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<?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:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:type="extPL:ClinicalDocument">
    <!-- Zlecenie jednorazowe na nebulizator -->
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    <code code="57829-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medical equipment or product Document">
        <translation code="02.81" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Zlecenie na zaopatrzenie w wyroby medyczne">
			<qualifier>
                <name code="TZLECWM" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb zlecenia na zapotrzebowanie wyrobu medycznego"/>
                <value code="JEDN" displayName="Zlecenie jednorazowe" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3"/>
            </qualifier>
		</translation>
    </code>
    <title>Zlecenie na zaopatrzenie w wyroby medyczne</title>
    <effectiveTime value="20130412"/>
    <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
    <languageCode code="pl-PL"/>
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        <templateId root="2.16.840.1.113883.3.4424.13.10.2.29"/>
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            <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
            <id extension="62011699999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
            <addr>
                <city>Warszawa</city>
                <postalCode>01-134</postalCode>
                <streetName>Odkryta</streetName>
                <houseNumber>41</houseNumber>
                <unitID>12</unitID>
            </addr>
            <patient>
                <name>
                    <given>Jan</given>
                    <given>Franciszek</given>
                    <family>Kowalski</family>
                </name>
                <birthTime value="19620116"/>
            </patient>
        </patientRole>
    </recordTarget>
    <author>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.4"/>
        <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="false"/>
            <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>
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            <representedOrganization>
                <templateId root="2.16.840.1.113883.3.4424.13.10.2.17"/>
                <id extension="000000001007-01" root="2.16.840.1.113883.3.4424.2.3.2" displayable="true"/>
                <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>
                </addr>
                <asOrganizationPartOf>
                    <wholeOrganization>
                        <id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
                        <name>NZOZ „POL-MED”</name>
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                                <id extension="000000001007" 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"/>
                                <name>POL-MED Sp. z o.o.</name>
                            </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="123456" root="2.16.840.1.113883.3.4424.8.6.1.7"/>
                    <extPL:bounding typeCode="PART">
                        <extPL:reimburser classCode="UNDWRT">
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        </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>
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    <legalAuthenticator>
		<templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
        <time value="20130412"/>
        <signatureCode code="S"/>
        <assignedEntity>
            <id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
        </assignedEntity>
    </legalAuthenticator>
    <participant typeCode="IND">
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.19"/>
        <associatedEntity classCode="UNDWRT">
            <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
        </associatedEntity>
    </participant>
    <component>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.30"/>
        <structuredBody>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.8"/>
                    <title>Środek pomocniczy</title>
                    <text ID="SPLY_1">
                        <paragraph>
                            <caption>Liczba porządkowa wyrobu medycznego:</caption>
							9254.01
						</paragraph>
                        <paragraph>
                            <caption>Liczba sztuk:</caption>
							1
						</paragraph>
                        <paragraph>
                            <caption>Określenie wyrobu medycznego wraz z pisemnym uzasadnieniem (np. według klasyfikacji ICD-10):</caption>
							Inhalator dyszowy - nebulizator (generator aerozolu)
			            </paragraph>
                        <paragraph>
                            <caption>Zaopatrzenie:</caption>
			                nie dotyczy
			            </paragraph>
                        <paragraph>
                            <caption>Dodatkowe wskazania zlecającego zaopatrzenie:</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="2.16.840.1.113883.3.4424.13.10.4.7"/>
                        <supply classCode="SPLY" moodCode="RQO">
                            <text>
                                <reference value="#SPLY_1"/>
                            </text>
                            <quantity value="1"/>
                            <product>
                                <manufacturedProduct>
                                    <manufacturedMaterial>
                                        <code code="9254.01" codeSystem="2.16.840.1.113883.3.4424.11.1.43" displayName="Inhalator dyszowy: - nebulizator (generator aerozolu)"/>
                                    </manufacturedMaterial>
                                </manufacturedProduct>
                            </product>
                        </supply>
                    </entry>
                </section>
            </component>
        </structuredBody>
    </component>
</ClinicalDocument>
