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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 leczenie uzdrowiskowe -->
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    <id extension="2345678" root="2.16.840.1.113883.3.4424.7.4.1" displayable="false"/>
    <code code="57832-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for diagnostic or specialist care Document">
        <translation code="02.10" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Skierowanie na badanie lub leczenie">
            <qualifier>
                <name code="RSUZDR" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaje świadczenia uzdrowiskowego"/>
                <value code="LU" displayName="Leczenie uzdrowiskowe" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3"/>
            </qualifier>
        </translation>
    </code>
    <title>Skierowanie na leczenie uzdrowiskowe</title>
    <effectiveTime value="20130412"/>
    <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
    <languageCode code="pl-PL"/>
    <setId extension="432231" root="2.16.840.1.113883.3.4424.7.4.2"/>
    <versionNumber value="1"/>
    <recordTarget>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.26"/>
        <patientRole>
            <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
            <id extension="99011699999" 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>Adam</given>
                    <family>Kowalski</family>
                </name>
                <birthTime value="19990116"/>
                <guardian classCode="GUARD">
                    <id extension="66031699999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
                    <guardianPerson>
						<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
                        <name>
                            <given>Maria</given>
                            <family>Kowalska</family>
                        </name>
                    </guardianPerson>
                </guardian>
            </patient>
        </patientRole>
    </recordTarget>
    <author>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.86"/>
        <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>
            </assignedPerson>
            <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>
                        <asOrganizationPartOf>
                            <wholeOrganization>
                                <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"/>
                            </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">
                            <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>
    <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="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
        </assignedEntity>
    </legalAuthenticator>
    <component>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.35"/>
        <structuredBody>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.9"/>
                    <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social history"/>
                    <text>
                        <paragraph>
                            <caption>Rodzaj szkoły, klasa:</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>
                </section>
            </component>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.10"/>
                    <code code="10164-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of present illness"/>
                    <title>Wywiad</title>
                    <text>
                        <paragraph>
							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>
                        <paragraph>
                            <caption>Szczepienia ochronne:</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>
                        <paragraph>
                            <caption>Przebyte leczenie uzdrowiskowe:</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>
                </section>
            </component>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.11"/>
                    <code code="29545-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Physical findings"/>
                    <title>Badanie przedmiotowe</title>
                    <text>
						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. 
					</text>
                </section>
            </component>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.1"/>
                    <code code="29548-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnosis"/>
					<title>Rozpoznania</title>
                    <text>
                        <paragraph>
							Choroba zasadnicza będąca podstawą wystawienia skierowania w języku polskim wg. ICD-10:
							<br/>
                            <content ID="OBS_1">I25.2 Przebyty zawał mięśnia sercowego ściany przedniej</content>
                            <br/>
							Choroby współistniejące:
							<br/>
                            <content ID="OBS_2">I10 Nadciśnienie tętnicze</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="I25.2" codeSystem="2.16.840.1.113883.6.3" codeSystemName="icd10" displayName="Stary (przebyty) zawał serca"/>
                                    <text>
                                        <reference value="#OBS_1"/>
                                    </text>
                                </observation>
                            </component>
                        </organizer>
                    </entry>
                    <entry>
                        <templateId root="2.16.840.1.113883.3.4424.13.10.4.2"/>
                        <organizer classCode="BATTERY" moodCode="EVN">
                            <code code="85097005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Secondary diagnosis"/>
                            <statusCode code="completed"/>
                            <component>
                                <observation classCode="OBS" moodCode="EVN">
                                    <code code="I10" codeSystem="2.16.840.1.113883.6.3" codeSystemName="icd10" displayName="Samoistne (pierwotne) nadciśnienie"/>
                                    <text>
                                        <reference value="#OBS_2"/>
                                    </text>
                                </observation>
                            </component>
                        </organizer>
                    </entry>
                </section>
            </component>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.7"/>
                    <code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Relevant diagnostic tests/laboratory data"/>
                    <title>Aktualne wyniki badań</title>
                    <text>
						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. 
					</text>
                </section>
            </component>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.3.12"/>
                    <code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
                    <title>Wskazanie proponowanego miejsca i rodzaju leczenia uzdrowiskowego</title>
                    <text ID="ENC_1">
                        <paragraph>
                            <caption>Uzdrowisko:</caption>
							nadmorskie
						</paragraph>
                        <paragraph>
                            <caption>Rodzaj świadczenia:</caption>
							uzdrowiskowe leczenie szpitalne
						</paragraph>
                        <paragraph>
                            <caption>Przeciwwskazania do zabiegów z udziałem naturalnych surowców leczniczych:</caption>
							nie
						</paragraph>
                    </text>
                    <entry>
                        <templateId root="2.16.840.1.113883.3.4424.13.10.4.8"/>
                        <encounter classCode="ENC" moodCode="RQO">
                            <code code="6100" codeSystem="2.16.840.1.113883.3.4424.11.2.4" displayName="Szpital (oddział) uzdrowiskowy">
                                <qualifier>
                                    <name code="RUZDR" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaje uzdrowisk"/>
                                    <value code="NADM" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="nadmorskie"/>
                                </qualifier>
                            </code>
                            <text>
                                <reference value="#ENC_1"/>
                            </text>
                        </encounter>
                    </entry>
                </section>
            </component>
        </structuredBody>
    </component>
</ClinicalDocument>
