer> <participant typeCode="LOC"> <participantRole classCode="SDLOC"> <!--Service Delivery Location v2.1--> <templateId root="2.16.840.1.113883.10.20.22.4.32"/> <code code="1060-3" codeSystem="2.16.840.1.113883.6.259" codeSystemName="HealthcareServiceLocation" displayName="Inpatient medical ward"> <originalText>MMH-MEDICAL</originalText> </code> <addr use="WP"> <streetAddressLine>71 Haynes St</streetAddressLine>

<city>Manchester</city> <state>CT</state> <postalCode>06040</postalCode> <country>US</country> </addr> <telecom use="WP" value="tel:+1860-646-1222"/> <playingEntity classCode="PLC" determinerCode="INSTANCE"> <name>Manchester Memorial Hospital</name> </playingEntity> </participantRole> </participant> <entryRelationship typeCode="RSON"> <observation classCode="OBS" moodCode="EVN"> <!--Indication v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.19"/> <!--Indication v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.19"/> <id extension="Z003905-D00008389-ENC-STATUS-IN-RSON" root="2.16.840.1.113883.17.43"/> <code nullFlavor="UNK"/> <text>SURGERY<reference value="#mrn-Z003905-acct-D00008389-status-2-INreason"/> </text> <statusCode code="completed"/> <effectiveTime> <low value="202305171424"/> <high value="202305181200"/> </effectiveTime> <value nullFlavor="UNK" xsi:type="CD"/>

</observation> </entryRelationship> <entryRelationship typeCode="SUBJ"> <act classCode="ACT" moodCode="EVN"> <!--Encounter Diagnosis Activity v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.80"/> <!--Encounter Diagnosis Activity v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.80"/> <code code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis" xsi:type="CE"/> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <!--Problem Observation v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <!--Problem Observation v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <id extension="Z003905-D00008389-visit-dx-1" root="2.16.840.1.113883.17.43"/> <code code="404684003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Finding"> <translation code="75321-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Clinical finding HL7.CCDAR2"/> </code> <statusCode code="completed"/> <effectiveTime> <low value="202305171424"/> </effectiveTime> <value nullFlavor="NAV" xsi:type="CD"> <originalText> <reference value="#mrn-Z003905-acct-D00008389-status-2-IN-visit-dx-2"/>

</originalText> </value> </observation> </entryRelationship> </act> </entryRelationship> </encounter> </entry> </section> </component> <!--*********************************************************************** Consolidated CDA Procedures Data ***********************************************************************--> <component contextConductionInd="true" typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Procedure Section Template --> <!--Procedures Section v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.7.1"/> <!--Procedures Section v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.7.1"/> <code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of procedures"/> <title>History of Procedures</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Procedure List</th> </tr> </thead>

<tbody> <tr> <td> <content>No Procedures Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Discharge Instructions ***********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Discharge Instructions Section Template --> <!--Hospital Discharge Instructions--> <templateId root="2.16.840.1.113883.10.20.22.2.41"/> <code code="8653-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Hospital Discharge Instructions"/> <title>Hospital Discharge Instructions</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Discharge Instructions</th> </tr> </thead>

<tbody> <tr> <th colspan="1">Visit/Account #D00008389 (May 17, 2023 1:39pm - May 18, 2023 12:00pm)</th> </tr> <tr> <th colspan="1">Discharge Information: </th> </tr> <tr> <td>No Discharge Instructions Information<br/> <content/> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Social History ***********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Social History section template --> <!--Social History Section Template v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.17"/> <!--Social History Section Template v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.17"/> <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 colspan="1">Social History</th> </tr> </thead> <tbody> <tr> <td> <content>No Social History Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Immunizations Section v2.1**********************************************************************--> <component> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Immunization Section Template --> <!--Immunizations Section v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.2.1"/> <!--Immunizations Section v1.1-->

<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> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Immunizations</th> </tr> </thead> <tbody> <tr> <td> <content>No Immunizations History<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Family History Data ***********************************************************************--> <component> <section nullFlavor="NI"> <!-- Family History Section Template --> <!--Family History Section v2.1-->

<templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.15"/> <!--Family History Section v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.15"/> <code code="10157-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Family History"/> <title>Family History</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Family History</th> </tr> </thead> <tbody> <tr> <td>No Family History Information<br/> <content/> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Health Concerns v2.1**********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Health Concerns Section Template -->

<!--Health Concerns Section Template v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.58"/> <code code="75310-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Health Concerns"/> <title>Health Concerns</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Health Concerns</th> </tr> </thead> <tbody> <tr> <td> <content>No Health Concerns Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** Consolidated CDA Medical Equipment Data ***********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Medical Equipment Section Template -->

<!--Medical Equipment Section Template v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.23"/> <!--Medical Equipment Section Template v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.23"/> <code code="46264-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medical Equipment"/> <title>Medical Equipment</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Medical Equipment</th> </tr> </thead> <tbody> <tr> <td> <content>No implanted devices or medical equipment information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Assessments Section ***********************************************************************--> <component typeCode="COMP">

<section nullFlavor="NI"> <!-- Assessments Section template --> <!--Assessments Section Template v2.1--> <templateId root="2.16.840.1.113883.10.20.22.2.8"/> <code code="51848-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Assessments"/> <title>Assessments</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Assessments</th> </tr> </thead> <tbody> <tr> <td> <content>No Assessments Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Plan of Treatment v2.1**********************************************************************--> <component>

<section nullFlavor="NI"> <!--Plan of Treatment Section Template v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.10"/> <!--Plan of Treatment Section Template v1.1--> <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="Plan of Treatment"/> <title>Plan of Treatment</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Plan of Treatment</th> </tr> </thead> <tbody> <tr> <td> <content>No Plan Of Treatment Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Goals v2.1**********************************************************************-->

<component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!--Goals Section Template v2.1--> <templateId root="2.16.840.1.113883.10.20.22.2.60"/> <code code="61146-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Goals"/> <title>Goals</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Goals</th> </tr> </thead> <tbody> <tr> <td> <content>No Goals Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Instructions ***********************************************************************--> <component typeCode="COMP">

<section classCode="DOCSECT" moodCode="EVN"> <!-- Instructions Section Template --> <!--Instructions Section Template v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.45"/> <!--Instructions Section Template v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.45"/> <code code="69730-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Instructions"/> <title>Instructions</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Instructions</th> </tr> </thead> <tbody> <tr> <th colspan="1">Visit/Account #D00008389 (May 17, 2023 1:39pm - May 18, 2023 12:00pm)</th> </tr> <tr> <th colspan="1">Discharge Information: </th> </tr> <tr> <td> <content ID="inst-acct-1-DIS-ds-General-Visit-Data-1"> <content styleCode="Bold">General Visit Information</content> <br/>

<br/>Reason for Visit/Admission Diagnosis: SURGERY<br/> <br/> </content> </td> </tr> </tbody> </table> </text> <entry> <act classCode="ACT" moodCode="INT"> <!--Instructions v2.1--> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.20"/> <!--Instructions v1.1--> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <code nullFlavor="UNK" xsi:type="CE"/> <text> <reference value="#inst-acct-1-DIS-ds-General-Visit-Data-1"/> </text> <statusCode code="completed"/> </act> </entry> </section> </component> <!--*********************************************************************** C.CDA Mental Status ***********************************************************************--> <component typeCode="COMP"> <section classCode="DOCSECT" moodCode="EVN" nullFlavor="NI"> <!-- Mental Status section template -->

<!--Mental Status Section Template v2.1--> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.56"/> <!--Mental Status Section Template v1.1--> <templateId root="2.16.840.1.113883.10.20.22.2.56"/> <code code="10190-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Mental Status"/> <title>Mental Status</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Mental Status</th> </tr> </thead> <tbody> <tr> <td> <content>No Mental Status Information<br/> </content> </td> </tr> </tbody> </table> </text> </section> </component> <!--*********************************************************************** C.CDA Reason for Visit ***********************************************************************--> <component typeCode="COMP">

<section classCode="DOCSECT" moodCode="EVN"> <!--Reason For Visit Section Template v2.1--> <templateId root="2.16.840.1.113883.10.20.22.2.12"/> <code code="29299-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Reason For Visit"/> <title>Reason For Visit</title> <text> <table border="1" width="100%"> <thead> <tr> <th colspan="1">Reason for Visit</th> </tr> </thead> <tbody> <tr> <th colspan="1">Visit/Account #D00008389 (May 17, 2023 1:39pm - May 18, 2023 12:00pm)</th> </tr> <tr> <th colspan="1">Reason</th> </tr> <tr> <td> <content>SURGERY<br/> </content> </td> </tr> </tbody> </table>

</text> </section> </component> </structuredBody> </component> </ClinicalDocument>