<ClinicalDocument xmlns="urn:hl*-org:v*" xmlns:voc="urn:hl7-org:v3/voc"
xmlns:sdtc="urn:hl7-org:sdtc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-
instance">
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<id root="2.16.840.1.113883.3.3710.0" extension="test-id-847322918"/>
<code code="34133-9" displayName="Summarization of episode note"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>View, Download, and Transmit Summary Document</title>
<effectiveTime value="202***********+0000"/>
<confidentialityCode code="N" displayName="normal"
codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality Code"/>
<languageCode code="en-US"/>
<recordTarget>
Patient
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<id root="2.16.840.1.113883.3.3710.200.501" extension="AdvancedMD"/>
<id root="2.16.840.1.113883.3.3710.200.500" extension="547758"/>
<addr use="H">
<streetAddressLine>7646 COTTAGE HILL RD., APT 1309</streetAddressLine>
<city>MOBILE</city>
<state>AK</state>
<postalCode>36695</postalCode>
<country>US</country>
<useablePeriod xsi:type="IVL_TS">
<low nullFlavor="NI"/>
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</useablePeriod>
</addr>
<telecom use="MC" value="tel:251-***-****"/>
<telecom value="mailto:*********@*****.***"/>
<patient>
<name>
<given>VIRGINIA</given>
<family>MARSTON</family>
</name>
<administrativeGenderCode code="F" displayName="Female"
codeSystem="2.16.840.1.113883.5.1" codeSystemName="Administrative Gender"/>
<birthTime value="19601212"/>
<maritalStatusCode nullFlavor="UNK"/>
<raceCode code="2106-3" displayName="White"
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<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino"
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<languageCommunication>
<languageCode code="en"/>
<preferenceInd value="true"/>
</languageCommunication>
</patient>
</patientRole>
</recordTarget>
<author>
<time value="202***********+0000"/>
Author
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
<addr use="WP">
<streetAddressLine>6163 Omni Park Drive</streetAddressLine>
<city>Mobile</city>
<state>AL</state>
<postalCode>366095195</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:251-***-****"/>
<assignedPerson>
<name>
<given>John</given>
<given qualifier="IN">Scott</given>
<family>VanLoock</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<custodian>
Custodian
<assignedCustodian>
<representedCustodianOrganization>
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<name>Mobile Dermatology, P.C.</name>
<telecom use="WP" value="tel:251-***-****"/>
<addr use="WP">
<streetAddressLine>6163 Omni Park Drive</streetAddressLine>
<city>Mobile</city>
<state>AL</state>
<postalCode>366095195</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<legalAuthenticator>
<time value="202***********+0000"/>
<signatureCode code="S"/>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<addr use="WP">
<streetAddressLine>6163 Omni Park Drive</streetAddressLine>
<city>Mobile</city>
<state>AL</state>
<postalCode>366095195</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:251-***-****"/>
<assignedPerson>
<name>
<given>John</given>
<given qualifier="IN">Scott</given>
<family>VanLoock</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<documentationOf>
Documentation Of
<serviceEvent classCode="PCPR">
<effectiveTime>
<low value="202***********"/>
<high value="202***********"/>
</effectiveTime>
<performer typeCode="PRF">
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<assignedPerson>
<name>
<given>John</given>
<given qualifier="IN">Scott</given>
<family>VanLoock</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<componentOf>
Component Of
<encompassingEncounter>
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extension="40624384"/>
<effectiveTime>
<low value="20210406"/>
</effectiveTime>
<encounterParticipant typeCode="ATND">
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<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
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<addr use="WP">
<streetAddressLine>6163 Omni Park Drive</streetAddressLine>
<city>Mobile</city>
<state>AL</state>
<postalCode>366095195</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:251-***-****"/>
<assignedPerson>
<name>
<given>John</given>
<given qualifier="IN">Scott</given>
<family>VanLoock</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</encounterParticipant>
<encounterParticipant typeCode="ATND">
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<streetAddressLine>6163 Omni Park Drive</streetAddressLine>
<city>Mobile</city>
<state>AL</state>
<postalCode>366095195</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:251-***-****"/>
<assignedPerson>
<name>
<given>Jessica</given>
<family>Lee</family>
<suffix>RN</suffix>
</name>
</assignedPerson>
</assignedEntity>
</encounterParticipant>
</encompassingEncounter>
</componentOf>
<component>
<structuredBody>
Social History Section
<component>
<section>
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<templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-
01"/>
<code code="29762-2" displayName="Social history Narrative"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Social History</title>
<text>
<table>
<thead>
<tr>
<th>Code</th>
<th>Activity</th>
<th>Start Date</th>
<th>End Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>449868002 (SNOMED)</td>
<td>
<content ID="SOCIAL1">Current every day smoker</content>
</td>
<td/>
<td/>
</tr>
<tr>
<td/>
<td>
<content ID="SOCIAL2">Birth Sex</content>
</td>
<td>female</td>
</tr>
</tbody>
</table>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.78"/>
<templateId root="2.16.840.1.113883.10.20.22.4.78" extension="2014-
06-09"/>
<id root="2.16.840.1.113883.3.3710.999.44.88800104237.7770000101"
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<code code="72166-2" displayName="Smoking Status"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#SOCIAL1"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20210406"/>
<value code="449868002" displayName="Current every day smoker"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" xsi:type="CD">
<originalText>
<reference value="#SOCIAL1"/>
</originalText>
</value>
<author typeCode="AUT">
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<time value="20210406"/>
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extension="7795929"/>
<code code="SELF" displayName="self"
codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode"/>
</assignedAuthor>
</author>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.200"/>
<templateId root="2.16.840.1.113883.10.20.22.4.200" extension="2016-
06-01"/>
<code code="76689-9" displayName="Sex Assigned At Birth"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#SOCIAL2"/>
</text>
<statusCode code="completed"/>
<value code="F" displayName="Female"
codeSystem="2.16.840.1.113883.5.1" codeSystemName="Administrative Gender"
xsi:type="CD">
<originalText>
<reference value="#SOCIAL2"/>
</originalText>
</value>
</observation>
</entry>
</section>
</component>
Problem Section
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.5.1"/>
<templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-
01"/>
<code code="11450-4" displayName="Problem List"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Problems</title>
<text>
<table>
<thead>
<tr>
<th>Problem</th>
<th>Code</th>
<th>Type</th>
<th>Status</th>
<th>Diagnosed Date</th>
<th>End Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="PROBLEM1">Basal cell carcinoma of upper extremity
(disorder)</content>
</td>
<td>402521004(SNOMED)</td>
<td>Diagnosis</td>
<td>active</td>
<td>04/06/2021</td>
<td/>
</tr>
<tr>
<td>
<content ID="PROBLEM2">Hyperthyroidism (disorder)</content>
</td>
<td>34486009(SNOMED)</td>
<td>Problem</td>
<td>active</td>
<td/>
<td/>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.3"/>
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<text>
<reference value="#PROBLEM1"/>
</text>
<statusCode code="active"/>
<effectiveTime>
<low value="20210406"/>
</effectiveTime>
<author>
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<time value="20210406"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4"
extension="2015-08-01"/>
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<code code="282291009" displayName="Diagnosis"
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</code>
<text>
<reference value="#PROBLEM1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20210406"/>
</effectiveTime>
<value code="402521004" displayName="Basal cell carcinoma of
upper extremity (disorder)" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED-CT" xsi:type="CD">
<originalText>
Basal cell carcinoma of upper extremity (disorder)
<reference value="#PROBLEM1"/>
</originalText>
<translation code="3543853"
codeSystem="2.16.840.1.113883.3.247.1.1" codeSystemName="IMO Core"
displayName="Basal cell carcinoma of upper extremity (disorder)"/>
</value>
<author>
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<time value="20210406"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
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</author>
</observation>
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</act>
</entry>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
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<id root="2.16.840.1.113883.3.3710.999.44.88800104237.7770000102"
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<code code="CONC" displayName="Concern"
codeSystem="2.16.840.1.113883.5.6" codeSystemName="HL7ActCode"/>
<text>
<reference value="#PROBLEM2"/>
</text>
<statusCode code="active"/>
<effectiveTime>
<low value="20210406"/>
</effectiveTime>
<author>
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<time value="20210406"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<templateId root="2.16.840.1.113883.10.20.22.4.4"
extension="2015-08-01"/>
<id root="2.16.840.1.113883.3.3710.999.44.88800104237.7770000102"
extension="126713569"/>
<code code="55607006" displayName="Problem"
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<translation code="75323-6" displayName="Condition"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
</code>
<text>
<reference value="#PROBLEM2"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="20210406"/>
</effectiveTime>
<value code="34486009" displayName="Hyperthyroidism (disorder)"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" xsi:type="CD">
<originalText>
Hyperthyroidism (disorder)
<reference value="#PROBLEM2"/>
</originalText>
</value>
<author>
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<time value="20210406"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
</assignedAuthor>
</author>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
Allergies Section
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
<templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-
01"/>
<code code="48765-2" displayName="Allergies &amp;or adverse
reactions" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Allergies</title>
<text>
<table>
<thead>
<tr>
<th>Substance</th>
<th>RxNorm</th>
<th>Reaction(s)</th>
<th>Severity</th>
<th>Status</th>
<th>Start Date</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="ALLERGYSUB1">No Known Allergies</content>
</td>
<td>N/A</td>
<td>
<content ID="Reaction1">N/A</content>
</td>
<td>
<content ID="Severity1">N/A</content>
</td>
<td>N/A</td>
<td>N/A</td>
</tr>
</tbody>
</table>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-
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<id nullFlavor="UNK"/>
<code code="CONC" displayName="Concern"
codeSystem="2.16.840.1.113883.5.6" codeSystemName="HL7ActCode"/>
<text>
<reference value="#ALLERGYSUB1"/>
</text>
<statusCode code="active"/>
<effectiveTime>
<low value="20210329"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<author>
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<time value="20210329"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
</assignedAuthor>
</author>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN" negationInd="true">
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<templateId root="2.16.840.1.113883.10.20.22.4.7"
extension="2014-06-09"/>
<id nullFlavor="NI"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
codeSystemName="HL7ActCode"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20210329"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<value code="419199007" displayName="allergy to substance"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" xsi:type="CD"/>
<author>
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<time value="20210329"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="136*******"/>
<code code="207N00000X" displayName="General Dermatology"
codeSystem="2.16.840.1.113883.6.101" codeSystemName="NUCC"/>
</assignedAuthor>
</author>
<participant typeCode="CSM">
<participantRole classCode="MANU">
<playingEntity classCode="MMAT">
<code nullFlavor="NI"/>
<name nullFlavor="NI"/>
</playingEntity>
</participantRole>
</participant>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
Medications Section
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.1.1"/>
<templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-
09"/>
<code code="10160-0" displayName="History of Medication use Narrative"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Medications</title>
<text>
<table>
<thead>
<tr>
<th>Medication</th>
<th>Generic Name</th>
<th>RxNorm</th>
<th>Strength</th>
<th>Strength Unit</th>
<th>Route</th>
<th>Dose</th>
<th>Dose Form</th>
<th>Frequency</th>
<th>Date Started</th>
<th>Date Ended</th>
<th>Status</th>
<th>Indication</th>
<th>Sig</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<content ID="MED1">Carafate</content>
</td>
<td>sucralfate</td>
<td/>
<td/>
<td/>
<td>Oral</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td>active</td>
<td/>
<td>
<content ID="Sig1">N/A</content>
</td>
</tr>
<tr>
<td>
<content ID="MED2">clonazepam</content>
</td>
<td>clonazepam</td>
<td/>
<td/>
<td/>
<td>Oral</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td>active</td>
<td/>
<td>
<content ID="Sig2">N/A</content>
</td>
</tr>
<tr>
<td>
<content ID="MED3">losartan</content>
</td>
<td>losartan</td>
<td/>
<td/>
<td/>
<td>Oral</td>
<td/>
<td/>
<td/>
<td/>
<td/>
<td>active</td>
<td/>
<td>
<content ID="Sig3">N/A</content>
</td>
</tr>
<tr>
<td>
<content ID="MED4">Percocet</content>
</td>
<td>oxycodone-acetaminophen</td>
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