Polska Implementacja Krajowa HL7 CDA (plcda-)

eZdrowie - Projekt P1

Przykłady - [1] Dokument recepty spełniający wymagania związane z refundacją

Recepta na Atoris [Pokaż przykład]

<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Recepta na Atoris -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.2"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.2"/>
  <id extension="2345678" root="2.16.840.1.113883.3.4424.7.2.1" displayable="true"/>
  <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
    <translation code="04.01" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Recepta">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Recepta</title>
  <effectiveTime value="20130412"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="432231" root="2.16.840.1.113883.3.4424.7.2.2"/>
  <versionNumber value="1"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.3"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <city>Warszawa</city>
        <postalCode>01-134</postalCode>
        <streetName>Odkryta</streetName>
        <houseNumber>41</houseNumber>
        <unitID>12</unitID>
      </addr>
      <patient>
        <name>
          <given>Jan</given>
          <given>Franciszek</given>
          <family>Kowalski</family>
        </name>
        <birthTime value="19620915"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.4"/>
    <time value="20130412"/>
    <assignedAuthor>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="false"/>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.5"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.63"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.24"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.78"/>
    <time value="20130412"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
      <code code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
      <assignedPerson xsi:type="extPL:Person">
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>lek.</prefix>
          <given>Piotr</given>
          <family>Nowak</family>
        </name>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0718" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="neurologia"/>
        </extPL:qualifiedEntity>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0726" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="radiologia i diagnostyka obrazowa"/>
        </extPL:qualifiedEntity>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.17"/>
        <id extension="1007-01" root="2.16.840.1.113883.3.4424.2.3.2" displayable="true"/>
        <name>Poradnia POZ</name>
        <telecom use="PUB" value="tel:22-1111123"/>
        <telecom use="PUB" value="fax:22-1111100"/>
        <addr>
          <postalCode>00-950</postalCode>
          <city>Warszawa</city>
          <streetName>Marszałkowska</streetName>
          <houseNumber>320</houseNumber>
        </addr>
        <asOrganizationPartOf>
          <wholeOrganization>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.16"/>
            <id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
            <name>NZOZ „POL-MED”</name>
            <asOrganizationPartOf>
              <wholeOrganization>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.14"/>
                <id extension="1007" root="2.16.840.1.113883.3.4424.2.3.1" displayable="true"/>
                <id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
                <name>POL-MED Sp. z o.o.</name>
              </wholeOrganization>
            </asOrganizationPartOf>
          </wholeOrganization>
        </asOrganizationPartOf>
      </representedOrganization>
    </assignedEntity>
  </legalAuthenticator>
  <participant typeCode="IND">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.19"/>
    <associatedEntity classCode="UNDWRT">
      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
    </associatedEntity>
  </participant>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.8"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.2"/>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>
          <text> Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque sed urna nibh. Donec lacus mi, varius sed ex at, elementum mattis mauris. In sit amet quam vel sem pellentesque euismod. </text>
          <component>
            <section>
              <templateId root="2.16.840.1.113883.3.4424.13.10.3.3"/>
              <code code="10186-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Identifying information"/>
              <title>Dokumenty uprawnień</title>
              <text>
                <paragraph>Nr leg.: 234/1992</paragraph>
              </text>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
          <code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
          <text ID="SBADM_1">
            <paragraph>
              <caption>Rp.</caption>
               Atoris 20mg tabletki
              <br/>
               No 28             </paragraph>
            <paragraph>
              <caption>Odpłatność</caption>
               30%             </paragraph>
          </text>
          <entry>
            <templateId root="2.16.840.1.113883.3.4424.13.10.4.3"/>
            <substanceAdministration classCode="SBADM" moodCode="RQO">
              <text>
                <reference value="#SBADM_1"/>
              </text>
              <effectiveTime xsi:type="PIVL_TS">
                <period value="24" unit="h"/>
              </effectiveTime>
              <doseQuantity value="1"/>
              <consumable>
                <manufacturedProduct>
                  <manufacturedLabeledDrug>
                    <code code="9876" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Atoris 20mg tabletki"/>
                  </manufacturedLabeledDrug>
                </manufacturedProduct>
              </consumable>
              <entryRelationship typeCode="COMP">
                <supply xsi:type="extPL:Supply" classCode="SPLY" moodCode="RQO">
                  <effectiveTime value="20130505"/>
                  <independentInd value="false"/>
                  <quantity value="28"/>
                  <extPL:coverage typeCode="COVBY">
                    <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.4.5"/>
                    <extPL:coveragePlan classCode="COV" moodCode="EVN">
                      <extPL:code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                        <qualifier>
                          <name code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                          <value code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1"/>
                        </qualifier>
                      </extPL:code>
                    </extPL:coveragePlan>
                  </extPL:coverage>
                </supply>
              </entryRelationship>
            </substanceAdministration>
          </entry>
          <component>
            <section>
              <templateId root="2.16.840.1.113883.3.4424.13.10.3.5"/>
              <code code="69730-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Instructions"/>
              <title>DS.</title>
              <text> 1x1 tabl. wieczorem </text>
            </section>
          </component>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Recepta na lek maść (CITO, Ryczałt) [Pokaż przykład]

<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Recepta na maść cholesterolową -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.2"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.2"/>
  <id extension="2345678" root="2.16.840.1.113883.3.4424.7.2.1" displayable="true"/>
  <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
    <translation code="04.01" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Recepta">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="R" displayName="Lek recepturowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Recepta</title>
  <effectiveTime value="20130412"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="432231" root="2.16.840.1.113883.3.4424.7.2.2"/>
  <versionNumber value="1"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.3"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <city>Warszawa</city>
        <postalCode>01-134</postalCode>
        <streetName>Odkryta</streetName>
        <houseNumber>41</houseNumber>
        <unitID>12</unitID>
      </addr>
      <patient>
        <name>
          <given>Jan</given>
          <given>Franciszek</given>
          <family>Kowalski</family>
        </name>
        <birthTime value="19620915"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.4"/>
    <time value="20130412"/>
    <assignedAuthor>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="false"/>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.5"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.63"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.24"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.78"/>
    <time value="20130412"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
      <code code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
      <assignedPerson xsi:type="extPL:Person">
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>lek.</prefix>
          <given>Piotr</given>
          <family>Nowak</family>
        </name>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0718" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="neurologia"/>
        </extPL:qualifiedEntity>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0726" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="radiologia i diagnostyka obrazowa"/>
        </extPL:qualifiedEntity>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.17"/>
        <id extension="1007-01" root="2.16.840.1.113883.3.4424.2.3.2" displayable="true"/>
        <name>Poradnia POZ</name>
        <telecom use="PUB" value="tel:22-1111123"/>
        <telecom use="PUB" value="fax:22-1111100"/>
        <addr>
          <postalCode>00-950</postalCode>
          <city>Warszawa</city>
          <streetName>Marszałkowska</streetName>
          <houseNumber>320</houseNumber>
        </addr>
        <asOrganizationPartOf>
          <wholeOrganization>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.16"/>
            <id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
            <name>NZOZ „POL-MED”</name>
            <asOrganizationPartOf>
              <wholeOrganization>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.14"/>
                <id extension="1007" root="2.16.840.1.113883.3.4424.2.3.1" displayable="true"/>
                <id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
                <name>POL-MED Sp. z o.o.</name>
              </wholeOrganization>
            </asOrganizationPartOf>
          </wholeOrganization>
        </asOrganizationPartOf>
      </representedOrganization>
    </assignedEntity>
  </legalAuthenticator>
  <participant typeCode="IND">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.19"/>
    <associatedEntity classCode="UNDWRT">
      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
    </associatedEntity>
  </participant>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.8"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
          <code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
          <text ID="SBADM_1">
            <paragraph>
              <caption>Rp.</caption>
               Cholesteroli 3,0
              <br/>
               Vaselini albi 18,0
              <br/>
               Paraffini liq. 64,0
              <br/>
               Paraffini solidi 15,0
              <br/>
               M.f. unq.             </paragraph>
            <paragraph>
              <caption>Odpłatność</caption>
               R             </paragraph>
            <paragraph> CITO! </paragraph>
          </text>
          <entry>
            <templateId root="2.16.840.1.113883.3.4424.13.10.4.48"/>
            <supply xsi:type="extPL:Supply" classCode="SPLY" moodCode="RQO">
              <text>
                <reference value="#SBADM_1"/>
              </text>
              <priorityCode code="UR" codeSystem="2.16.840.1.113883.5.7"/>
              <extPL:coverage typeCode="COVBY">
                <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.4.5"/>
                <extPL:coveragePlan classCode="COV" moodCode="EVN">
                  <extPL:code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <value code="R" displayName="ryczałt" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </qualifier>
                  </extPL:code>
                </extPL:coveragePlan>
              </extPL:coverage>
            </supply>
          </entry>
          <component>
            <section>
              <templateId root="2.16.840.1.113883.3.4424.13.10.3.5"/>
              <code code="69730-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Instructions"/>
              <title>DS.</title>
              <text> 2x dziennie </text>
            </section>
          </component>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Recepta na lek maść (data realizacji od:) [Pokaż przykład]

<ClinicalDocument xsi:type="extPL:ClinicalDocument">
  <!-- Recepta na maść cholesterolową -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.2"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.3"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.2"/>
  <id extension="2345678" root="2.16.840.1.113883.3.4424.7.2.1" displayable="true"/>
  <code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
    <translation code="04.01" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Recepta">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="R" displayName="Lek recepturowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Recepta</title>
  <effectiveTime value="20130412"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="432231" root="2.16.840.1.113883.3.4424.7.2.2"/>
  <versionNumber value="1"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.3"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <city>Warszawa</city>
        <postalCode>01-134</postalCode>
        <streetName>Odkryta</streetName>
        <houseNumber>41</houseNumber>
        <unitID>12</unitID>
      </addr>
      <patient>
        <name>
          <given>Jan</given>
          <given>Franciszek</given>
          <family>Kowalski</family>
        </name>
        <birthTime value="19620915"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.4"/>
    <time value="20130412"/>
    <assignedAuthor>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="false"/>
    </assignedAuthor>
  </author>
  <custodian>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.5"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <legalAuthenticator>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.63"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.24"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.78"/>
    <time value="20130412"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
      <code code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
      <assignedPerson xsi:type="extPL:Person">
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>lek.</prefix>
          <given>Piotr</given>
          <family>Nowak</family>
        </name>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0718" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="neurologia"/>
        </extPL:qualifiedEntity>
        <extPL:qualifiedEntity classCode="QUAL">
          <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.10"/>
          <extPL:code code="0726" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="radiologia i diagnostyka obrazowa"/>
        </extPL:qualifiedEntity>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.17"/>
        <id extension="1007-01" root="2.16.840.1.113883.3.4424.2.3.2" displayable="true"/>
        <name>Poradnia POZ</name>
        <telecom use="PUB" value="tel:22-1111123"/>
        <telecom use="PUB" value="fax:22-1111100"/>
        <addr>
          <postalCode>00-950</postalCode>
          <city>Warszawa</city>
          <streetName>Marszałkowska</streetName>
          <houseNumber>320</houseNumber>
        </addr>
        <asOrganizationPartOf>
          <wholeOrganization>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
            <templateId root="2.16.840.1.113883.3.4424.13.10.2.16"/>
            <id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
            <name>NZOZ „POL-MED”</name>
            <asOrganizationPartOf>
              <wholeOrganization>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.14"/>
                <id extension="1007" root="2.16.840.1.113883.3.4424.2.3.1" displayable="true"/>
                <id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
                <name>POL-MED Sp. z o.o.</name>
              </wholeOrganization>
            </asOrganizationPartOf>
          </wholeOrganization>
        </asOrganizationPartOf>
      </representedOrganization>
    </assignedEntity>
  </legalAuthenticator>
  <participant typeCode="IND">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.19"/>
    <associatedEntity classCode="UNDWRT">
      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
    </associatedEntity>
  </participant>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.8"/>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
          <code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
          <text ID="SBADM_1">
            <paragraph>
              <caption>Rp.</caption>
               Cholesteroli 3,0
              <br/>
               Vaselini albi 18,0
              <br/>
               Paraffini liq. 64,0
              <br/>
               Paraffini solidi 15,0
              <br/>
               M.f. unq.             </paragraph>
            <paragraph>
              <caption>Odpłatność</caption>
               R             </paragraph>
            <paragraph>
              <caption>Data realizacji od:</caption>
               2015-11-22             </paragraph>
          </text>
          <entry>
            <templateId root="2.16.840.1.113883.3.4424.13.10.4.48"/>
            <supply xsi:type="extPL:Supply" classCode="SPLY" moodCode="RQO">
              <text>
                <reference value="#SBADM_1"/>
              </text>
              <effectiveTime value="20151122"/>
              <extPL:coverage typeCode="COVBY">
                <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.4.5"/>
                <extPL:coveragePlan classCode="COV" moodCode="EVN">
                  <extPL:code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <value code="R" displayName="ryczałt" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </qualifier>
                  </extPL:code>
                </extPL:coveragePlan>
              </extPL:coverage>
            </supply>
          </entry>
          <component>
            <section>
              <templateId root="2.16.840.1.113883.3.4424.13.10.3.5"/>
              <code code="69730-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Instructions"/>
              <title>DS.</title>
              <text> 2x dziennie </text>
            </section>
          </component>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>