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hl7example.xml
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<?xml version="1.0" encoding="UTF-8"?>
<?xml-stylesheet href="CDA_PL_IG_1.3.1.xsl" type="text/xsl"?>
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:extPL="http://www.csioz.gov.pl/xsd/extPL/r2" xmlns:pharm="urn:ihe:pharm" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="extPL:ClinicalDocument">
<!-- Dokument recepty na lek OTC-->
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
<templateId root="1.3.6.1.4.1.19376.1.9.1.1.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.1.3" extension="1.3.1"/>
<id extension="876543" root="2.16.840.1.113883.3.4424.2.7.99999.2.1" displayable="true"/>
<code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
<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"/>
<value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
</qualifier>
<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"/>
</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"/>
</qualifier>
</translation>
</code>
<title>Recepta</title>
<effectiveTime value="20171012"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="pl-PL"/>
<setId extension="432231" root="2.16.840.1.113883.3.4424.2.7.99999.2.1"/>
<versionNumber value="1"/>
<recordTarget>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.3.4424.2.7.99999.17.1" displayable="false"/>
<id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
<addr>
<country>Polska</country>
<postalCode xsi:type="extPL:adxp.postalCode" postCity="Piaseczno">03-134</postalCode>
<city>Warszawa</city>
<streetName>Odkryta</streetName>
<houseNumber>41</houseNumber>
<unitID>12</unitID>
<censusTract>TERYT SIMC: 987654</censusTract>
</addr>
<patient>
<name>
<given>Jan</given>
<given>Franciszek</given>
<family>Kowalski</family>
</name>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/>
<birthTime value="19620915"/>
</patient>
</patientRole>
</recordTarget>
<author>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.82"/>
<functionCode code="FEL" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Felczer"/>
<time value="20171012"/>
<assignedAuthor>
<id extension="98765" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
<assignedPerson>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
<name>
<given>Adam</given>
<family>Kowalski</family>
</name>
</assignedPerson>
<representedOrganization>
<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=""/>
<addr>
<postalCode>00-950</postalCode>
<city>Warszawa</city>
<streetName>Marszałkowska</streetName>
<houseNumber>320</houseNumber>
</addr>
<asOrganizationPartOf>
<wholeOrganization>
<id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
<asOrganizationPartOf>
<wholeOrganization>
<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"/>
</wholeOrganization>
</asOrganizationPartOf>
</wholeOrganization>
</asOrganizationPartOf>
</representedOrganization>
</assignedAuthor>
</author>
<custodian>
<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"/>
<time value="20171012"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="98765" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
</assignedEntity>
</legalAuthenticator>
<component>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
<structuredBody>
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.9.1.2.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
<id extension="4321" root="2.16.840.1.113883.3.4424.2.7.99999.2.4"/>
<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<title>Rp.</title>
<text>
<paragraph ID="SBADM_1">
Polocard 150mg tabletki<br/>
1 op. po 60 tabl.<br/>
Odpłatność: 100%<br/>
D.S. 1 x 1 tabl. rano
</paragraph>
</text>
<entry>
<substanceAdministration classCode="SBADM" moodCode="INT">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.2"/>
<templateId root="2.16.840.1.113883.10.20.1.24"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7"/>
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.3"/>
<id extension="876543-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
<text>
<reference value="#SBADM_1"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20171012"/>
<high nullFlavor="NA"/>
</effectiveTime>
<repeatNumber value="1"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.1.53"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2"/>
<manufacturedMaterial>
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>
<code code="5679" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Polocard 150mg tabletki"/>
<name>Polocard 150mg tabletki</name>
<pharm:asContent classCode="CONT">
<pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
<pharm:code code="5909990655007" codeSystem="1.3.160" codeSystemName="GS1"/>
<pharm:name>Polocard 150mg (60 tabl.)</pharm:name>
<pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" displayName="Tablet container"/>
<pharm:capacityQuantity value="60"/>
</pharm:containerPackagedMedicine>
</pharm:asContent>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
<entryRelationship typeCode="COMP">
<supply classCode="SPLY" moodCode="RQO">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.8"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.55"/>
<effectiveTime value="20171012"/>
<independentInd value="false"/>
<quantity value="1"/>
<product>
<manufacturedProduct>
<manufacturedLabeledDrug>
<code code="5909990655007" codeSystem="1.3.160" codeSystemName="GS1" displayName="Polocard 150mg (60 tabl.)"/>
</manufacturedLabeledDrug>
</manufacturedProduct>
</product>
</supply>
</entryRelationship>
</substanceAdministration>
</entry>
</section>
</component>
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.1.9"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.5.3.7"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.69"/>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>Dane o ubezpieczeniu i uprawnieniach</title>
<text>
<paragraph ID="ACT_2"> Oddział NFZ: 07 <br/> Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015) </paragraph>
</text>
<entry>
<act classCode="ACT" moodCode="DEF">
<templateId root="2.16.840.1.113883.10.20.1.20"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>
<id nullFlavor="NA"/>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
<text><reference value="#ACT_2"/></text>
<statusCode code="completed"/>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN"> <!-- Uprawnienie dodatkowe -->
<templateId root="2.16.840.1.113883.10.20.1.26"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>
<id nullFlavor="NA"/>
<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
<qualifier>
<name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
<value code="IB" displayName="IB" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
</qualifier>
</code>
<text><reference value="#ACT_2"/></text>
<statusCode code="completed"/>
<performer typeCode="PRF"> <!-- Dane ubezpieczyciela/płatnika -->
<assignedEntity>
<id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
</assignedEntity>
</performer>
<entryRelationship typeCode="REFR">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.19"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>
<id nullFlavor="NA"/>
<code nullFlavor="NA"/>
<entryRelationship typeCode="SUBJ">
<substanceAdministration classCode="SBADM" moodCode="PRMS">
<id extension="2345678-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
<consumable>
<manufacturedProduct>
<manufacturedMaterial nullFlavor="NA"/>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entryRelationship>
</act>
</entryRelationship>
<reference typeCode="REFR">
<externalAct classCode="ACT" moodCode="EVN"> <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
<templateId root="2.16.840.1.113883.3.4424.13.10.4.58"/>
<id extension="123" root="2.16.840.1.113883.3.4424.8.4"/>
<code code="ELG" codeSystem="2.16.840.1.113883.5.4" displayName="Eligible"/>
</externalAct>
</reference>
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>