<ClinicalDocument>
<!-- Skierowanie do objęcia długoterminową opieką pielęgniarską -->
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<code code="34140-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Transfer of care referral note">
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</code>
<title>Skierowanie na objęcie pielęgniarską opieką długoterminową</title>
<effectiveTime value="20130412"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="pl-PL"/>
<setId extension="432231" root="2.16.840.1.113883.3.4424.7.4.2"/>
<versionNumber value="1"/>
<recordTarget>
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<templateId root="2.16.840.1.113883.3.4424.13.10.2.26"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.38"/>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
<id extension="62011699999" 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="19620116"/>
</patient> </patientRole> </recordTarget>
<author>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.4"/>
<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="2.16.840.1.113883.3.4424.13.10.2.27"/>
<signatureCode code="S"/>
<assignedEntity xsi:type="extPL: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>
<extPL:boundedBy typeCode="PART">
<extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>
<extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
<extPL:id extension="123456" root="2.16.840.1.113883.3.4424.8.6.7"/>
<extPL:bounding typeCode="PART">
<extPL:reimburser classCode="UNDWRT">
<extPL:id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
</extPL:reimburser> </extPL:bounding> </extPL:reimbursementRelatedContract> </extPL:boundedBy> </assignedEntity> </legalAuthenticator>
<component>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.8"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.28"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.39"/>
<structuredBody>
<component>
<section>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.10"/>
<code code="10164-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of present illness"/>
<title>Wywiad</title>
<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>
</section> </component>
<component>
<section>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.11"/>
<code code="29545-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Physical findings"/>
<title>Badanie przedmiotowe</title>
<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>
</section> </component>
<component>
<section>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.1"/>
<code code="29548-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis"/>
<title>Rozpoznanie:</title>
<text>
<paragraph>
<content ID="OBS_1">I25.2 Przebyty zawał mięśnia sercowego ściany przedniej</content>
</paragraph> </text>
<entry>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.1"/>
<organizer classCode="BATTERY" moodCode="EVN">
<code code="8319008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Principal diagnosis"/>
<statusCode code="completed"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<code code="I25.2" codeSystem="2.16.840.1.113883.6.3" codeSystemName="icd10" displayName="Stary (przebyty) zawał serca"/>
<text>
<reference value="#OBS_1"/>
</text> </observation> </component> </organizer> </entry> </section> </component>
<component>
<section>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.16"/>
<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<title>Zalecenia lekarskie</title>
<text>
<paragraph ID="ENC_1">
Stwierdzam, że osoba wyżej wymieniona wymaga pielęgnacji i w chwili obecnej
nie wymaga hospitalizacji.
</paragraph>
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>
<entry>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.10"/>
<encounter classCode="ENC" moodCode="RQO">
<code code="2142" codeSystem="2.16.840.1.113883.3.4424.11.2.4" displayName="Pielęgniarska opieka długoterminowa"/>
<text>
<reference value="#ENC_1"/>
</text> </encounter> </entry> </section> </component> </structuredBody> </component> </ClinicalDocument>
