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<title>Recepta na import docelowy</title>
<effectiveTime value="20130412"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="pl-PL"/>
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<versionNumber value="1"/>
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<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"/>
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<author>
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<custodian>
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<legalAuthenticator>
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<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">
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<extPL:code code="0718" codeSystem="2.16.840.1.113883.3.4424.11.3.3" displayName="neurologia"/>
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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>
</addr>
<asOrganizationPartOf>
<wholeOrganization>
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<name>NZOZ „POL-MED”</name>
<asOrganizationPartOf>
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<name>POL-MED Sp. z o.o.</name>
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<participant typeCode="IND">
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<associatedEntity classCode="UNDWRT">
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<component>
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<section>
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<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<text ID="SBADM_1">
<paragraph>
<caption>Rp.</caption>
Glatiramer acetate 20mg/ml
No 28
</paragraph>
<paragraph>
<caption>Odpłatność</caption>
100%
</paragraph> </text>
<component>
<section>
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<code code="69730-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Instructions"/>
<title>DS.</title>
<text>
1x/dobę podskórnie
</text>
</section> </component> </section> </component> </structuredBody> </component> </ClinicalDocument>
