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<!-- Recepta na Atoris -->
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<title>Recepta</title>
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<city>Warszawa</city>
<postalCode>01-134</postalCode>
<streetName>Odkryta</streetName>
<houseNumber>41</houseNumber>
<unitID>12</unitID>
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<patient>
<name>
<given>Jan</given>
<given>Franciszek</given>
<family>Kowalski</family>
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<name>
<prefix>lek.</prefix>
<given>Piotr</given>
<family>Nowak</family>
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<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>
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<asOrganizationPartOf>
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<name>NZOZ „POL-MED”</name>
<asOrganizationPartOf>
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<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>
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<participant typeCode="IND">
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<associatedEntity classCode="UNDWRT">
<id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
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<structuredBody>
<component>
<section>
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<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>
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<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
No 28
</paragraph>
<paragraph>
<caption>Odpłatność</caption>
30%
</paragraph> </text>
<entry>
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<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"/>
<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"/>
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<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>
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
<!-- Recepta na maść cholesterolową -->
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<id extension="2345678" root="2.16.840.1.113883.3.4424.7.2.1" displayable="true"/>
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<qualifier>
<name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
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<qualifier>
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<value code="R" displayName="Lek recepturowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
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<name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
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<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"/>
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<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>
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<birthTime value="19620915"/>
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<author>
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<assignedAuthor>
<id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="false"/>
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<id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>
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<name>
<prefix>lek.</prefix>
<given>Piotr</given>
<family>Nowak</family>
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<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>
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<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"/>
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<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"/>
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<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
Vaselini albi 18,0
Paraffini liq. 64,0
Paraffini solidi 15,0
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>
<ClinicalDocument xsi:type="extPL:ClinicalDocument">
<!-- Recepta na maść cholesterolową -->
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
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<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"/>
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<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"/>
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<title>Recepta</title>
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<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>
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<prefix>lek.</prefix>
<given>Piotr</given>
<family>Nowak</family>
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<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>
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<name>NZOZ „POL-MED”</name>
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<id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
<name>POL-MED Sp. z o.o.</name>
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<participant typeCode="IND">
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<text ID="SBADM_1">
<paragraph>
<caption>Rp.</caption>
Cholesteroli 3,0
Vaselini albi 18,0
Paraffini liq. 64,0
Paraffini solidi 15,0
M.f. unq.
</paragraph>
<paragraph>
<caption>Odpłatność</caption>
R
</paragraph>
<paragraph>
<caption>Data realizacji od:</caption>
2015-11-22
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<reference value="#SBADM_1"/>
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<effectiveTime value="20151122"/>
<extPL:coverage typeCode="COVBY">
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<extPL:coveragePlan classCode="COV" moodCode="EVN">
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<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"/>
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<title>DS.</title>
<text>
2x dziennie
</text>
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