<?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">
    <!-- Recepta wystawiona przez asystenta medycznego -->
    <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="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.3.1"/>
    <id extension="000000000000324234" 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="Rpz" 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>
            <qualifier>
                <name code="RRECE" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
                <value code="ZW" displayName="zwykła" 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="ff543" root="2.16.840.1.113883.3.4424.2.7.99999.2.2"/>
    <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="2.16.840.1.113883.3.4424.13.10.2.79"/>
        <functionCode code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
        <time value="20130412"/>
        <assignedAuthor xsi:type="extPL:AssignedAuthor">
            <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
            <code code="0718_0726" codeSystem="2.16.840.1.113883.3.4424.11.3.3.1" displayName="neurologia, radiologia i diagnostyka obrazowa"/>
            <assignedPerson>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
                <name>
                    <prefix>lek.</prefix>
                    <given>Piotr</given>
                    <family>Nowak</family>
                </name>
            </assignedPerson>
            <representedOrganization>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.18"/>
                <id extension="000000008610-008" root="2.16.840.1.113883.3.4424.2.3.3" displayable="true"/>
                <name>Poradnia neurologiczna</name>
                <telecom use="PUB" value="tel:22-1111123"/>
                <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="000000008610" 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>
            <extPL:boundedBy typeCode="PART">
                <extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>
                <extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
                    <extPL:id extension="3329978" root="2.16.840.1.113883.3.4424.8.6.1.7"/>
                    <extPL:bounding typeCode="PART">
                        <extPL:reimburser classCode="UNDWRT">
                            <extPL:id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
                        </extPL:reimburser>
                    </extPL:bounding>
                </extPL:reimbursementRelatedContract>
            </extPL:boundedBy>
        </assignedAuthor>
    </author>
    <dataEnterer>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.90"/>
        <assignedEntity>
            <id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="false"/>
            <assignedPerson>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
                <name>
                    <given>Adam</given>
                    <family>Kwaśniewski</family>
                </name>
            </assignedPerson>
        </assignedEntity>
    </dataEnterer>
    <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="20130412"/>
        <signatureCode code="S"/>
        <assignedEntity>
            <id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="false"/>
            <assignedPerson>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
                <name>
                    <given>Adam</given>
                    <family>Kwaśniewski</family>
                </name>
            </assignedPerson>
        </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="9876" 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>Rpz (Cito)</title>
					<text>
						<paragraph ID="SBADM_1">
							<content ID="p1_nazwaLeku" styleCode="xPLbig">Rilutek 50mg tabl.
								powl.</content>
							<content ID="p1_mocSkladnikowLeku">(0.05 g)</content>
							<content ID="p1_edytuj_mocLeku"></content>
							<content ID="p1_edytuj_postacLeku"></content>
							<content ID="p1_nieZamieniac" styleCode="xPLbig">NZ</content>
						</paragraph>
						<paragraph>
							<content ID="p1_iloscLeku">2</content>
							<content ID="p1_krotnosc_opis">op. po</content>
							<content ID="p1_wielkoscOpakowania">56 szt.</content>
						</paragraph>
						<paragraph ID="DS_1">
							<content ID="p1_stosowanie_opis_1">D.S.</content>
							<content ID="p1_stosowanie_wartosc_1" styleCode="Bold">2 x
								dziennie po 1 tabl.</content>
							<content ID="p1_edytuj_stosowanie_wartosc_1"
								styleCode="Bold"></content>
						</paragraph>
						<paragraph ID="ACT_2">
							<content ID="p1_odplatnosc_opis">Odpłatność</content>
							<content ID="p1_odplatnosc_wartosc" styleCode="Bold">100%</content>
						</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="000000000000324234-1" 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="20130412"/>
                                <high nullFlavor="NA"/>
                            </effectiveTime>
							<effectiveTime xsi:type="PIVL_TS" operator='A'>
								<period value="12" unit="h"/>
							</effectiveTime>
                            <repeatNumber value="0"/>
                            <doseQuantity value='1' unit="tabl."/>
                            <rateQuantity 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="7897" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Rilutek 50mg tabl. powl."/>
                                        <name>Rilutek 50mg tabl. powl.</name>
                                        <pharm:asContent classCode="CONT">
                                            <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                                                <pharm:code code="5909990760619" codeSystem="1.3.160" codeSystemName="GS1"/>
                                                <pharm:name>Rilutek 50mg tabl. powl. (56 tabl.)</pharm:name>
                                                <!-- należy zdefiniować słownik polskojęzyczny celem generowania treści bloku narracyjnego -->
                                                <!--<pharm:formCode code="30066000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Tablet container"/>-->
                                                <pharm:capacityQuantity value="56"/>
                                            </pharm:containerPackagedMedicine>
                                        </pharm:asContent>
                                        <pharm:ingredient classCode="ACTI">
                                            <pharm:quantity>
                                                <numerator xsi:type="PQ" value="0.05" unit="g"/>
                                                <denominator xsi:type="PQ" value="1"/>
                                            </pharm:quantity>
                                            <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                                                <pharm:code code="23432" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Wazelina biała"/>
                                                <pharm:name>ryluzol</pharm:name>
                                            </pharm:ingredient>
                                        </pharm:ingredient>
                                    </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="20130412"/>
                                    <priorityCode code="UR" codeSystem="2.16.840.1.113883.5.7"/>
                                    <independentInd value="false"/>
                                    <quantity value="2"/>
                                    <product>
                                        <manufacturedProduct>
                                            <manufacturedLabeledDrug>
                                                <code code="5909990760619" codeSystem="1.3.160" codeSystemName="GS1"/>
                                            </manufacturedLabeledDrug>
                                        </manufacturedProduct>
                                    </product>
                                    <entryRelationship typeCode="COMP">
                                        <act classCode="ACT" moodCode="DEF">
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.57"/>
                                            <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">
                                                    <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" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Poziomy odpłatności leków refundowanych"/>
                                                            <value code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1" displayName="pełnopłatne" />
                                                        </qualifier>
                                                    </code>
                                                    <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>
                                                </act>
                                            </entryRelationship>
                                        </act>
                                    </entryRelationship>
                                </supply>
                            </entryRelationship>
                            <entryRelationship typeCode="COMP">
                                <act classCode="ACT" moodCode="DEF">
                                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.9.1"/>
                                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.56"/>
                                    <code code="N" codeSystem="2.16.840.1.113883.5.1070" codeSystemName="HL7 Substance Admin Substitution"/>
                                    <text><reference value="#ACT_1"/></text>
                                    <statusCode code="completed"/>
                                </act>
                            </entryRelationship>
                            <!-- informacja o stosowaniu leku podana w bloku narracyjnym -->
                            <entryRelationship typeCode='SUBJ' inversionInd='true'>
								<act classCode='ACT' moodCode='INT'>
									<templateId root='2.16.840.1.113883.3.4424.13.10.4.74'/>
									<templateId root='2.16.840.1.113883.10.20.1.49'/>
									<templateId root='1.3.6.1.4.1.19376.1.5.3.1.4.3'/>
									<code code='PINSTRUCT' codeSystem='1.3.6.1.4.1.19376.1.5.3.2' codeSystemName='IHEActCode' />
									<text>
										<reference value='#DS_1'/>
									</text>
									<statusCode code='completed' />
								</act>
							</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_3">
							<content ID="p1_platnik_opis_1">Oddział NFZ</content>
							<content ID="p1_platnik_wartosc_1" styleCode="Bold">07</content>
						</paragraph>
						<paragraph>
							<content ID="p1_uprawnieniaDodatkowe_opis_1">Uprawnienia dodatkowe</content>
							<content ID="p1_uprawnieniaDodatkowe_wartosc_1"
								styleCode="Bold">IB</content>
							(
							<content ID="p1_dokumentUprawnien_wartosc_1">Nr leg.: 234/1992</content>
							)
						</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_3"/></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_3"/></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="de343d-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">
                                        <externalDocument classCode="DOC" moodCode="EVN"> <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
                                            <text>Nr leg.: 234/1992</text>
                                        </externalDocument>
                                    </reference>
                                </act>
                            </entryRelationship>
                        </act>
                    </entry>
                </section>
            </component>
        </structuredBody>
    </component>
</ClinicalDocument>
