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<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:extPL="http://www.csioz.gov.pl/xsd/extPL/r2" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="extPL:ClinicalDocument">
	<!-- Skierowanie na RTG -->
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        <translation code="02.10" displayName="Skierowanie na badanie lub leczenie" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1"/>
    </code>
    <title>Skierowanie na RTG</title>
    <effectiveTime value="20141001"/>
    <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
    <languageCode code="pl-PL"/>
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        <patientRole>
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            <id extension="72020299999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
            <addr>
                <city>Warszawa</city>
                <postalCode>01-926</postalCode>
                <streetName>Kwitnąca</streetName>
                <houseNumber>6a</houseNumber>
            </addr>
            <patient>
                <name>
                    <given>Józef</given>
                    <family>Wojewódzki</family>
                </name>
                <birthTime value="19720202"/>
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        <templateId root="2.16.840.1.113883.3.4424.13.10.2.86"/>
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                <name>
                    <prefix>dr n. med.</prefix>
                    <given>Marian</given>
                    <family>Walewski</family>
                </name>
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                <templateId root="2.16.840.1.113883.3.4424.13.10.2.17"/>
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                <name>Poradnia POZ</name>
                <telecom use="PUB" value="tel:22-1111123"/>
                <addr>
                    <postalCode>00-950</postalCode>
                    <city>Warszawa</city>
                    <streetName>Marszałkowska</streetName>
                    <houseNumber>320</houseNumber>
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                        <name>NZOZ „POL-MED”</name>
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                                <id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
                                <name>POL-MED Sp. z o.o.</name>
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                    <extPL:bounding typeCode="PART">
                        <extPL:reimburser classCode="UNDWRT">
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    <custodian>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>
        <assignedCustodian>
            <representedCustodianOrganization>
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    <informationRecipient typeCode="PRCP">
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                <name>DIAG-MED Warszawa</name>
                <telecom use="PUB" value="tel:22-343434555"/>
                <addr>
                    <postalCode>00-345</postalCode>
                    <city>Warszawa</city>
                    <streetName>Spokojna</streetName>
                    <houseNumber>112</houseNumber>
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        </intendedRecipient>
    </informationRecipient>
    <legalAuthenticator>
		<templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
        <time value="20141001"/>
        <signatureCode code="S"/>
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        <associatedEntity classCode="UNDWRT">
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                    <code code="29548-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis"/>
					<title>Rozpoznanie</title>
                    <text>
                        <paragraph>
                            <content ID="OBS_1">S53.1 Zwichnięcie stawu łokciowego, nie określone</content>
                        </paragraph>
                    </text>
                    <entry>
                        <templateId root="2.16.840.1.113883.3.4424.13.10.4.1"/>
                        <organizer classCode="BATTERY" moodCode="EVN">
                            <code code="8319008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Principal diagnosis"/>
                            <statusCode code="completed"/>
                            <component>
                                <observation classCode="OBS" moodCode="EVN">
                                    <code code="S53.1" codeSystem="2.16.840.1.113883.6.3" codeSystemName="icd10" displayName="Zwichnięcie stawu łokciowego, nie określone"/>
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                                        <reference value="#OBS_1"/>
                                    </text>
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                        </organizer>
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                </section>
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            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.6"/>
                    <code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
                    <!-- tytuł wymagany przez CSIOZ, to jest główna sekcja dokumentu skierowania -->
                    <title>Inne informacje</title>
                    <text ID="ENC_1">
                        <paragraph>
							<caption>Rodzaj badania: </caption>
							<content ID="OBS_1">RTG</content>
						</paragraph>
						<paragraph>
							<caption>Cel badania (uzasadnienie): </caption>
							In sit amet quam vel sem pellentesque euismod.
						</paragraph>
						<paragraph>
							<caption>Badania dotychczas wykonane: </caption>
							Lorem ipsum dolor sit amet, consectetur adipiscing elit. Quisque sed urna nibh. 
							Donec lacus mi, varius sed ex at, elementum mattis mauris. In sit amet quam vel sem pellentesque euismod. 
						</paragraph>
                    </text>
                    <entry>
                        <templateId root="2.16.840.1.113883.3.4424.13.10.4.6"/>
                        <encounter classCode="ENC" moodCode="RQO">
                            <code code="7240" codeSystem="2.16.840.1.113883.3.4424.11.2.4" displayName="Pracownia rentgenodiagnostyki ogólnej"/>
                            <text>
                                <reference value="#ENC_1"/>
                            </text>
                            <entryRelationship typeCode="COMP">
                                <observation classCode="OBS" moodCode="RQO">
                                    <code code="88.22" codeSystem="2.16.840.1.113883.3.4424.11.2.6" codeSystemName="ICD-9-PL" displayName="Zdjęcie RTG kości łokcia/przedramienia"/>
                                    <text>
                                        <reference value="#OBS_1"/>
                                    </text>
                                    <targetSiteCode code="005.003.006" codeSystem="2.16.840.1.113883.3.4424.11.3.23" codeSystemName="Słownik okolic ciała" displayName="Staw łokciowy">
                                        <qualifier>
                                           <name code="182353008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Side"/>
                                           <value code="7771000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT" displayName="Left (quailfier value)"/>
                                        </qualifier>
                                     </targetSiteCode>
                                </observation>
                            </entryRelationship>
                        </encounter>
                    </entry>
                </section>
            </component>
        </structuredBody>
    </component>
</ClinicalDocument>
