CCD Sample 4

<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:dt="urn:schemas-microsoft-com:datatypes" xmlns:ms="urn:schemas-microsoft-com:xslt" xmlns:sdtc="urn:hl7-org:sdtc" xmlns:voc="urn:hl7org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7org:v3 http://xreg2.nist.gov:8080/hitspValidation/schema/cdar2c32/infrastructure/cda/C32_CDA.xsd"> <realmCode code="US"/> <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.1.1"/> <templateId root="2.16.840.1.113883.10.20.22.1.1"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.1.2"/> <templateId root="2.16.840.1.113883.10.20.22.1.2"/> <id assigningAuthorityName="Aprima" extension="PRM CDA" root="2ffcd731-0b14-4369-9201fb89a1d812b1"/> <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Summarization of episode note"/> <title>CCD document using C-CDA</title> <effectiveTime value="20230602161715-0500"/> <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/> <languageCode code="en-US"/> <recordTarget> <patientRole> <id extension="2587412" root="2.16.840.1.113883.3.638.1067686"/> <addr use="HP"> <streetAddressLine>239 Upton Walk</streetAddressLine> <city>Lowell</city> <state>MA</state> <postalCode>01852</postalCode> <country>US</country> </addr> <telecom use="HP" value="tel:+1(240)111-0010"/> <telecom use="MC" value="tel:+1(410)111-0100"/>

<telecom value=""/> <patient> <name use="L"> <given>QTF TEST</given> <family>QTFTEST-003</family> </name> <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1" displayName="Female"/> <birthTime value="19730402"/> <maritalStatusCode code="S" codeSystem="2.16.840.1.113883.5.2" displayName="Never Married"/> <raceCode code="2028-9" codeSystem="2.16.840.1.113883.6.238" displayName="White"/> <ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238" displayName="Not Hispanic or Latino"/> <languageCommunication> <languageCode code="en"/> </languageCommunication> </patient> <providerOrganization> <id root="2.16.840.1.113883.3.638.1067686"/> <name>Johnston Family Medicine</name> <telecom use="WP" value="tel:+1(410)751-6684"/> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <streetAddressLine>Suite 100</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157-3008</postalCode> <country>US</country> </addr>

<asOrganizationPartOf> <wholeOrganization> <id root="2.16.840.1.113883.3.638.1067686"/> <name>Johnston Family Medicine</name> </wholeOrganization> </asOrganizationPartOf> </providerOrganization> </patientRole> </recordTarget> <author> <time value="20230602161715-0500"/> <assignedAuthor> <id extension="1912275926" root="2.16.840.1.113883.4.6"/> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom use="WP" value="tel:+1(410)751-6684"/> <assignedPerson> <name> <given>Dennis</given> <family>Vinias</family> </name> </assignedPerson> <representedOrganization> <id root="2.16.840.1.113883.3.638.1067686"/> <name>Johnston Family Medicine</name>

<telecom use="WP" value="tel:+1(410)751-6684"/> </representedOrganization> </assignedAuthor> </author> <custodian> <assignedCustodian> <representedCustodianOrganization> <id root="2.16.840.1.113883.3.638.1067686"/> <name>Johnston Family Medicine. Client ID: 1067686</name> <telecom use="WP" value="tel:+1(410)751-6684"/> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <streetAddressLine>Suite 100</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157-3008</postalCode> <country>US</country> </addr> </representedCustodianOrganization> </assignedCustodian> </custodian> <legalAuthenticator> <time value="20230602"/> <signatureCode code="S"/> <assignedEntity> <id extension="1912275926" root="2.16.840.1.113883.4.6"/> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city>

<state>MD</state> <postalCode>21157</postalCode> </addr> <telecom use="WP" value="tel:+1(410)751-6684"/> <assignedPerson> <name> <given>Dennis</given> <family>Vinias</family> </name> </assignedPerson> </assignedEntity> </legalAuthenticator> <documentationOf> <serviceEvent classCode="PCPR"> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <performer typeCode="PRF"> <templateId root="2.16.840.1.113883.10.20.6.2.1"/> <functionCode code="PP" codeSystem="2.16.840.1.113883.12.443" displayName="Primary Care Provider"> <originalText>Primary Provider</originalText> </functionCode> <time> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </time> <assignedEntity>

<id extension="1699730010" root="2.16.840.1.113883.4.6"/> <code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="ProviderCodes" displayName="Family Practice"/> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name> <given>Renee</given> <family>Orlando-Hart</family> </name> </assignedPerson> <representedOrganization> <id extension="463753120" root="2.16.840.1.113883.4.2"/> <name>Johnston Family Medicine</name> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <streetAddressLine>Suite 100</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157-3008</postalCode> <country>US</country> </addr> </representedOrganization> </assignedEntity>

</performer> <performer typeCode="PRF"> <templateId root="2.16.840.1.113883.10.20.6.2.1"/> <functionCode code="CCM" codeSystem="2.16.840.1.113883.12.443" displayName="Chronic Care Management"> <originalText>Chronic Care Management</originalText> </functionCode> <time> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </time> <assignedEntity> <id nullFlavor="NI"/> <code codeSystem="2.16.840.1.113883.6.101" codeSystemName="ProviderCodes" nullFlavor="UNK"/> <addr nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <assignedPerson> <name/> </assignedPerson> <representedOrganization> <id root="2.16.840.1.113883.3.638.1067686"/> <name>Johnston Family Medicine</name> <addr use="HP"> <streetAddressLine>41 Magna Way</streetAddressLine> <streetAddressLine>Suite 100</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157-3008</postalCode>

<country>US</country> </addr> </representedOrganization> </assignedEntity> </performer> </serviceEvent> </documentationOf> <component> <structuredBody> <component> <section> <templateId root="2.16.840.1.113883.10.20.1.13"/> <code code="48764-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <title>Summary Purpose</title> <text>Interface Exchange</text> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.30"/> <code code="23745001" codeSystem="2.16.840.1.113883.6.96" displayName="Documentation procedure"/> <statusCode code="completed"/> <entryRelationship typeCode="RSON"> <act classCode="ACT" moodCode="EVN"> <code code="308292007" codeSystem="2.16.840.1.113883.6.96" displayName="Transfer of care"/> <statusCode code="completed"/> </act> </entryRelationship> </act>

</entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.18"/> <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment sources"/> <title>Insurance Providers</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Payer name</th> <th>Policy type / Coverage type</th> <th>Covered party ID</th> <th>Effective Begin Date</th> <th>Effective End Date</th> </tr> </thead> <tbody> <tr> <td>Aetna</td> <td>Commercial Insurance</td> <td>W223215594</td> <td>Unknown</td> <td>Unknown</td> </tr> </tbody>

</table> </text> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.60"/> <id root="886d87d9-a687-4457-b891-ca2c8dd59b6c"/> <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment sources"/> <statusCode code="completed"/> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.61"/> <templateId assigningAuthorityName="HITSP C32" root="2.16.840.1.113883.3.88.11.32.5"/> <templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.26"/> <id extension="W223215594" root="90008474-f608-4905-93f1-e4658b782a37"/> <code code="CI" codeSystem="2.16.840.1.113883.6.255.1336" displayName="Commercial Insurance"/> <statusCode code="completed"/> <performer typeCode="PRF"> <templateId root="2.16.840.1.113883.10.20.22.4.87"/> <assignedEntity> <id root="90008474-f608-4905-93f1-e4658b782a37"/> <code code="PAYOR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="RoleCode"/> <addr nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <assignedPerson> <name/>

</assignedPerson> <representedOrganization> <name>Aetna</name> <telecom nullFlavor="UNK"/> <addr nullFlavor="UNK"/> </representedOrganization> </assignedEntity> </performer> <performer typeCode="PRF"> <templateId root="2.16.840.1.113883.10.20.22.4.88"/> <assignedEntity> <id root="90008474-f608-4905-93f1-e4658b782a37"/> <code code="GUAR" codeSystem="2.16.840.1.113883.5.110" codeSystemName="HL7RoleClass"/> <addr nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <assignedPerson> <name/> </assignedPerson> <representedOrganization> <name>Aetna</name> <telecom nullFlavor="UNK"/> <addr nullFlavor="UNK"/> </representedOrganization> </assignedEntity> </performer> <participant typeCode="COV"> <templateId root="2.16.840.1.113883.10.20.22.4.89"/> <time>

<low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </time> <participantRole classCode="PAT"> <id extension="W223215594" root="88f21c75-3338-4c86-be42f765cdbb5867"/> <code code="19" codeSystem="2.16.840.1.113883.5.111" displayName="Child"/> <telecom nullFlavor="UNK"/> <telecom value="mailto:eli.barbe@outlook.com"/> <playingEntity> <name use="L"> <given>ELIJAH</given> <family>BARBE</family> </name> </playingEntity> </participantRole> </participant> <participant typeCode="HLD"> <templateId root="2.16.840.1.113883.10.20.22.4.90"/> <participantRole> <id extension="W223215594" root="2eea1191-746f-4213-a514815b705387d2"/> <addr use="HP"> <streetAddressLine>1485 CARRIAGE HILL DRIVE</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <addr use="HP">

<streetAddressLine>1485 CARRIAGE HILL DRIVE</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom use="MC" value="tel:+1(240)481-6497"/> <telecom value="mailto:chia71179@gmail.com"/> <playingEntity> <name use="L"> <given>MICHELLE</given> <family>BARBE</family> </name> </playingEntity> </participantRole> </participant> <entryRelationship typeCode="REFR"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.19"/> <id root="7b4c63c7-fe13-48ef-81e5-3afc963f3fee"/> <code nullFlavor="NA"/> <entryRelationship typeCode="SUBJ"> <procedure classCode="PROC" moodCode="PRMS"> <code code="73761001" codeSystem="2.16.840.1.113883.6.96" displayName="Child"/> </procedure> </entryRelationship> </act> </entryRelationship> </act>

</entryRelationship> </act> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.15"/> <code code="10157-6" codeSystem="2.16.840.1.113883.6.1"/> <title>Family history</title> <text> <paragraph>Mother</paragraph> <table border="1" width="100%"> <thead> <tr> <th>Diagnosis</th> <th>Age At Onset</th> </tr> </thead> <tbody> <tr> <td>No Known Diseases</td> <td>N/A</td> </tr> </tbody> </table> <paragraph>Paternal Grandmother</paragraph> <table border="1" width="100%"> <thead>

<tr> <th>Diagnosis</th> <th>Age At Onset</th> </tr> </thead> <tbody> <tr> <td>Stroke</td> <td>Unknown</td> </tr> </tbody> </table> <paragraph>Sister</paragraph> <table border="1" width="100%"> <thead> <tr> <th>Diagnosis</th> <th>Age At Onset</th> </tr> </thead> <tbody> <tr> <td>No Known Diseases</td> <td>N/A</td> </tr> </tbody> </table> <paragraph>Father</paragraph> <table border="1" width="100%">

<thead> <tr> <th>Diagnosis</th> <th>Age At Onset</th> </tr> </thead> <tbody> <tr> <td>Asthma</td> <td>Unknown</td> </tr> <tr> <td>Allergies</td> <td>Unknown</td> </tr> </tbody> </table> <paragraph>Paternal Grandfather</paragraph> <table border="1" width="100%"> <thead> <tr> <th>Diagnosis</th> <th>Age At Onset</th> </tr> </thead> <tbody> <tr> <td>Cancer</td> <td>Unknown</td>

</tr> </tbody> </table> </text> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.45"/> <id root="71c182b0-8f68-4755-9579-6a2521d0a4b2"/> <statusCode code="completed"/> <subject> <relatedSubject classCode="PRS"> <code code="72705000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Mother"/> <telecom nullFlavor="UNK"/> <subject> <name/> <administrativeGenderCode code="UN" codeSystem="2.16.840.1.113883.5.1" displayName="Undifferentiated"/> <birthTime nullFlavor="UNK"/> </subject> </relatedSubject> </subject> </organizer> </entry> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.45"/> <id root="9c592634-39ee-4376-8599-759736b4d384"/> <statusCode code="completed"/>

<subject> <relatedSubject classCode="PRS"> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <subject> <name/> <administrativeGenderCode code="UN" codeSystem="2.16.840.1.113883.5.1" displayName="Undifferentiated"/> <birthTime nullFlavor="UNK"/> </subject> </relatedSubject> </subject> <component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.46"/> <id root="ed09d57a-903c-4c48-88df-cc065cabd960"/> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Stroke" nullFlavor="UNK" xsi:type="CD"> <originalText>Stroke</originalText> </value> </observation> </component>

</organizer> </entry> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.45"/> <id root="6d65889c-2b2e-4553-af44-d1b58d1c03a1"/> <statusCode code="completed"/> <subject> <relatedSubject classCode="PRS"> <code code="27733009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Sister"/> <telecom nullFlavor="UNK"/> <subject> <name/> <administrativeGenderCode code="UN" codeSystem="2.16.840.1.113883.5.1" displayName="Undifferentiated"/> <birthTime nullFlavor="UNK"/> </subject> </relatedSubject> </subject> </organizer> </entry> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.45"/> <id root="100d56f5-5049-4f5c-97d0-f76a45b3711a"/> <statusCode code="completed"/> <subject> <relatedSubject classCode="PRS">

<code code="66839005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Father"/> <telecom nullFlavor="UNK"/> <subject> <name/> <administrativeGenderCode code="UN" codeSystem="2.16.840.1.113883.5.1" displayName="Undifferentiated"/> <birthTime nullFlavor="UNK"/> </subject> </relatedSubject> </subject> <component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.46"/> <id root="a79cf259-6e5e-445d-ad35-61dfee84b606"/> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Asthma" nullFlavor="UNK" xsi:type="CD"> <originalText>Asthma</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.22.4.46"/> <id root="cccfe985-7023-4d33-83ac-8365b0c043d2"/> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Allergies" nullFlavor="UNK" xsi:type="CD"> <originalText>Allergies</originalText> </value> </observation> </component> </organizer> </entry> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.45"/> <id root="17689467-ce04-4c88-af07-f8db6b6c1745"/> <statusCode code="completed"/> <subject> <relatedSubject classCode="PRS"> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="UNK"/> <telecom nullFlavor="UNK"/> <subject> <name/>

<administrativeGenderCode code="UN" codeSystem="2.16.840.1.113883.5.1" displayName="Undifferentiated"/> <birthTime nullFlavor="UNK"/> </subject> </relatedSubject> </subject> <component> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.46"/> <id root="64be1eb3-a6a5-40b6-ac60-c1ec11cd5d6a"/> <code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Problem"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Cancer" nullFlavor="UNK" xsi:type="CD"> <originalText>Cancer</originalText> </value> </observation> </component> </organizer> </entry> </section> </component> <component> <section> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.17"/>

<templateId root="2.16.840.1.113883.10.20.22.2.17"/> <code code="29762-2" codeSystem="2.16.840.1.113883.6.1"/> <title>Social History</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Social History Element</th> <th>Codes</th> <th>Description</th> <th>Effective Dates</th> </tr> </thead> <tbody> <tr> <td>Marital status</td> <td>Unknown</td> <td>Single</td> <td>06/01/2023</td> </tr> <tr> <td>Education level</td> <td>Unknown</td> <td>Grade School</td> <td>06/01/2023</td> </tr> <tr> <td>Employment</td> <td>Unknown</td>

<td>Student</td> <td>06/01/2023</td> </tr> <tr> <td>Tobacco history</td> <td>SNOMED CT: 266919005</td> <td>Never smoker</td> <td>06/01/2023</td> </tr> <tr> <td>Alcohol history</td> <td>SNOMED CT: 105542008</td> <td>Never drinks alcohol</td> <td>06/01/2023</td> </tr> <tr> <td>Has the patient ever used illegal drugs?</td> <td>Unknown</td> <td>Has never used illegal drugs</td> <td>06/01/2023</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.38"/> <id root="0e06c147-4dce-4d79-82f4-0a3cc9fbd92f"/>

<code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Marital status" nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime value="20230601"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Single" nullFlavor="UNK" xsi:type="CD"> <originalText>Single</originalText> </value> </observation> </entry> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.38"/> <id root="e889268d-9a9d-4361-98e6-8a63fd4ef390"/> <code code="105421008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Education level"/> <statusCode code="completed"/> <effectiveTime value="20230601"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Grade School" nullFlavor="UNK" xsi:type="CD"> <originalText>Grade School</originalText> </value> </observation> </entry> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.38"/> <id root="ddf3690c-eb5c-416f-b520-a25dcbd711d2"/> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Employment" nullFlavor="UNK"/>

<statusCode code="completed"/> <effectiveTime value="20230601"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Student" nullFlavor="UNK" xsi:type="CD"> <originalText>Student</originalText> </value> </observation> </entry> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.78"/> <id root="f08bbaf3-ffed-4567-bf84-a763fa7b1109"/> <code code="72166-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <statusCode code="completed"/> <effectiveTime value="20230601"/> <value code="266919005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Never smoker" xsi:type="CD"> <originalText>Never smoker</originalText> </value> </observation> </entry> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.38"/> <id root="3805601a-3bf3-49a2-af1c-64f0b2937552"/> <code code="160573003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Alcohol history"/> <statusCode code="completed"/> <effectiveTime value="20230601"/>

<value code="105542008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Alcohol history" xsi:type="CD"> <originalText>Never drinks alcohol</originalText> </value> </observation> </entry> <entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.38"/> <id root="9945273f-2caa-4765-9f3b-418bb3d3f508"/> <code code="363908000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Has the patient ever used illegal drugs?"/> <statusCode code="completed"/> <effectiveTime value="20230601"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Has never used illegal drugs" nullFlavor="UNK" xsi:type="CD"> <originalText>Has never used illegal drugs</originalText> </value> </observation> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.6"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.6.1"/> <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"/> <title>Allergies, Adverse Reactions, Alerts</title> <text>

<table border="1" width="100%"> <thead> <tr> <th>Substance</th> <th>Reaction</th> <th>Codes</th> <th>Entered Date</th> <th>Inactivated Date</th> <th>Status</th> </tr> </thead> <tbody> <tr> <td> <content ID="substance1">* NO KNOWN DRUG ALLERGIES</content> </td> <td/> <td>Unknown</td> <td>06/01/2023</td> <td>No Inactive Date</td> <td>Active</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.30"/> <templateId root="2.16.840.1.113883.10.20.22.4.30"/>

<id root="ff075d96-1d67-4452-877e-131a06e202b0"/> <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20230601"/> <high nullFlavor="UNK"/> </effectiveTime> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.7"/> <templateId root="2.16.840.1.113883.10.20.22.4.7"/> <id root="ff075d96-1d67-4452-877e-131a06e202b0"/> <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20230601"/> <high nullFlavor="UNK"/> </effectiveTime> <value code="416098002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Drug Allergy" xsi:type="CD"/> <participant typeCode="CSM"> <participantRole classCode="MANU"> <playingEntity classCode="MMAT"> <code displayName="* NO KNOWN DRUG ALLERGIES" nullFlavor="UNK"> <originalText> <reference value="#substance1"/>* NO KNOWN DRUG ALLERGIES</originalText> </code>

<name>* NO KNOWN DRUG ALLERGIES</name> </playingEntity> </participantRole> </participant> <entryRelationship inversionInd="true" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.28"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" displayName="Status"/> <statusCode code="completed"/> <value code="55561003" codeSystem="2.16.840.1.113883.6.96" displayName="Active" xsi:type="CE"/> </observation> </entryRelationship> </observation> </entryRelationship> </act> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.5"/> <templateId extension="2015-08-01" 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"/> <code code="11450-4" codeSystem="2.16.840.1.113883.6.1"/> <title>Problems</title> <text> <table border="1" width="100%">

<thead> <tr> <th>Condition</th> <th>Codes</th> <th>Effective Dates</th> <th>Condition Status</th> </tr> </thead> <tbody> <tr> <td> <content ID="Condition1">Well child examination</content> </td> <td>ICD-10: Z00.129<br/>ICD-9: V20.2</td> <td>06/02/2023</td> <td>Active</td> </tr> <tr> <td> <content ID="Condition2">Encounter for screening for other disorder</content> </td> <td>ICD-10: Z13.89<br/>ICD-9: V79.1</td> <td>05/12/2022</td> <td>Active</td> </tr> <tr> <td> <content ID="Condition3">Unspecified asthma, uncomplicated</content> </td>

<td>ICD-10: J45.909<br/>ICD-9: 493.90</td> <td>01/04/2017</td> <td>Active</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.3"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.3"/> <templateId root="2.16.840.1.113883.10.20.22.2.5"/> <id root="ffb26569-1efc-45b2-8bf1-66893cb50c7b"/> <code nullFlavor="NA"/> <statusCode code="active"/> <effectiveTime xsi:type="IVL_TS"> <low value="20230602"/> </effectiveTime> <entryRelationship inversionInd="false" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <id root="ffb26569-1efc-45b2-8bf1-66893cb50c7b"/> <code code="64572001" codeSystem="2.16.840.1.113883.6.96" displayName="Disorder"> <translation code="75323-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Condition"/> </code> <text>

<reference value="#Condition1"/>Well child examination</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20230602"/> </effectiveTime> <value code="Z00.129" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10" displayName="Well child examination" xsi:type="CD"> <translation code="V20.2" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9" displayName="Well child examination"/> </value> </observation> </entryRelationship> </act> </entry> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.3"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.3"/> <templateId root="2.16.840.1.113883.10.20.22.2.5"/> <id root="d83c4001-de15-4ae5-8b8f-f42cdfd69eef"/> <code nullFlavor="NA"/> <statusCode code="active"/> <effectiveTime xsi:type="IVL_TS"> <low value="20220512"/> </effectiveTime> <entryRelationship inversionInd="false" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/>

<id root="d83c4001-de15-4ae5-8b8f-f42cdfd69eef"/> <code code="64572001" codeSystem="2.16.840.1.113883.6.96" displayName="Disorder"> <translation code="75323-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Condition"/> </code> <text> <reference value="#Condition2"/>Encounter for screening for other disorder</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20220512"/> </effectiveTime> <value code="Z13.89" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10" displayName="Encounter for screening for other disorder" xsi:type="CD"> <translation code="V79.1" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9" displayName="Encounter for screening for other disorder"/> </value> </observation> </entryRelationship> </act> </entry> <entry typeCode="DRIV"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.3"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.3"/> <templateId root="2.16.840.1.113883.10.20.22.2.5"/> <id root="3d31a359-2089-459a-8e39-d6f896274f22"/> <code nullFlavor="NA"/> <statusCode code="active"/>

<effectiveTime xsi:type="IVL_TS"> <low value="20170104"/> </effectiveTime> <entryRelationship inversionInd="false" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN" negationInd="false"> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <id root="3d31a359-2089-459a-8e39-d6f896274f22"/> <code code="64572001" codeSystem="2.16.840.1.113883.6.96" displayName="Disorder"> <translation code="75323-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Condition"/> </code> <text> <reference value="#Condition3"/>Unspecified asthma, uncomplicated</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20170104"/> </effectiveTime> <value code="J45.909" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10" displayName="Unspecified asthma, uncomplicated" xsi:type="CD"> <translation code="493.90" codeSystem="2.16.840.1.113883.6.103" codeSystemName="ICD-9" displayName="Unspecified asthma, uncomplicated"/> </value> </observation> </entryRelationship> </act> </entry> </section> </component>

<component> <section> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.1.1"/> <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"/> <title>Medications</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Medication</th> <th>Codes</th> <th>Instructions</th> <th>Start Date</th> <th>Stop Date</th> <th>Status</th> <th>Fill Instructions</th> </tr> </thead> <tbody> <tr> <td> <content ID="med1">Ventolin HFA 90 mcg/actuation aerosol inhaler</content> </td> <td>RxNorm: </td> <td>0</td> <td>05/12/2022</td> <td>No Stop Date</td>

<td>Active</td> <td/> </tr> <tr> <td> <content ID="med2">amoxicillin 500 mg capsule</content> </td> <td>RxNorm: </td> <td>0</td> <td>11/02/2021</td> <td>05/12/2022</td> <td>Inactive</td> <td/> </tr> <tr> <td> <content ID="med3">penicillin V potassium 250 mg tablet</content> </td> <td>RxNorm: </td> <td>0</td> <td>04/28/2021</td> <td>11/02/2021</td> <td>Inactive</td> <td/> </tr> <tr> <td> <content ID="med4">Medrol 4 mg tablet</content> </td>

<td>RxNorm: </td> <td>0</td> <td>12/04/2019</td> <td>03/10/2020</td> <td>Inactive</td> <td/> </tr> <tr> <td> <content ID="med5">amoxicillin 250 mg chewable tablet</content> </td> <td>RxNorm: </td> <td>2 PO 10</td> <td>07/19/2016</td> <td>07/29/2016</td> <td>Inactive</td> <td/> </tr> <tr> <td> <content ID="med6">penicillin V potassium 250 mg/5 mL oral solution</content> </td> <td>RxNorm: </td> <td>10 ml PO 10</td> <td>01/21/2016</td> <td>01/31/2016</td> <td>Inactive</td> <td/> </tr>

<tr> <td> <content ID="med7">Allegra Allergy 180 mg tablet</content> </td> <td>RxNorm: 997422</td> <td>oral</td> <td>06/02/2023</td> <td/> <td>Active</td> <td/> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="1e670c9b-2cdb-4fc5-8e51-9836267ed47a"/> <text> <reference value="#med1"/>Ventolin HFA 90 mcg/actuation aerosol inhaler 0</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20220512"/> <high nullFlavor="UNK"/> </effectiveTime> <routeCode nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable>

<manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>Ventolin HFA 90 mcg/actuation aerosol inhaler</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value code="55561003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Active" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <high nullFlavor="UNK"/> </effectiveTime>

<repeatNumber value="1"/> <quantity nullFlavor="UNK"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="076fb2d7-1f62-415c-a10b-5b228c96f1cc"/> <text> <reference value="#med2"/>amoxicillin 500 mg capsule 0</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20211102"/> <high value="20220512"/> </effectiveTime> <routeCode nullFlavor="NA"/>

<doseQuantity nullFlavor="NA"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>amoxicillin 500 mg capsule</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20211102000000"/> <assignedAuthor> <id extension="1912275926" root="2.16.840.1.113883.4.6"/> <addr> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom value="tel:+1(410)751-6684"/> <assignedPerson> <name> <family>Vinias</family> <given>Dennis</given> </name> </assignedPerson> </assignedAuthor>

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<code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="4b39e814-b24f-4d2b-b6c4-6d9bab29001b"/> <text> <reference value="#med3"/>penicillin V potassium 250 mg tablet 0</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20210428"/> <high value="20211102"/> </effectiveTime> <routeCode nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>penicillin V potassium 250 mg tablet</name>

</manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20210428000000"/> <assignedAuthor> <id extension="1699730010" root="2.16.840.1.113883.4.6"/> <addr> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom value="tel:+1(410)751-6684"/> <assignedPerson> <name> <family>Orlando-Hart</family> <given>Renee</given> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/>

<value code="73425007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Inactive" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <width unit="d" value="0"/> <high value="20211102"/> </effectiveTime> <repeatNumber value="1"/> <quantity value="21"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration>

</entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="f76de280-3b32-497c-b5de-b66553d84ba9"/> <text> <reference value="#med4"/>Medrol 4 mg tablet 0</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20191204"/> <high value="20200310"/> </effectiveTime> <routeCode nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>Medrol 4 mg tablet</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20191204000000"/> <assignedAuthor> <id extension="1699730010" root="2.16.840.1.113883.4.6"/>

<addr> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom value="tel:+1(410)751-6684"/> <assignedPerson> <name> <family>Orlando-Hart</family> <given>Renee</given> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value code="73425007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Inactive" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/>

<templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <width unit="d" value="0"/> <high value="20200310"/> </effectiveTime> <repeatNumber value="1"/> <quantity value="20"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="ac8e4bed-491f-4ab8-aedb-66ec8a176309"/> <text>

<reference value="#med5"/>amoxicillin 250 mg chewable tablet 2 PO 10</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20160719"/> <high value="20160729"/> </effectiveTime> <routeCode nullFlavor="NA"/> <doseQuantity value="2"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>amoxicillin 250 mg chewable tablet</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20160719000000"/> <assignedAuthor> <id extension="1699730010" root="2.16.840.1.113883.4.6"/> <addr> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom value="tel:+1(410)751-6684"/>

<assignedPerson> <name> <family>Orlando-Hart</family> <given>Renee</given> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value code="73425007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Inactive" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <width unit="d" value="10"/> <high value="20160729"/> </effectiveTime>

<repeatNumber value="1"/> <quantity value="40"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="953c7876-b818-47de-a32c-acf76e57ee36"/> <text> <reference value="#med6"/>penicillin V potassium 250 mg/5 mL oral solution 10 ml PO 10</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20160121"/> <high value="20160131"/> </effectiveTime>

<routeCode nullFlavor="NA"/> <doseQuantity value="10"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> <name>penicillin V potassium 250 mg/5 mL oral solution</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20160121000000"/> <assignedAuthor> <id extension="1699730010" root="2.16.840.1.113883.4.6"/> <addr> <streetAddressLine>41 Magna Way</streetAddressLine> <city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> </addr> <telecom value="tel:+1(410)751-6684"/> <assignedPerson> <name> <family>Orlando-Hart</family> <given>Renee</given> </name> </assignedPerson>

</assignedAuthor> </author> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value code="73425007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Inactive" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <width unit="d" value="10"/> <high value="20160131"/> </effectiveTime> <repeatNumber value="1"/> <quantity value="200"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/>

<manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.16"/> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="8cbbbfb0-4ffc-4960-872c-007d4d1c6076"/> <text> <reference value="#med7"/>Allegra Allergy 180 mg tablet oral</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20230602"/> <high nullFlavor="UNK"/> </effectiveTime> <routeCode nullFlavor="NA"/> <doseQuantity nullFlavor="NA"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial>

<code code="997422" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Allegra Allergy 180 mg tablet"> <originalText>Allegra Allergy 180 mg tablet<reference value="#med7"/> </originalText> </code> <name>Allegra Allergy 180 mg tablet</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.57"/> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value code="55561003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Active" xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.17"/> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="NI"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <high nullFlavor="UNK"/> </effectiveTime> <repeatNumber nullFlavor="UNK"/>

<quantity nullFlavor="UNK"/> <product> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.23"/> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="997422" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Allegra Allergy 180 mg tablet"> <originalText>Allegra Allergy 180 mg tablet<reference value="#med7"/> </originalText> </code> </manufacturedMaterial> </manufacturedProduct> </product> </supply> </entryRelationship> </substanceAdministration> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.38"/> <code code="29549-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medications Administered"/> <title>Medication Administered</title> <text>No Medication Administered data</text> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="INT">

<templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id root="E1877938-07EC-414D-A492-07CFEDCF7E50"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <routeCode nullFlavor="NA"/> <approachSiteCode nullFlavor="NA"/> <consumable> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code nullFlavor="NA"/> </manufacturedMaterial> </manufacturedProduct> </consumable> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.47"/> <code nullFlavor="NA"/> <value xsi:type="CE"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId assigningAuthorityName="CCD" root="2.16.840.1.113883.10.20.1.34"/>

<templateId assigningAuthorityName="HITSP/C32" root="2.16.840.1.113883.3.88.11.32.11"/> <id nullFlavor="NA"/> <code nullFlavor="NA"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low nullFlavor="UNK"/> </effectiveTime> </supply> </entryRelationship> </substanceAdministration> </entry> </section> </component> <component> <section> <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"/> <title>Immunizations</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Vaccine</th> <th>Codes</th> <th>Dose</th> <th>Date</th> <th>Status</th> </tr>

</thead> <tbody> <tr> <td>HPV

</td>

<td>CVX: 137</td> <td/> <td>01/18/2021</td> <td/> </tr> <tr> <td>HPV

</td>

<td>CVX: 137</td> <td/> <td>09/17/2020</td> <td/> </tr> <tr> <td>HEPA

</td>

<td>CVX: 83</td> <td/> <td>03/10/2020</td> <td/> </tr> <tr> <td>HPV

</td>

<td>CVX: 137</td> <td/> <td>03/10/2020</td> <td/>

</tr> <tr> <td>HEPA

</td>

<td>CVX: 83</td> <td/> <td>02/19/2019</td> <td/> </tr> <tr> <td>MCV4

</td>

<td>CVX: 114</td> <td/> <td>02/19/2019</td> <td/> </tr> <tr> <td>TDAP

</td>

<td>CVX: 115</td> <td/> <td>02/19/2019</td> <td/> </tr> <tr> <td>VARICELLA

</td>

<td>Unknown</td> <td/> <td>02/19/2013</td> <td/> </tr>

<tr> <td>DTAP

</td>

<td>CVX: 20</td> <td/> <td>02/23/2012</td> <td/> </tr> <tr> <td>IPV

</td>

<td>CVX: 10</td> <td/> <td>02/23/2012</td> <td/> </tr> <tr> <td>MMR

</td>

<td>CVX: 03</td> <td/> <td>02/23/2012</td> <td/> </tr> <tr> <td>DTAP

</td>

<td>CVX: 20</td> <td/> <td>05/18/2009</td> <td/> </tr> <tr>

<td>HIB

</td>

<td>CVX: 49</td> <td/> <td>05/18/2009</td> <td/> </tr> <tr> <td>IPV

</td>

<td>CVX: 10</td> <td/> <td>05/18/2009</td> <td/> </tr> <tr> <td>MMR

</td>

<td>CVX: 03</td> <td/> <td>02/20/2009</td> <td/> </tr> <tr> <td>PREVNAR

</td>

<td>Unknown</td> <td/> <td>02/20/2009</td> <td/> </tr> <tr> <td>VARICELLA

</td>

<td>Unknown</td> <td/> <td>02/20/2009</td> <td/> </tr> <tr> <td>DTAP

</td>

<td>CVX: 20</td> <td/> <td>08/15/2008</td> <td/> </tr> <tr> <td>HEPBVACCIN

</td>

<td>Unknown</td> <td/> <td>08/15/2008</td> <td/> </tr> <tr> <td>HIB

</td>

<td>CVX: 49</td> <td/> <td>08/15/2008</td> <td/> </tr> <tr> <td>PREVNAR <td>Unknown</td>

</td>

<td/> <td>08/15/2008</td> <td/> </tr> <tr> <td>DTAP

</td>

<td>CVX: 20</td> <td/> <td>06/13/2008</td> <td/> </tr> <tr> <td>HIB

</td>

<td>CVX: 49</td> <td/> <td>06/13/2008</td> <td/> </tr> <tr> <td>IPV

</td>

<td>CVX: 10</td> <td/> <td>06/13/2008</td> <td/> </tr> <tr> <td>PREVNAR <td>Unknown</td> <td/>

</td>

<td>06/13/2008</td> <td/> </tr> <tr> <td>DTAP

</td>

<td>CVX: 20</td> <td/> <td>04/15/2008</td> <td/> </tr> <tr> <td>HIB

</td>

<td>CVX: 49</td> <td/> <td>04/15/2008</td> <td/> </tr> <tr> <td>IPV

</td>

<td>CVX: 10</td> <td/> <td>04/15/2008</td> <td/> </tr> <tr> <td>PREVNAR

</td>

<td>Unknown</td> <td/> <td>04/15/2008</td>

<td/> </tr> <tr> <td>HEPBVACCIN

</td>

<td>Unknown</td> <td/> <td>03/12/2008</td> <td/> </tr> <tr> <td>HEPBVACCIN

</td>

<td>Unknown</td> <td/> <td>02/12/2008</td> <td/> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="b21c7985-8747-4814-8aa1-2753db877c28"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20210118"/> </effectiveTime> <consumable>

<manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="137" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="HPV"> <originalText>HPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="03a1edb7-d4fd-4fda-9879-aadc6a78d69b"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20200917"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="137" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="HPV">

<originalText>HPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="7da9e4b6-c352-4fcc-a6a0-a796aacd05dd"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20200310"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="83" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hep A, ped/adol, 2 dose"> <originalText>HEPA </code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration>

</originalText>

</entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="e93f2291-9e93-436f-b04a-0fffc7631aa7"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20200310"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="137" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="HPV"> <originalText>HPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="f767f5bc-926f-4ea8-beb0-d9ecaa96d03f"/>

<statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20190219"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="83" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hep A, ped/adol, 2 dose"> <originalText>HEPA

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="28f3530b-2e0f-46a9-8223-7492c39952ff"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20190219"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU">

<templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="114" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Meningococcal MCV4P"> <originalText>MCV4

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="2f1d05f1-4c0f-4521-be98-ab52fe335a8e"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20190219"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="115" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Tdap"> <originalText>TDAP

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="5fd3f7d2-8679-4f43-83a9-f062217040de"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20130219"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="VARICELLA

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/>

<templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="dd34c4c6-3754-4683-be80-417664f3647b"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20120223"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="20" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="DTaP"> <originalText>DTAP

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="237ff937-38c0-49aa-b0f7-fd1721f6536e"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20120223"/> </effectiveTime>

<consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="10" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="IPV"> <originalText>IPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="662ada8b-b0f2-4b6d-a096-d5fcc82cd55c"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20120223"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial>

<code code="03" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="MMR"> <originalText>MMR

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="267d32d9-088b-4e9a-9781-128dc509a4c8"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090518"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="20" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="DTaP"> <originalText>DTAP </code> </manufacturedMaterial> </manufacturedProduct>

</originalText>

</consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="60563202-157b-47b8-a0ea-20d032c71e4e"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090518"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="49" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hib (PRP-OMP)"> <originalText>HIB

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/>

<templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="1a742e42-e54c-4306-be3e-c8d08877eb02"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090518"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="10" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="IPV"> <originalText>IPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="68a9466d-e23e-4f7f-874f-94c5d45191ab"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090220"/> </effectiveTime>

<consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="03" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="MMR"> <originalText>MMR

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="1890a924-fc01-4fca-b83a-e9be15a55b01"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090220"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="PREVNAR

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="72e4e00f-5011-4d59-a633-d681c31a9b51"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090220"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="VARICELLA

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/>

<id root="f188860d-d891-497a-94f5-e666656fb8f7"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080815"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="20" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="DTaP"> <originalText>DTAP

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="63630be7-d417-4299-a433-483cd902a457"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080815"/> </effectiveTime> <consumable>

<manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="HEPBVACCIN

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="ed6a341f-573f-4a22-be72-7173527b1665"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080815"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="49" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hib (PRP-OMP)"> <originalText>HIB </code> </manufacturedMaterial>

</originalText>

</manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="f9bc590c-917d-410d-a35d-728047d575f8"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080815"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="PREVNAR

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="584625a6-d90c-45e9-ab57-e11ae652ecba"/>

<statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080613"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="20" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="DTaP"> <originalText>DTAP

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="a00762b9-1fcf-4f82-b312-3bd5cc30f0cc"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080613"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU">

<templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="49" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hib (PRP-OMP)"> <originalText>HIB

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="a0331d21-dd73-495a-a64c-ca2012002bf2"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080613"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="10" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="IPV"> <originalText>IPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="6fdcbe48-f0bf-4079-ad0b-5e440589eadb"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080613"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="PREVNAR

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/>

<templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="236f1fb2-6708-4196-8604-3ad405e5491d"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080415"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="20" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="DTaP"> <originalText>DTAP

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="69be2214-f02b-463d-9d69-27f3744cb203"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080415"/> </effectiveTime>

<consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code code="49" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="Hib (PRP-OMP)"> <originalText>HIB

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="6fc2e0ce-1c1b-4344-b800-bebd9eb79b39"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080415"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial>

<code code="10" codeSystem="2.16.840.1.113883.12.292" codeSystemName="CVX" displayName="IPV"> <originalText>IPV

</originalText>

</code> </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="f8102439-0a09-47a8-a6b7-a7192953e9b1"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080415"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="PREVNAR </manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry>

" nullFlavor="UNK"/>

<entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="c5940dec-83cf-4e47-bf5b-b874ba4b256c"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080312"/> </effectiveTime> <consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="HEPBVACCIN

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> <entry typeCode="DRIV"> <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.52"/> <templateId root="2.16.840.1.113883.10.20.22.4.52"/> <id root="5966c2b0-d1aa-45ab-a954-7c64c7d0ac65"/> <statusCode code="normal"/> <effectiveTime xsi:type="IVL_TS"> <low value="20080212"/> </effectiveTime>

<consumable> <manufacturedProduct classCode="MANU"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.54"/> <templateId root="2.16.840.1.113883.10.20.22.4.54"/> <manufacturedMaterial> <code displayName="HEPBVACCIN

" nullFlavor="UNK"/>

</manufacturedMaterial> </manufacturedProduct> </consumable> </substanceAdministration> </entry> </section> </component> <component> <section> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.3.1"/> <templateId root="2.16.840.1.113883.10.20.22.2.3.1"/> <templateId root="2.16.840.1.113883.10.20.22.2.3"/> <code code="30954-2" codeSystem="2.16.840.1.113883.6.1" displayName="STUDIES SUMMARY"/> <title>Results</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Observation</th> <th>Observation Code</th> <th>Item</th> <th>Item Code</th>

<th>Result</th> <th>Date</th> <th>Service Location</th> </tr> </thead> <tbody> <tr> <td>AUDIT-C</td> <td/> <td>How often do you have a drink containing alcohol</td> <td>68518-0</td> <td>Never </td> <td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>AUDIT-C</td> <td/> <td>How many standard drinks containing alcohol do you have on a typical day?</td> <td>68519-8</td> <td>N/A </td> <td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>AUDIT-C</td> <td/> <td>How often do you have 6 or more drinks on 1 occasion</td>

<td>68520-6</td> <td>Never </td> <td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>AUDIT-C</td> <td/> <td>Total Score</td> <td/> <td>0 </td> <td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>Patient Health Questionnaire (PHQ2)</td> <td/> <td>Little interest or pleasure in doing things</td> <td>44250-9</td> <td>0 </td> <td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>Patient Health Questionnaire (PHQ2)</td> <td/> <td>Feeling down, depressed, or hopeless</td> <td>44255-8</td> <td>0 </td>

<td>06/02/2023</td> <td>Unknown</td> </tr> <tr> <td>Patient Health Questionnaire (PHQ2)</td> <td/> <td>Total Score</td> <td/> <td>0 </td> <td>06/02/2023</td> <td>Unknown</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <organizer classCode="BATTERY" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.1"/> <templateId root="2.16.840.1.113883.10.20.22.4.1"/> <id root="00000000-1111-0000-0000-000000000005"/> <code displayName="AUDIT-C" nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <component> <procedure classCode="PROC" moodCode="EVN"> <id root="00000000-1111-0000-0000-000000000005"/>

<code displayName="AUDIT-C" nullFlavor="UNK"> <originalText>AUDIT-C</originalText> </code> <text>AUDIT-C</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> </procedure> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0001-000000000005"/> <code code="68518-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="How often do you have a drink containing alcohol"/> <text>How often do you have a drink containing alcohol</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>Never</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0002-000000000005"/>

<code code="68519-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="How many standard drinks containing alcohol do you have on a typical day?"/> <text>How many standard drinks containing alcohol do you have on a typical day?</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>N/A</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0003-000000000005"/> <code code="68520-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="How often do you have 6 or more drinks on 1 occasion"/> <text>How often do you have 6 or more drinks on 1 occasion</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>Never</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN">

<templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0005-000000000001"/> <code displayName="Total Score" nullFlavor="UNK"/> <text>Total Score</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>0</originalText> </value> </observation> </component> </organizer> </entry> <entry typeCode="DRIV"> <organizer classCode="BATTERY" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.1"/> <templateId root="2.16.840.1.113883.10.20.22.4.1"/> <id root="00000000-1111-0000-0000-000000000003"/> <code displayName="Patient Health Questionnaire (PHQ2)" nullFlavor="UNK"/> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <component> <procedure classCode="PROC" moodCode="EVN"> <id root="00000000-1111-0000-0000-000000000003"/>

<code displayName="Patient Health Questionnaire (PHQ2)" nullFlavor="UNK"> <originalText>Patient Health Questionnaire (PHQ2)</originalText> </code> <text>Patient Health Questionnaire (PHQ2)</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> </procedure> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0001-000000000004"/> <code code="44250-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Little interest or pleasure in doing things"/> <text>Little interest or pleasure in doing things</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>0</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0002-000000000004"/>

<code code="44255-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Feeling down, depressed, or hopeless"/> <text>Feeling down, depressed, or hopeless</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>0</originalText> </value> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.2"/> <templateId root="2.16.840.1.113883.10.20.22.4.2"/> <id root="00000000-1111-0000-0005-000000000001"/> <code displayName="Total Score" nullFlavor="UNK"/> <text>Total Score</text> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH" xsi:type="CD"> <originalText>0</originalText> </value> </observation> </component> </organizer> </entry> </section> </component>

<component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.7.1"/> <templateId root="2.16.840.1.113883.10.20.22.2.7"/> <code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of Procedures"/> <title>Procedures</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Procedure</th> <th>Codes</th> <th>Date</th> </tr> </thead> <tbody> <tr> <td> <content ID="Procedure1">Eye Chart- Visual Acuity Screen<br/>Left Eye/20/20 uncorrected, Both Eyes/20/20 uncorrected, Right Eye/20/20 uncorrected</content> </td> <td>CPT-4: 99173Unknown</td> <td>06/02/2023</td> </tr> <tr> <td> <content ID="Procedure2">URINALYSIS AUTO W/O SCOPE</content> </td>

<td>CPT-4: 81003</td> <td>06/02/2023</td> </tr> <tr> <td> <content ID="Procedure3">Negative Adult Depression Screening Performed</content> </td> <td>SNOMED CT: 428171000124102<br/>CPT-4: NegAdult</td> <td>06/02/2023</td> </tr> <tr> <td> <content ID="Procedure4">Negative Child Depression Screening Performed</content> </td> <td>SNOMED CT: 428171000124102<br/>CPT-4: NegChild</td> <td>06/02/2023</td> </tr> <tr> <td> <content ID="Procedure5">Audiogram<br/>Right Ear/40 db 500/Yes, Left Ear/40 db 2000/Yes, Left Ear/40 db 1000/Yes, Left Ear/20 db 500/Yes, Right Ear/40 db 1000/Yes, Left Ear/20 db 1000/Yes, Left Ear/20 db 4000/Yes, Left Ear/25 db 2000/Yes, Right Ear/25 db 2000/Yes, Right Ear/40 db 2000/Yes, Right Ear/20 db 4000/Yes, Right Ear/20 db 500/Yes, Left Ear/25 db 4000/Yes, Right Ear/25 db 1000/Yes, Right Ear/20 db 1000/Yes, Right Ear/25 db 4000/Yes, Left Ear/25 db 1000/Yes, Right Ear/40 db 4000/Yes, Left Ear/40 db 4000/Yes, Left Ear/40 db 500/Yes, Left Ear/25 db 500/Yes, Right Ear/25 db 500/Yes, Left Ear/20 db 2000/Yes, Right Ear/20 db 2000/Yes</content> </td> <td>CPT-4: 92587Unknown</td> <td>06/02/2023</td> </tr>

</tbody> </table> </text> <entry typeCode="DRIV"> <procedure classCode="PROC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id root="a020d6b2-89c2-4f23-86f7-3d9881b194be"/> <code code="99173" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="Eye Chart- Visual Acuity Screen"> <originalText>Eye Chart- Visual Acuity Screen</originalText> </code> <text> <reference value="#Procedure1"/>Eye Chart- Visual Acuity Screen Additional Information:Left Eye/20/20 uncorrected, Both Eyes/20/20 uncorrected, Right Eye/20/20 uncorrected</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <targetSiteCode displayName="Left Eye/20/20 uncorrected, Both Eyes/20/20 uncorrected, Right Eye/20/20 uncorrected" nullFlavor="UNK"> <originalText>Left Eye/20/20 uncorrected, Both Eyes/20/20 uncorrected, Right Eye/20/20 uncorrected</originalText> </targetSiteCode> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.40"/> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/> <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>

<text> <reference value="#Procedure1"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </procedure> </entry> <entry typeCode="DRIV"> <procedure classCode="PROC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id root="61c9beb2-838d-4875-9351-d24ba6ba4cb9"/> <code code="81003" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="URINALYSIS AUTO W/O SCOPE"> <originalText>URINALYSIS AUTO W/O SCOPE</originalText> </code> <text> <reference value="#Procedure2"/>URINALYSIS AUTO W/O SCOPE Additional Information:</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.40"/> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/> <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>

<text> <reference value="#Procedure2"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </procedure> </entry> <entry typeCode="DRIV"> <procedure classCode="PROC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id root="2c80fcfc-c4b8-4921-9334-6e1ae5da2f14"/> <code code="428171000124102" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Negative Adult Depression Screening Performed"> <originalText>Negative Adult Depression Screening Performed</originalText> <translation code="NegAdult" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="Negative Adult Depression Screening Performed"/> </code> <text> <reference value="#Procedure3"/>Negative Adult Depression Screening Performed Additional Information:</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.40"/> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/>

<code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/> <text> <reference value="#Procedure3"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </procedure> </entry> <entry typeCode="DRIV"> <procedure classCode="PROC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id root="5fca4683-f2e6-4e87-a72b-b05c9434a385"/> <code code="428171000124102" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Negative Child Depression Screening Performed"> <originalText>Negative Child Depression Screening Performed</originalText> <translation code="NegChild" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="Negative Child Depression Screening Performed"/> </code> <text> <reference value="#Procedure4"/>Negative Child Depression Screening Performed Additional Information:</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/> </effectiveTime> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN">

<templateId root="2.16.840.1.113883.10.20.1.40"/> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/> <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/> <text> <reference value="#Procedure4"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </procedure> </entry> <entry typeCode="DRIV"> <procedure classCode="PROC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id root="5c7921ce-cf2d-4785-ac9f-b1c9952c865d"/> <code code="92587" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" displayName="Audiogram"> <originalText>Audiogram</originalText> </code> <text> <reference value="#Procedure5"/>Audiogram Additional Information:Right Ear/40 db 500/Yes, Left Ear/40 db 2000/Yes, Left Ear/40 db 1000/Yes, Left Ear/20 db 500/Yes, Right Ear/40 db 1000/Yes, Left Ear/20 db 1000/Yes, Left Ear/20 db 4000/Yes, Left Ear/25 db 2000/Yes, Right Ear/25 db 2000/Yes, Right Ear/40 db 2000/Yes, Right Ear/20 db 4000/Yes, Right Ear/20 db 500/Yes, Left Ear/25 db 4000/Yes, Right Ear/25 db 1000/Yes, Right Ear/20 db 1000/Yes, Right Ear/25 db 4000/Yes, Left Ear/25 db 1000/Yes, Right Ear/40 db 4000/Yes, Left Ear/40 db 4000/Yes, Left Ear/40 db 500/Yes, Left Ear/25 db 500/Yes, Right Ear/25 db 500/Yes, Left Ear/20 db 2000/Yes, Right Ear/20 db 2000/Yes</text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="202306020000-0500"/> <high value="202306020000-0500"/>

</effectiveTime> <targetSiteCode displayName="Right Ear/40 db 500/Yes, Left Ear/40 db 2000/Yes, Left Ear/40 db 1000/Yes, Left Ear/20 db 500/Yes, Right Ear/40 db 1000/Yes, Left Ear/20 db 1000/Yes, Left Ear/20 db 4000/Yes, Left Ear/25 db 2000/Yes, Right Ear/25 db 2000/Yes, Right Ear/40 db 2000/Yes, Right Ear/20 db 4000/Yes, Right Ear/20 db 500/Yes, Left Ear/25 db 4000/Yes, Right Ear/25 db 1000/Yes, Right Ear/20 db 1000/Yes, Right Ear/25 db 4000/Yes, Left Ear/25 db 1000/Yes, Right Ear/40 db 4000/Yes, Left Ear/40 db 4000/Yes, Left Ear/40 db 500/Yes, Left Ear/25 db 500/Yes, Right Ear/25 db 500/Yes, Left Ear/20 db 2000/Yes, Right Ear/20 db 2000/Yes" nullFlavor="UNK"> <originalText>Right Ear/40 db 500/Yes, Left Ear/40 db 2000/Yes, Left Ear/40 db 1000/Yes, Left Ear/20 db 500/Yes, Right Ear/40 db 1000/Yes, Left Ear/20 db 1000/Yes, Left Ear/20 db 4000/Yes, Left Ear/25 db 2000/Yes, Right Ear/25 db 2000/Yes, Right Ear/40 db 2000/Yes, Right Ear/20 db 4000/Yes, Right Ear/20 db 500/Yes, Left Ear/25 db 4000/Yes, Right Ear/25 db 1000/Yes, Right Ear/20 db 1000/Yes, Right Ear/25 db 4000/Yes, Left Ear/25 db 1000/Yes, Right Ear/40 db 4000/Yes, Left Ear/40 db 4000/Yes, Left Ear/40 db 500/Yes, Left Ear/25 db 500/Yes, Right Ear/25 db 500/Yes, Left Ear/20 db 2000/Yes, Right Ear/20 db 2000/Yes</originalText> </targetSiteCode> <entryRelationship typeCode="COMP"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.40"/> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2"/> <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/> <text> <reference value="#Procedure5"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </procedure> </entry> </section> </component> <component>

<section> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.2.4.1"/> <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>Date</th> <th>Vital</th> </tr> </thead> <tbody> <tr> <td>06/02/2023</td> <td> <content>Blood Pressure 1: 104/80 Code: 8480-6</content> </td> <td> <content>BMI: 19.5 Code: 39156-5</content> </td> <td> <content>Heart Rate 1: 74 bpm</content> </td> <td> <content>Height: 5'9" Code: 8302-2</content> </td>

<td> <content>Temperature: 36.7 (C) / 98.0 (F)</content> </td> <td> <content>Weight: 131 lbs 5 oz Code: 29463-7</content> </td> </tr> </tbody> </table> </text> <entry typeCode="DRIV"> <organizer classCode="CLUSTER" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.26"/> <templateId root="2.16.840.1.113883.10.20.22.4.26"/> <id root="66e5f603-5f04-4053-aec7-551afea4ee5f"/> <code code="46680005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="LOINC" displayName="Vital signs"> <translation code="74728-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Vital signs, weight, height, head circumference, oximetry, BMI, and BSA panel"/> </code> <statusCode code="completed"/> <effectiveTime value="20230602"/> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="a7b302b4-da26-4bc9-b05c-0ef67436eb54"/> <code code="8310-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Body Temperature"/>

<statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value unit="Cel" value="37" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="cb001636-092b-4782-b8b1-5d395db02bbd"/> <code code="39156-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BMI"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value value="19.5" xsi:type="PQ"/> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId assigningAuthorityName="HITSP C32" root="2.16.840.1.113883.3.88.11.32.15"/> <templateId root="2.16.840.1.113883.10.20.1.31"/> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="a2a2665e-4b7c-460b-aae6-6f431670f1f2"/> <code code="8480-6" codeSystem="2.16.840.1.113883.6.1" displayName="SYSTOLIC BLOOD PRESSURE"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/>

<value unit="mm[Hg]" value="104" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> <referenceRange> <observationRange> <value xsi:type="IVL_PQ"> <low unit="mm[Hg]" value="0"/> <high unit="mm[Hg]" value="999"/> </value> </observationRange> </referenceRange> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId assigningAuthorityName="HITSP C32" root="2.16.840.1.113883.3.88.11.32.15"/> <templateId root="2.16.840.1.113883.10.20.1.31"/> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="a2a2665e-4b7c-460b-aae6-6f431670f1f2"/> <code code="8462-4" codeSystem="2.16.840.1.113883.6.1" displayName="DIASTOLIC BLOOD PRESSURE"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value unit="mm[Hg]" value="80" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> <referenceRange> <observationRange> <value xsi:type="IVL_PQ">

<low unit="mm[Hg]" value="0"/> <high unit="mm[Hg]" value="999"/> </value> </observationRange> </referenceRange> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="b382706e-d554-406b-82a2-895cf69b39e2"/> <code code="29463-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BODY WEIGHT"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value unit="kg" value="59.562348" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> <referenceRange> <observationRange> <value xsi:type="IVL_PQ"> <low unit="kg" value="0"/> <high unit="kg" value="549.754"/> </value> </observationRange> </referenceRange> </observation> </component> <component>

<observation classCode="OBS" moodCode="EVN"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="72d5ca49-0ff5-4715-b8d6-cef6774b85c6"/> <code code="8302-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="BODY HEIGHT"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/> <value unit="cm" value="175" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> <referenceRange> <observationRange> <value xsi:type="IVL_PQ"> <low unit="cm" value="0"/> <high unit="cm" value="274.32"/> </value> </observationRange> </referenceRange> </observation> </component> <component> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.4.27"/> <templateId root="2.16.840.1.113883.10.20.22.4.27"/> <id root="60c05782-0fd9-4d92-913a-e4366b5e74c5"/> <code code="8867-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Heart Rate"/> <statusCode code="completed"/> <effectiveTime value="202306020000-0500"/>

<value unit="/min" value="74" xsi:type="PQ"/> <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/> <referenceRange> <observationRange> <value xsi:type="IVL_PQ"> <low unit="bpm" value="60"/> <high unit="bpm" value="100"/> </value> </observationRange> </referenceRange> </observation> </component> </organizer> </entry> </section> </component> <component> <section nullFlavor="NI"> <templateId root="2.16.840.1.113883.10.20.1.5"/> <templateId root="2.16.840.1.113883.10.20.22.2.14"/> <code code="47420-5" codeSystem="2.16.840.1.113883.6.1"/> <title>Functional Status</title> <text>No Functional Status data</text> </section> </component> <component> <section> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.13.2.1"/>

<code code="10154-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="CHIEF COMPLAINT"/> <title>Reason For Visit</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Reason For Visit</th> <th>Effective Dates</th> <th>Notes</th> </tr> </thead> <tbody> <tr> <td>well man exam (12-17 years)</td> <td>06/02/2023</td> <td/> </tr> </tbody> </table> </text> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/> <templateId root="2.16.840.1.113883.10.20.22.4.49"/> <code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of encounters"/>

<title>Encounters</title> <text> <table border="1" width="100%"> <thead> <tr> <th>Encounter</th> <th>Performer</th> <th>Location</th> <th>Location Address</th> <th>Codes</th> <th>Date</th> </tr> </thead> <tbody> <tr> <td> <content ID="Encounter1">(99394) PREV VISIT EST AGE 12-17<br/>Diagnosis: Well child examination[ICD10: Z00.129]</content> </td> <td>Dennis Vinias</td> <td>Johnston Family Medicine</td> <td>41 Magna Way Suite 100 WESTMINSTER, MD 21157</td> <td>CPT-4: 99394</td> <td>06/02/2023</td> </tr> </tbody> </table> </text> <entry typeCode="DRIV">

<encounter classCode="ENC" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/> <templateId root="2.16.840.1.113883.10.20.22.4.49"/> <id assigningAuthorityName="Johnston Family Medicine" extension="66e5f603-5f044053-aec7-551afea4ee5f" root="b660e2f5-fda6-4c32-9d58-ce029f6768f0"/> <code code="99394" codeSystem="2.16.840.1.113883.6.12" codeSystemName="CPT-4" codeSystemVersion="4" displayName="(99394) PREV VISIT EST AGE 12-17"> <originalText>(99394) PREV VISIT EST AGE 12-17<reference value="#Encounter1"/> </originalText> </code> <effectiveTime value="202306020000-0500"/> <performer> <assignedEntity> <id extension="1912275926" root="2.16.840.1.113883.4.6"/> <telecom nullFlavor="UNK"/> <assignedPerson> <name> <given>Dennis</given> <family>Vinias</family> </name> </assignedPerson> </assignedEntity> </performer> <participant typeCode="LOC"> <participantRole classCode="SDLOC"> <templateId root="2.16.840.1.113883.10.20.22.4.32"/> <code code="1251-8" codeSystem="2.16.840.1.113883.6.259" codeSystemName="HealthcareServiceLocation" displayName="Johnston Family Medicine"/> <addr> <streetAddressLine>41 Magna Way</streetAddressLine>

<city>WESTMINSTER</city> <state>MD</state> <postalCode>21157</postalCode> <country>US</country> </addr> <telecom use="WP" value="(410)751-6684"/> </participantRole> </participant> <entryRelationship inversionInd="false" typeCode="SUBJ"> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.80"/> <id root="4cfa9dbb-ed19-477b-a1c4-65f0eaa6480d"/> <code code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="ENCOUNTER DIAGNOSIS"/> <statusCode code="active"/> <effectiveTime> <low value="20230602"/> </effectiveTime> <entryRelationship inversionInd="false" typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.4"/> <templateId root="2.16.840.1.113883.10.20.22.4.4"/> <id root="37f74577-c451-4817-b185-04727aa2bd87"/> <code code="282291009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Diagnosis"> <translation code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis"/> </code> <text>Well child examination</text> <statusCode code="completed"/>

<effectiveTime> <low value="202306020000-0500"/> </effectiveTime> <value codeSystem="2.16.840.1.113883.6.96" nullFlavor="OTH" xsi:type="CD"> <translation code="Z00.129" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD-10-CM" displayName="Well child examination"/> </value> </observation> </entryRelationship> </act> </entryRelationship> </encounter> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.10"/> <templateId assigningAuthorityName="HITSP/C83" root="2.16.840.1.113883.3.88.11.83.124"/> <templateId assigningAuthorityName="IHE PCC" root="1.3.6.1.4.1.19376.1.5.3.1.3.31"/> <templateId assigningAuthorityName="HL7 CCD" root="2.16.840.1.113883.10.20.2.7"/> <templateId assigningAuthorityName="HL7 CCD" root="2.16.840.1.113883.10.20.1.10"/> <templateId root="2.16.840.1.113883.10.20.22.2.10"/> <code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Treatment plan"/> <title>Plan of Care</title> <text> <table border="1" width="100%"> <thead>

<tr> <th>Planned Activity</th> <th>Notes</th> <th>Codes</th> <th>Status</th> <th>Date</th> </tr> </thead> <tbody> <tr> <td>Visit Plan: </td> <td>Z00.129-V20.2 Well child examination<br/> </td> <td/> <td/> <td>06/02/2023</td> </tr> <tr> <td>Patient Education: Patient Medication Summary</td> <td/> <td/> <td>Completed</td> <td>06/02/2023</td> </tr> </tbody> </table> </text> <entry> <act classCode="ACT" moodCode="RQO">

<templateId root="2.16.840.1.113883.10.20.22.4.39"/> <id root="ba074461-0dff-4193-a982-a92bbd0c90bc"/> <code code="399684003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Care Plan"/> <text>Z00.129-V20.2 Well child examination </text> <statusCode code="new"/> <effectiveTime value="20230602" xsi:type="IVL_TS"/> </act> </entry> <entry> <encounter classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <id root="6504f9a7-6a52-4ef9-8f15-5649e04ccb8a"/> <code code="311401005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Patient Education"/> <text> <reference value="#Instruction_0"/> </text> <statusCode code="completed"/> <effectiveTime value="20230602" xsi:type="IVL_TS"/> </encounter> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.45"/> <id root="184fdbe3-f480-4199-976d-e0bb0dd02551"/>

<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>Comment</th> <th>Date</th> </tr> </thead> <tbody> <tr> <td> <content ID="sect1">. Z00.129-V20.2 Well child examination<br/> </content> </td> <td>06/02/2023</td> </tr> </tbody> </table> </text> <entry> <act classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <id extension="1633075919" root="MDHT"/> <code displayName="Procedure" nullFlavor="UNK"/> <text> <reference value="#sect1"/>. Z00.129-V20.2 Well child examination

</text> <statusCode code="completed"/> </act> </entry> </section> </component> <component> <section> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.22.2.23"/> <templateId root="2.16.840.1.113883.10.20.22.2.23"/> <code code="46264-8" codeSystem="2.16.840.1.113883.6.1"/> <title>Medical Equipment</title> <text>No Medical Equipment data</text> </section> </component> <component> <section nullFlavor="NI"> <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 Document"/> <title>Health Concerns Section</title> <text>Health Concerns data not found</text> </section> </component> <component> <section nullFlavor="NI"> <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 Section</title> <text>Goals data not found</text> </section> </component> <component> <section nullFlavor="NI"> <templateId extension="2014-06-09" root="2.16.840.1.113883.10.20.21.2.3"/> <code code="62387-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Interventions Provided"/> <title>Interventions Section</title> <text>Interventions data not found</text> </section> </component> <component> <section nullFlavor="NI"> <templateId root="2.16.840.1.113883.10.20.22.2.61"/> <code code="11383-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Patient Problem Outcome"/> <title>Health Status Evaluations/Outcomes Section</title> <text>Health Status Evaluations/Outcomes data not found</text> </section> </component> <component> <section> <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.48"/> <templateId root="2.16.840.1.113883.10.20.22.4.48"/> <code code="42348-3" codeSystem="2.16.840.1.113883.6.1"/> <title>Advance Directives</title> <text>No Advance Directive data</text>

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