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			<qualifier>
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				<value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
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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" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
			</qualifier>
			<qualifier>
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                <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
            </qualifier>
            <qualifier>
                <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
                <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
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			<qualifier>
				<name code="TWLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wydania leku"/>
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	<title>Realizacja recepty elektronicznej</title>
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			<addr>
				<country>Polska</country>
				<postalCode>58-200</postalCode>
				<city>Dzierżoniów</city>
				<streetName>Szpitalna</streetName>
				<houseNumber>3a</houseNumber>
				<unitID>10</unitID>
			</addr>
			<patient>
				<name>
					<given>Anna</given>
					<given>Maria</given>
					<family>Nowak</family>
				</name>
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				<birthTime value="19960130"/>
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	<author>
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		<functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>
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				<name>
					<prefix>mgr</prefix>
					<given>Miłosz</given>
					<family>Najman</family>
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				<name>Apteka porcelanowa</name>
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				<addr>
					<country>Polska</country>
					<postalCode>31-867</postalCode>
					<city>Kraków</city>
					<streetName>Mikołaja Kopernika</streetName>
					<houseNumber>36</houseNumber>
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		<time value="20150301122300"/>
		<signatureCode code="S"/>
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		<structuredBody>
			<component>
				<section>
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					<title>Wydanie leku</title>
					<text>
						<paragraph ID="SPLY_1">
							<caption>Wydanie leku recepturowego</caption>
							Receptura:<br/>
							Lanolini 25,0<br/>
                            Vaselini albi 25,0<br/>
                            Paraffini liq. 10,0<br/>
                            Aquae aa ad 100,0<br/>
							Postać: maść<br/>
							Ilość: 100 g<br/>
						</paragraph>
						<paragraph ID="ACT_1">
							<caption>Taksacja:</caption>
							Wartość wydanego leku: 30,00<br/>
                            Poziom odpłatności leku refundowanego: 30%<br/>
                            Kwota refundacji: 21,00 <br/>
                            Zapłacono: 9,00<br/>
                            Taksa laborum: 12,33
						</paragraph>
						<paragraph ID="ACT_3">
							<caption>Osoba przyjmująca do realizacji:</caption>
							Anna Nowak
						</paragraph>
						<paragraph ID="ACT_4">
							<caption>Osoba przygotowująca:</caption>
							Anna Nowak
						</paragraph>
					</text>
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						<supply classCode="SPLY" moodCode="EVN">
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							<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
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							<text>
								<reference value="#SPLY_1"/>
							</text>
							<quantity value="100" unit="g"/>
							<product>
								<manufacturedProduct>
									<manufacturedMaterial>
										<templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
										<templateId root="2.16.840.1.113883.3.4424.13.10.4.70"/>
										<code nullFlavor="NA"/>
										<name>Maść pośladkowa</name>
										<pharm:formCode code="10504000" codeSystem="0.4.0.127.0.16.1.1.2.1" codeSystemName="EDQM" displayName="Ointment"/>
                                        <pharm:ingredient classCode="ACTI">
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
											<pharm:quantity>
												<numerator xsi:type="PQ" value="25" 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>Vaselinum album</pharm:name>
                                            </pharm:ingredient>
                                        </pharm:ingredient>
                                        <pharm:ingredient classCode="ACTI">
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
											<pharm:quantity>
												<numerator xsi:type="PQ" value="25" unit="g"/>
												<denominator xsi:type="PQ" value="1"/>
											</pharm:quantity>
                                            <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                                            	<pharm:code code="34543" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Lanolina"/>
                                                <pharm:name>Lanolinum</pharm:name>
                                            </pharm:ingredient>
                                        </pharm:ingredient>
                                        <pharm:ingredient classCode="ACTI">
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
											<pharm:quantity>
												<numerator xsi:type="PQ" value="10" unit="g"/>
												<denominator xsi:type="PQ" value="1"/>
											</pharm:quantity>
                                            <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                                            	<pharm:code code="45654" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Parafina ciekła"/>
                                                <pharm:name>Paraffinum liquidum</pharm:name>
                                            </pharm:ingredient>
                                        </pharm:ingredient>
                                        <pharm:ingredient classCode="ACTI">
                                            <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
                                            <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                                            	<pharm:code code="56765" codeSystem="2.16.840.1.113883.3.4424.6.3" displayName="Woda do receptury aptecznej FP"/>
                                                <pharm:name>Aqua</pharm:name>
                                            </pharm:ingredient>
                                        </pharm:ingredient>
									</manufacturedMaterial>
								</manufacturedProduct>
							</product>
							<entryRelationship typeCode="REFR">
								<substanceAdministration classCode="SBADM" moodCode="INT">
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									</consumable>
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											<id extension="656789" root="2.16.840.1.113883.3.4424.2.7.99999.2.1"/>
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							</entryRelationship>
							<entryRelationship typeCode="COMP">
								<act classCode="ACT" moodCode="EVN">
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									<code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
									<text>
										<reference value="#ACT_1"/>
									</text>
									<statusCode code="completed"/>
									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="DEF">
											<code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
											<statusCode code="completed"/>
											<value xsi:type="REAL" value="30.00"/>
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									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="DEF">
											<code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
											<statusCode code="completed"/>
											<value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
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										<observation classCode="OBS" moodCode="INT">
											<code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
											<statusCode code="completed"/>
											<value xsi:type="REAL" value="21.00"/>
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										<observation classCode="OBS" moodCode="EVN">
											<code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
											<statusCode code="completed"/>
											<value xsi:type="REAL" value="9.00"/>
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									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="EVN">
											<code code="TAKL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksa laborum"/>
											<statusCode code="completed"/>
											<value xsi:type="REAL" value="12.33"/>
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							</entryRelationship>
							<entryRelationship typeCode="COMP">
								<act classCode="ACT" moodCode="EVN">
									<templateId root="2.16.840.1.113883.3.4424.13.10.4.81"/>
									<code code="PRLR" codeSystem="2.16.840.1.113883.3.4424.13.5.3.14"/>
									<text>
										<reference value="#ACT_3"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime value="201810231230"/>
									<performer typeCode="PRF">
										<templateId root="2.16.840.1.113883.3.4424.13.10.4.83"/>
										<assignedEntity>
											<id extension="7724514" root="2.16.840.1.113883.3.4424.1.6.1"/>
											<assignedPerson>
												<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
												<name>
													<given>Anna</given>
													<family>Nowak</family>
												</name>
											</assignedPerson>
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									</performer>
								</act>
							</entryRelationship>
							<entryRelationship typeCode="COMP">
								<act classCode="ACT" moodCode="EVN">
									<templateId root="2.16.840.1.113883.3.4424.13.10.4.82"/>
									<code code="PLR" codeSystem="2.16.840.1.113883.3.4424.13.5.3.14" displayName="Przygotowanie leku recepturowego"/>
									<text>
										<reference value="#ACT_4"/>
									</text>
									<statusCode code="completed"/>
									<effectiveTime value="201810231230"/>
									<performer typeCode="PRF">
										<templateId root="2.16.840.1.113883.3.4424.13.10.4.83"/>
										<assignedEntity>
											<id extension="7724514" root="2.16.840.1.113883.3.4424.1.6.1"/>
											<assignedPerson>
												<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
												<name>
													<given>Anna</given>
													<family>Nowak</family>
												</name>
											</assignedPerson>
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									</performer>
								</act>
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						</supply>
					</entry>
				</section>
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				<section>
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					<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>
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								<reference value="#ACT_2"/>
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							<statusCode code="completed"/>
							<entryRelationship typeCode="COMP">
								<act classCode="ACT" moodCode="EVN">
									<!-- Uprawnienie dodatkowe -->
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											<name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
											<value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
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									</code>
									<statusCode code="completed"/>
									<performer typeCode="PRF">
										<!-- Dane ubezpieczyciela/płatnika -->
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											<id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
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										<act classCode="ACT" moodCode="EVN">
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												<supply classCode="SPLY" moodCode="PRMS">
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									</entryRelationship>
									<!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
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										<externalDocument classCode="DOC" moodCode="EVN">
											<templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
											<text>Nr leg.: 238/2015</text>
										</externalDocument>
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						</act>
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				</section>
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