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<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<ClinicalDocument
xmlns = "urn:hl7-org:v3"
xmlns:xsi = "http://www.w3.org/2001/XMLSchema-instance"
xmlns:voc = "urn:hl7-org:v3/voc"
xmlns:sdtc = "urn:hl7-org:sdtc">
<realmCode code = "US"/>
<typeId extension = "POCD_HD000040" root = "2.16.840.1.113883.1.3"/>
<templateId root = "2.16.840.1.113883.10.20.22.1.1" extension = "2015-08-01"/>
<templateId root = "2.16.840.1.113883.10.20.22.1.1"/>
<templateId root = "2.16.840.1.113883.10.20.22.1.2" extension = "2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.1.2" />
<id root="3db70aff-83f5-4caf-91dc-d23fcc5e03bb" />
<code code="34133-9" displayName="Summarization of Episode Note"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Medical Summary</title>
<effectiveTime value="20250101000000-0500" />
<languageCode code="en-US" />
<recordTarget>
<patientRole>
<id root="d7830f15-e2c8-4cee-aa2d-a24b36080d53" />
<id extension="111223333" root="2.16.840.1.113883.4.1" />
<telecom nullFlavor="UNK" />
<addr nullFlavor="UNK" />
<patient>
<name use="L">
<given>Katherine</given>
<family>Madison</family>
</name>
<raceCode nullFlavor="UNK"/>
<ethnicGroupCode nullFlavor="UNK"/>
</patient>
</patientRole>
</recordTarget>
<component>
<structuredBody>
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-01" />
<templateId root="2.16.840.1.113883.10.20.22.2.6.1" />
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Allergies, Adverse Reactions and Alerts</title>
<text>
<table>
<thead>
<tr>
<th>Allergen</th>
<th>Reaction</th>
<th>Reaction Severity</th>
<th>Documentation Date</th>
<th>Start Date</th>
</tr>
</thead>
<tbody>
<tr ID="allergy5">
<td ID="allergy5allergen">Egg</td>
<td ID="allergy5reaction">Hives</td>
<td ID="allergy5reactionseverity">Moderate</td>
<td>Jan 4 2014</td>
<td>1998</td>
</tr>
</tbody>
</table>
</text>
<entry>
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30" />
<templateId root="2.16.840.1.113883.10.20.22.4.30"
extension="2015-08-01" />
<id root="0fffb34f-c1e0-47c2-92af-c414a3ff21ec" />
<code code="CONC" codeSystem="2.16.840.1.113883.5.6" />
<text>
<reference value="#allergy5" />
</text>
<statusCode code="active" />
<!-- This is the time stamp for when the allergy was first documented as
a concern-->
<effectiveTime>
<low value="20140104123506-0500"/>
</effectiveTime>
<author>
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20140104123506-0500" />
<assignedAuthor>
<id root="b0ff47f4-ff49-43ee-8e46-43db7b57d986" />
<id extension="99999999" root="2.16.840.1.113883.4.6" />
<code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101"
codeSystemName="NUCC Health Care Provider Taxonomy"
displayName="Allopathic & Osteopathic Physicians; Family Medicine" />
<telecom value="tel:555-555-1002" />
<addr nullFlavor="UNK" />
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- allergy observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7" />
<templateId root="2.16.840.1.113883.10.20.22.4.7"
extension="2014-06-09" />
<id root="0fffb34f-c1e0-47c2-92af-c414a3ff21ec" />
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
<text>
<reference value="#allergy5" />
</text>
<statusCode code="completed" />
<!-- This is the time stamp for the biological onset of the
allergy. -->
<!-- Just the year is shown since a specific month and date was
not reported -->
<effectiveTime>
<low value="19980101000000+0000" />
<high nullFlavor="NI" />
</effectiveTime>
<!-- This specifies that the allergy is to a food in contrast to
other allergies (drug) -->
<value xsi:type="CD" code="414285001"
displayName="Allergy to food (finding)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" />
<author>
<templateId root="2.16.840.1.113883.10.20.22.4.119" />
<time value="20140104123506-0500" />
<assignedAuthor>
<id root="b0ff47f4-ff49-43ee-8e46-43db7b57d986" />
<id extension="99999999" root="2.16.840.1.113883.4.6" />
<code code="207Q00000X"
codeSystem="2.16.840.1.113883.6.101"
codeSystemName="NUCC Health Care Provider Taxonomy"
displayName="Allopathic & Osteopathic Physicians; Family Medicine" />
<telecom value="tel:555-555-1002" />
<addr nullFlavor="UNK" />
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<!-- In C-CDA R2.1 the participant is required. -->
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code code="102263004" displayName="Eggs (edible)"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT">
<originalText>
<reference value="#allergy5allergen" />
</originalText>
</code>
</playingEntity>
</participantRole>
</participant>
<entryRelationship typeCode="MFST" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- Reaction Observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.9" />
<templateId root="2.16.840.1.113883.10.20.22.4.9"
extension="2014-06-09" />
<id root="d89ce431-e0f1-4f8d-a81f-489b6ed91f09" />
<code code="ASSERTION"
codeSystem="2.16.840.1.113883.5.4" />
<text>
<reference value="#allergy5reaction" />
</text>
<statusCode code="completed" />
<effectiveTime value="19980101" />
<value xsi:type="CD" code="247472004"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Wheal" />
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<!-- Severity Observation template -->
<templateId
root="2.16.840.1.113883.10.20.22.4.8" />
<templateId
root="2.16.840.1.113883.10.20.22.4.8"
extension="2014-06-09" />
<code code="SEV"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode" />
<text>
<reference value="#allergy5reactionseverity" />
</text>
<statusCode code="completed" />
<value xsi:type="CD" code="6736007"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Moderate" />
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>