<ClinicalDocument xsi:type="extPL:ClinicalDocument">
<!-- Recepta farmaceutyczna na Captopril -->
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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="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3"/>
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<qualifier>
<name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
<value code="F" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Farmaceutyczna"/>
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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" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Zwykły"/>
</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>
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<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"/>
<assignedAuthor>
<id extension="545632" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>
</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"/>
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<templateId root="2.16.840.1.113883.3.4424.13.10.2.33"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="545632" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>
<code code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>
<assignedPerson>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
<name>
<prefix>mgr farm.</prefix>
<given>Artur</given>
<family>Zwoliński</family>
</name> </assignedPerson>
<representedOrganization>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.2"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
<id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
<id extension="1007" root="2.16.840.1.113883.3.4424.2.6" displayable="true"/>
<name>Apteka 24h</name>
<telecom use="PUB" value="tel:22-2345123"/>
<telecom use="PUB" value="fax:22-2345100"/>
<addr>
<postalCode>00-950</postalCode>
<city>Warszawa</city>
<streetName>Dąbrowszczaków</streetName>
<houseNumber>34</houseNumber>
</addr> </representedOrganization> </assignedEntity> </legalAuthenticator>
<component>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.8"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.62"/>
<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>
<paragraph>
<caption>Powód wystawienia recepty farmaceutycznej</caption>
Stan nagły - kryza nadciśnieniowa.
</paragraph> </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>Dokument uprawnień</title>
<text>
<paragraph>Nr leg.: 234/1992</paragraph>
</text> </section> </component> </section> </component>
<component>
<section>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.38"/>
<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<text ID="SBADM_1">
<paragraph>
<caption>Rp. (Cito)</caption>
Captopril 25mg tabletki
1 op. po 30 tabl.
</paragraph>
<paragraph>
<caption>Odpłatność</caption>
100%
</paragraph> </text>
<entry>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.29"/>
<substanceAdministration classCode="SBADM" moodCode="RQO">
<text>
<reference value="#SBADM_1"/>
</text>
<consumable>
<manufacturedProduct>
<manufacturedLabeledDrug>
<code code="4532" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Captopril 25mg tabletki"/>
</manufacturedLabeledDrug> </manufacturedProduct> </consumable>
<entryRelationship typeCode="COMP">
<supply xsi:type="extPL:Supply" classCode="SPLY" moodCode="RQO">
<effectiveTime value="20130505"/>
<priorityCode code="UR" codeSystem="2.16.840.1.113883.5.7"/>
<independentInd value="false"/>
<product>
<manufacturedProduct>
<manufacturedLabeledDrug>
<code code="5909990673391" codeSystem="1.3.160" codeSystemName="GS1" displayName="Captopril Jelfa 25mg (30 tabl.)"/>
</manufacturedLabeledDrug> </manufacturedProduct> </product> </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>
1 tabl. podjęzykowo - doraźnie w razie wzwyżki ciśnienia tętniczego
</text>
</section> </component> </section> </component> </structuredBody> </component> </ClinicalDocument>