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<postalCode>97005</postalCode> <country>US</country> </addr> <telecom value="tel:+1-(555)555-1049"/> <assignedPerson> <name> <family>Puffer</family> <given>Penny</given> <prefix>Dr</prefix> </name> </assignedPerson> </assignedEntity> </performer> </serviceEvent> </documentationOf> <componentOf> <encompassingEncounter> <id extension="5283815" root="1.3.6.1.4.1.22812.3.99930.3.3.4"/> <effectiveTime> <low value="20120815090051"/> <high value="20130130080051-0500"/> </effectiveTime> </encompassingEncounter> </componentOf> <component> <structuredBody> <templateId extension="IMPL_CDAR2_LEVEL1" root="2.16.840.1.113883.10"/> <component> <section> <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.1"/> <code code="42349-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Reason For Referral"/> <title>Reason For Referral</title> <text> <content ID="ID0EAADACA">Dr. Puffer please see this patient and evaluate by performing Pulmonary Function Tests</content> </text> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.14"/> <code code="47420-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Functional Status"/> <title>Functional Status</title> <text> <list> <caption>Functional Status Health Issues</caption> <item> <table> <thead> <tr> <th>Name</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr> <td styleCode="xmain"> <content styleCode="Bold"> <content ID="ID0EBAABEACA">No Functional Impairment</content> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"/> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"> <content styleCode="xlabel">Onset<content styleCode="xasIgnore">:</content> </content> <content styleCode="Bold">15-Aug-2012</content> </content> </td> <td styleCode="xdetails"> <content styleCode="xdiv"> <content styleCode="xstatus"> <content styleCode="xlabel">Status: </content> <content 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value="20120815"/> </effectiveTime> <value xsi:type="CD" code="66557003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="No Impairment"> <originalText> <reference value="#ID0EBAAAEACA"/> </originalText> </value> </observation> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.5.1"/> <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem List"/> <title>Problems</title> <text> <table> <thead> <tr> <th>Name</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr> <td styleCode="xmain"> <content styleCode="Bold"> <content ID="ID0ECBBLACA">Hypertension</content> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"/> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"> <content styleCode="xlabel">Onset<content styleCode="xasIgnore">:</content> </content> <content styleCode="Bold">1-May-2009</content> </content> </td> <td styleCode="xdetails"> <content styleCode="xdiv"> <content styleCode="xstatus"> <content styleCode="xlabel">Status: </content> <content styleCode="xvalue" ID="ID0EBFBBLACA">Active</content> </content> </content> </td> </tr> <tr> <td styleCode="xmain"> <content styleCode="Bold"> <content ID="ID0EAAALACA">Asthma</content> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"/> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"> <content styleCode="xlabel">Onset<content styleCode="xasIgnore">:</content> </content> <content styleCode="Bold">3-Jan-2007</content> </content> </td> <td styleCode="xdetails"> <content styleCode="xdiv"> <content styleCode="xstatus"> <content styleCode="xlabel">Status: </content> <content styleCode="xvalue" ID="ID0EBDAALACA">Active</content> </content> </content> </td> </tr> </tbody> </table> </text> <entry> <act 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root="2.16.840.1.113883.10.20.22.4.4"/> <id extension="636842200007" root="1.3.6.1.4.1.22812.3.99930.3.4.1.2.1"/> <id extension="660100900011" root="1.3.6.1.4.1.22812.3.99930.3.4.1.2.1"/> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55607006" displayName="Problem"/> <text> <reference value="#ID0EAAALACA"/> </text> <statusCode code="completed"/> <effectiveTime> <low value="20070103000000-0500"/> </effectiveTime> <value xsi:type="CD" code="195967001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Asthma"> <originalText> <reference value="#ID0EAAALACA"/> </originalText> </value> <author> <time value="20070103000000-0500"/> <assignedAuthor> <id nullFlavor="UNK"/> <addr nullFlavor="UNK"> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name nullFlavor="UNK"/> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="REFR"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.6"/> <code displayName="Status" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="33999-4"/> <text> <reference value="#ID0EBDAALACA"/> </text> <statusCode code="completed"/> <value xsi:type="CD" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55561003" displayName="Active"/> </observation> </entryRelationship> </observation> </entryRelationship> </act> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.1.1"/> <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of medication use"/> <title>Medications</title> <text> <table> <thead> <tr> <th>Name</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr ID="ID0EBKACA"> <td styleCode="xmain"> <content styleCode="xdiv"> <content styleCode="Bold" ID="ID0EDBKACA">fluticasone inhaled</content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"> <content ID="ID0ELBKACA">88 mcg twice daily AS DIRECTED.</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"/> </content> </td> <td styleCode="xdates"/> <td styleCode="xdetails"> <list styleCode="xlistForTable"> <item styleCode="xlistForTable"> <table styleCode="xtableWithinTable"> <tbody styleCode="xtableWithinTable"> <tr> <td> <content styleCode="xlabel"> Started </content>1-Oct-2007</td> </tr> </tbody> </table> </item> </list> <content styleCode="xstatus"> <content styleCode="xlabel"/> <content styleCode="xvalue">Active</content> </content> <content styleCode="xdiv"> <content ID="ID0EBBKACA">Generic substitution allowed</content> </content> <content styleCode="xasIgnore"> <br/> </content> </td> </tr> <tr ID="ID0EAKACA"> <td styleCode="xmain"> <content styleCode="xdiv"> <content styleCode="Bold" ID="ID0EDAKACA">metoprolol tartrate 50 MG Oral Tablet</content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"> <content ID="ID0EJAKACA">TAKE 1 TABLET twice daily As Directed</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xdiv"> <content styleCode="xsecondary"/> </content> </td> <td styleCode="xdates"/> <td styleCode="xdetails"> <list styleCode="xlistForTable"> <item styleCode="xlistForTable"> <table styleCode="xtableWithinTable"> <tbody styleCode="xtableWithinTable"> <tr> <td> <content styleCode="xlabel"> Started </content>1-May-2009</td> </tr> </tbody> </table> </item> </list> <content styleCode="xstatus"> <content styleCode="xlabel"/> <content styleCode="xvalue">Active</content> </content> <content styleCode="xdiv"> <content ID="ID0EBAKACA">Generic substitution allowed</content> </content> <content styleCode="xasIgnore"> <br/> </content> </td> </tr> </tbody> </table> </text> <entry> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id extension="659122500005" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/> <id extension="659122500007" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/> <text> <reference value="#ID0EBKACA"/> </text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20071001"/> <high nullFlavor="UNK"/> </effectiveTime> <effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A"> <period value="12" unit="h"/> </effectiveTime> <routeCode codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" code="C38216" displayName="RESPIRATORY (INHALATION)"/> <doseQuantity value="88" unit="mcg"/> <administrationUnitCode codeSystemName="NCI Thesaurus" codeSystem="2.16.840.1.113883.3.26.1.1" code="C42960" displayName="AEROSOL, METERED"/> <consumable typeCode="CSM"> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="1165655" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="fluticasone inhaled"> <originalText> <reference value="#ID0EDBKACA"/> </originalText> </code> <name>Fluticasone</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" displayName="Status" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <statusCode code="completed"/> <value xsi:type="CE" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55561003" displayName="Active"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="UNK"/> <statusCode code="completed"/> <product> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="1165655" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="fluticasone inhaled"> <originalText> <reference value="#ID0EDBKACA"/> </originalText> </code> <name>Fluticasone</name> </manufacturedMaterial> </manufacturedProduct> </product> <entryRelationship typeCode="SUBJ" inversionInd="true"> <act classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <code code="423564006" displayName="Provider instructions for treatment" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> <text> <reference value="#ID0EBBKACA"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </supply> </entryRelationship> </substanceAdministration> </entry> <entry> <substanceAdministration classCode="SBADM" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.16"/> <id extension="6370322000351" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/> <id extension="6654719000131" root="1.3.6.1.4.1.22812.3.99930.3.4.9"/> <text> <reference value="#ID0EAKACA"/> </text> <statusCode code="completed"/> <effectiveTime xsi:type="IVL_TS"> <low value="20090501"/> <high nullFlavor="UNK"/> </effectiveTime> <effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A"> <period value="12" unit="h"/> </effectiveTime> <routeCode codeSystem="2.16.840.1.113883.3.26.1.1" codeSystemName="NCI Thesaurus" code="C38288" displayName="ORAL"/> <doseQuantity value="1"/> <administrationUnitCode codeSystemName="NCI Thesaurus" codeSystem="2.16.840.1.113883.3.26.1.1" code="C42998" displayName="TABLET"/> <consumable typeCode="CSM"> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="866924" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="metoprolol tartrate 50 MG Oral Tablet"> <originalText> <reference value="#ID0EDAKACA"/> </originalText> </code> <name>Zantac</name> </manufacturedMaterial> </manufacturedProduct> </consumable> <author> <time value="20090501154300"/> <assignedAuthor> <id nullFlavor="UNK"/> <addr nullFlavor="UNK"> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name nullFlavor="UNK"/> </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" displayName="Status" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <statusCode code="completed"/> <value xsi:type="CE" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55561003" displayName="Active"/> </observation> </entryRelationship> <entryRelationship typeCode="REFR"> <supply classCode="SPLY" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.17"/> <id nullFlavor="UNK"/> <statusCode code="completed"/> <product> <manufacturedProduct classCode="MANU"> <templateId root="2.16.840.1.113883.10.20.22.4.23"/> <manufacturedMaterial> <code code="866924" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="metoprolol tartrate 50 MG Oral Tablet"> <originalText> <reference value="#ID0EDAKACA"/> </originalText> </code> <name>Zantac</name> </manufacturedMaterial> </manufacturedProduct> </product> <entryRelationship typeCode="SUBJ" inversionInd="true"> <act classCode="ACT" moodCode="INT"> <templateId root="2.16.840.1.113883.10.20.22.4.20"/> <code code="423564006" displayName="Provider instructions for treatment" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> <text> <reference value="#ID0EBAKACA"/> </text> <statusCode code="completed"/> </act> </entryRelationship> </supply> </entryRelationship> </substanceAdministration> </entry> </section> </component> <component> <section> <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" displayName="Allergies, adverse reactions, alerts"/> <title>Allergies and Adverse Reactions</title> <text> <table> <thead> <tr> <th>Name</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr> <td styleCode="xmain"> <content styleCode="Bold"> <content ID="ID0EEBMACA">Aspirin</content> </content> <content styleCode="xdiv"> <content styleCode="xlabel">Severity: </content> <content ID="ID0ECBMACA"> <content styleCode="xlabel">Mild to moderate</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"/> </td> <td styleCode="xdetails"> <content styleCode="xdiv"> <content styleCode="xreaction"> <content styleCode="xlabel">Reaction: </content> <content ID="ID0EBADBMACA">Hives</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xstatus"> <content styleCode="xlabel">Status: </content> <content styleCode="xvalue" ID="ID0EDGBMACA">Active</content> </content> </td> </tr> <tr> <td styleCode="xmain"> <content styleCode="Bold"> <content ID="ID0ECAMACA">Bactrim</content> </content> <content styleCode="xdiv"> <content styleCode="xlabel">Severity: </content> <content ID="ID0EAAMACA"> <content styleCode="xlabel">Moderate to severe</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"/> </td> <td styleCode="xdetails"> <content styleCode="xdiv"> <content styleCode="xreaction"> <content styleCode="xlabel">Reaction: </content> <content ID="ID0EBABAMACA">Rash</content> </content> </content> <content styleCode="xasIgnore"> <br/> </content> <content styleCode="xstatus"> <content styleCode="xlabel">Status: </content> <content styleCode="xvalue" ID="ID0EBEAMACA">Active</content> </content> </td> </tr> </tbody> </table> </text> <entry> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.30"/> <id extension="613618700107" root="1.3.6.1.4.1.22812.3.99930.3.4.10"/> <id extension="613618700109" root="1.3.6.1.4.1.22812.3.99930.3.4.10"/> <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Allergies, adverse reactions, alerts"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.7"/> <id extension="613618700107" root="1.3.6.1.4.1.22812.3.99930.3.4.10.2"/> <id extension="613618700109" root="1.3.6.1.4.1.22812.3.99930.3.4.10.2"/> <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> <value xsi:type="CD" codeSystem="2.16.840.1.113883.6.96" code="416098002" displayName="drug allergy" codeSystemName="SNOMED CT"> <originalText> <reference value="#ID0EEBMACA"/> </originalText> </value> <performer typeCode="PRF"> <assignedEntity> <id extension="1111111111" root="2.16.840.1.113883.4.6"/> <addr> <streetAddressLine>Get Well Clinic</streetAddressLine> <streetAddressLine>1004 Healthcare Dr.</streetAddressLine> <city>Portland</city> <state>OR</state> <postalCode>97005</postalCode> <country>US</country> </addr> <telecom value="tel:+1-(555)555-1004"/> <assignedPerson> <name> <family>Khan</family> <given>Samir</given> <prefix>Dr</prefix> </name> </assignedPerson> </assignedEntity> </performer> <author> <time value="20130130000000-0500"/> <assignedAuthor> <id nullFlavor="UNK"/> <addr nullFlavor="UNK"> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name nullFlavor="UNK"/> </assignedPerson> </assignedAuthor> </author> <participant typeCode="CSM"> <participantRole classCode="MANU"> <playingEntity classCode="MMAT"> <code code="1191" codeSystem="2.16.840.1.113883.6.88" codeSystemName="RxNorm" displayName="Aspirin"> <originalText> <reference value="#ID0EEBMACA"/> </originalText> </code> <name>Aspirin</name> </playingEntity> </participantRole> </participant> <entryRelationship typeCode="SUBJ" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.28"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value xsi:type="CE" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55561003" displayName="Active"/> </observation> </entryRelationship> <entryRelationship typeCode="MFST" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.9"/> <id extension="613618700107" root="1.3.6.1.4.1.22812.3.99930.3.4.11.1.1"/> <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/> <text> <reference value="#ID0EBADBMACA"/> </text> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> <value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Hives"> <originalText> <reference value="#ID0EBADBMACA"/> </originalText> </value> </observation> </entryRelationship> <entryRelationship typeCode="SUBJ" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.8"/> <code code="SEV" displayName="Severity Observation" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/> <text> <reference value="#ID0ECBMACA"/> </text> <statusCode code="completed"/> <value xsi:type="CD" displayName="Mild to moderate" code="371923003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> </observation> </entryRelationship> </observation> </entryRelationship> <entryRelationship typeCode="SUBJ"> <encounter classCode="ENC" moodCode="EVN"> <id extension="5283815" root="1.3.6.1.4.1.22812.3.99930.3.3.4"/> </encounter> </entryRelationship> </act> </entry> <entry> <act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.30"/> <id extension="624373800001" root="1.3.6.1.4.1.22812.3.99930.3.4.10"/> <id extension="637073500005" root="1.3.6.1.4.1.22812.3.99930.3.4.10"/> <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Allergies, adverse reactions, alerts"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> <high nullFlavor="UNK"/> </effectiveTime> <entryRelationship typeCode="SUBJ"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.7"/> <id extension="624373800001" root="1.3.6.1.4.1.22812.3.99930.3.4.10.2"/> <id extension="637073500005" root="1.3.6.1.4.1.22812.3.99930.3.4.10.2"/> <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> <value xsi:type="CD" codeSystem="2.16.840.1.113883.6.96" code="416098002" displayName="drug allergy" codeSystemName="SNOMED CT"> <originalText> <reference value="#ID0ECAMACA"/> </originalText> </value> <author> <time value="20130130000000-0500"/> <assignedAuthor> <id nullFlavor="UNK"/> <addr nullFlavor="UNK"> <streetAddressLine nullFlavor="UNK"/> <city nullFlavor="UNK"/> <state nullFlavor="UNK"/> <postalCode nullFlavor="UNK"/> <country nullFlavor="UNK"/> </addr> <telecom nullFlavor="UNK"/> <assignedPerson> <name nullFlavor="UNK"/> </assignedPerson> </assignedAuthor> </author> <participant typeCode="CSM"> <participantRole classCode="MANU"> <playingEntity classCode="MMAT"> <code nullFlavor="OTH"> <originalText> <reference value="#ID0ECAMACA"/> </originalText> <translation xsi:type="CD" code="208416" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Bactrim"/> </code> <name>Bactrim</name> </playingEntity> </participantRole> </participant> <entryRelationship typeCode="SUBJ" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.28"/> <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Status"/> <statusCode code="completed"/> <value xsi:type="CE" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="55561003" displayName="Active"/> </observation> </entryRelationship> <entryRelationship typeCode="MFST" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.9"/> <id extension="624373800001" root="1.3.6.1.4.1.22812.3.99930.3.4.11.1.1"/> <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/> <text> <reference value="#ID0EBABAMACA"/> </text> <statusCode code="completed"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> <value xsi:type="CD" code="112625008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Rash"> <originalText> <reference value="#ID0EBABAMACA"/> </originalText> </value> </observation> </entryRelationship> <entryRelationship typeCode="SUBJ" inversionInd="true"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.8"/> <code code="SEV" displayName="Severity Observation" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7ActCode"/> <text> <reference value="#ID0EAAMACA"/> </text> <statusCode code="completed"/> <value xsi:type="CD" displayName="Moderate to severe" code="371924009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/> </observation> </entryRelationship> </observation> </entryRelationship> </act> </entry> </section> </component> <component> <section> <templateId root="2.16.840.1.113883.10.20.22.2.7.1"/> <code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of Procedures"/> <title>Procedures</title> <text> <table> <thead> <tr> <th>Procedure</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr> <td styleCode="xmain"> <content styleCode="Bold" ID="ID0EAAFACA">No Known Procedures</content> </td> <td styleCode="xdates"/> <td styleCode="xdetails"/> </tr> </tbody> </table> </text> <entry> <procedure classCode="PROC" moodCode="EVN" negationInd="true"> <templateId root="2.16.840.1.113883.10.20.22.4.14"/> <id extension="1898101" root="1.3.6.1.4.1.22812.3.99930.3.4.7"/> <code nullFlavor="UNK"/> <statusCode code="active"/> <effectiveTime> <low nullFlavor="UNK"/> </effectiveTime> </procedure> </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" codeSystemName="LOINC" displayName="Immunizations"/> <title>Immunization</title> <text> <table> <thead> <tr> <th>Name</th> <th>Dates</th> <th>Details</th> </tr> </thead> <tbody> <tr ID="ID0EAJACA"> <td styleCode="xmain"> <content styleCode="xdiv"> <content styleCode="Bold" ID="ID0EDAJACA">Influenza virus vaccine</content> </content> <content styleCode="xasIgnore"> <br/> </content> </td> <td styleCode="xdates"> <content styleCode="xdiv"> <content styleCode="xlabel">Administered on<content styleCode="xasIgnore">:</content> </content> <content styleCode="Bold">15-Aug-2012</content> </content>