<?xml version="1.0"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
xmlns="urn:hl7-org:v3"
xmlns:cda="urn:hl7-org:v3">
<!-- Start of CDA Header -->
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- CRC Document Template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.1.3"/>
<id extension="999021" root="2.16.840.1.113883.19"/>
<code codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" code="34896-1"
displayName="Interventional Procedure Note - Cardiology"/>
<title>Electrophysiology Report - Implant of single chamber ICD (1 Lead)</title>
<effectiveTime value="20130926"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<recordTarget>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.19"/>
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(781)555-1212" use="HP"/>
<patient>
<name>
<prefix>Mr.</prefix>
<given>Adam</given>
<given>Frankie</given>
<family>Everyman</family>
</name>
<administrativeGenderCode code="M"
codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="19541125"/>
</patient>
</patientRole>
</recordTarget>
<author>
<time value="20130926224411+0500"/>
<assignedAuthor>
<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>Good Health EP Clinic</name>
<telecom value="tel:(555)555-1212" use="WP"/>
<addr use="WP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<legalAuthenticator>
<time value="20130926224411+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time value="20130926224411+0500"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="KP00017" root="2.16.840.1.113883.19"/>
<addr>
<streetAddressLine>21 North Ave.</streetAddressLine>
<city>Burlington</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:(555)555-1003"/>
<assignedPerson>
<name>
<given>Henry</given>
<family>Seven</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<inFulfillmentOf>
<order>
<id root="1.2.3.4.5.6" extension="accession#1" />
<priorityCode code="R" codeSystem=" 2.16.840.1.113883.5.7"
codeSystemName="ActPriority" displayName="Routine"/>
</order>
</inFulfillmentOf>
<authorization typeCode="AUTH">
<consent classCode="CONS" moodCode="EVN">
<id root="629deb70-5306-11df-9879-0800200c9a66" />
<code codeSystem=" 2.16.840.1.113883.6.1" codeSystemName="LOINC"
code="64293-4" displayName="Procedure Consent"/>
<statusCode code="completed"/>
</consent>
</authorization>
<authorization typeCode="AUTH">
<consent classCode="CONS" moodCode="EVN">
<id root="629deb70-5306-11df-9879-0800200c9a66" />
<code codeSystem=" 2.16.840.1.113883.6.1" codeSystemName="LOINC"
code="61359-6" displayName="Anesthesia Consent"/>
<statusCode code="completed"/>
</consent>
</authorization>
<componentOf>
<encompassingEncounter>
<id extension="KP00017" root="2.16.840.1.113883.19"/>
<effectiveTime value="20130926"/>
<code code="425435003" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Implantation of cardioverter defibrillator with one electrode lead"/>
<location>
<healthCareFacility>
<id root="1.2.3.4.5.6.7" extension="facility ID"/>
<code code="CVDX" codeSystem="2.16.840.1.113883.5.111"
codeSystemName="roleCode" displayName="EP Lab"/>
<serviceProviderOrganization>
<name>My Favorite Electrophysiology Care Organization</name>
<addr>
<streetAddressLine>Healthcare Lane</streetAddressLine>
<city>East Town</city>
<state>OH</state>
<country>US</country>
</addr>
<telecom value="1-800-555-1212" use="WP"/>
</serviceProviderOrganization>
<location>
<name>My Cardiac Hospital</name>
<addr>
<streetAddressLine>Healthcare Lane</streetAddressLine>
<city>East Town</city>
<state>OH</state>
<country>US</country>
</addr>
</location>
</healthCareFacility>
</location>
<encounterParticipant typeCode="REF">
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="12345"/>
<!-- Need real code -->
<code code="xyz" codeSystem="2.16.840.1.113883.6.101"
codeSystemName="nuccProviderCodes"
displayName="Referring cardiologist"/>
<addr>Referring Physician Lane, USA</addr>
<telecom value="1-800-555-1212" use="WP"/>
<assignedPerson>
<name>Dr. Referring Physician</name>
</assignedPerson>
</assignedEntity>
</encounterParticipant>
</encompassingEncounter>
</componentOf>
<documentationOf>
<serviceEvent classCode="PROC">
<!-- need to check code...change to specific EP procedure code -->
<code code="252425004" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Cardiac electrophysiology"/>
<!-- need to check on ID to use for this service event... -->
<id root="DICOM study instance UID" extension="accession1"/>
<effectiveTime>
<low value="201309261000" />
<width value="15" unit="m"/>
</effectiveTime>
<performer typeCode="PPRF">
<assignedEntity>
<id extension="IO00017" root="2.16.840.1.113883.19.5" />
<!-- need a code... -->
<code code="17561000"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Cardiologist" />
<addr>
<streetAddressLine>1001 Hospital Lane</streetAddressLine>
<city>Ann Arbor</city>
<state>MI</state>
<postalCode>99999</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(999)555-1212" />
<assignedPerson>
<name>
<prefix>Dr.</prefix>
<given>Tony</given>
<family>Tum</family>
</name>
</assignedPerson>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!-- End of CDA Header -->
<!-- Start of CDA Body -->
<component>
<structuredBody>
<!-- *** Document Summary Section*** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.16"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
code="55112-7" displayName="DOCUMENT SUMMARY"/>
<title>EP PROCEDURE SUMMARY</title>
<text>
<paragraph>An implant of a single chamber ICD was performed. The following image shows the
region of interest.</paragraph>
<renderMultiMedia referencedObject="EPRC-image1"/>
<paragraph>The patient needed no further interventions.</paragraph>
</text>
<entry>
<observationMedia classCode="OBS" moodCode="EVN" ID="EPRC-image1">
<id root="2.16.840.1.113883.19.2.1"/>
<value xsi:type="ED" mediaType="image/jpeg">
<reference value="sample EP implant image.jpeg"/>
</value>
</observationMedia>
</entry>
</section>
</component>
<!-- *** Medical History - Cardiac Section *** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.17"/>
<templateId root="2.16.840.1.113883.10.20.22.2.39"/>
<code code="11329-0" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="MEDICAL (GENERAL) HISTORY"/>
<title>MEDICAL (GENERAL) HISTORY</title>
<text>
<list listType="ordered">
<item><content ID="medhist1">The patient has ischemic cardiomyopathy resulting in chronic
systolic heart failure.</content></item>
<item><content ID="medhist2">The patient denies palpitiations or syncope.</content></item>
<item><content ID="medhist3">The patient had recent weight gain due to sedentary lifestyle
and new job.</content></item>
<item><content ID="medhist4">The patient had a left heart cath procedure in
2006.</content></item>
<item><content ID="medhist5">The patient had another left heart cath procedure in
2011.</content></item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.9"/>
<!-- Problem Observation - Cardiac template -->
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<code code="55607006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Problem"/>
<text>
<reference value="#medhist1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
</effectiveTime>
<value xsi:type="CD" code="194849004"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Ischemic Cardiomyopathy"/>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.31"/>
<!-- Age observation template -->
<code code="445518008" codeSystem="2.16.840.1.113883.6.96"
displayName="Age At Onset"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="70" unit="a"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<!-- Problem status template -->
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Active"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="REFR" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.5"/>
<!-- Health status observation template -->
<code code="11323-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Health status"/>
<statusCode code="completed"/>
<value xsi:type="CE" code="413322009"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Resolved"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="REFR" inversionInd="true">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
<!-- Severity observation template -->
<code code="SEV" displayName="Severity Observation"
codeSystem="2.16.840.1.113883.5.4"
codeSystemName="ActCode"/>
<text>Severity: Moderate to severe</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="371924009" displayName="Moderate to severe"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"/>
</observation>
</entryRelationship>
</observation>
</entry>
<entry>
<act classCode="ACT" moodCode="EVN" negationInd="True">
<templateId root="2.16.840.1.113883.10.20.22.4.3"/>
<!-- Problem Concern ACT template (CCDA)-->
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<code code="CONC" codeSystem="2.16.840.1.113883.5.6"
codeSystemName="HL7 Act Class"
displayName="Concern"/>
<text>
<reference value="#medhist2"/>
</text>
<statusCode code="completed"/>
<effectiveTime><low value="201309261000"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation classCode="OBS" moodCode="EVN" negationInd="true">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<!-- Problem observation template -->
<code code="64572001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Condition"/>
<value xsi:type="CD" code="271594007"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Syncope"/>
<statusCode code="completed"/>
</observation>
</entryRelationship>
</act>
</entry>
<entry>
<procedure classCode="PROC" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<!-- Procedure Activity Procedure template -->
<id root="e401f340-7be2-11db-9fe1-0800200c9a66"/>
<code code="500786010" codeSystem="1.3.6.1.4.1.19376.1.4.1.5.40"
displayName="Left Heart Cath Procedure">
<originalText>
<reference value="#medhist4"/>
</originalText>
</code>
<text>
<reference value="#medhist4"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="2006"/>
<targetSiteCode code="41879009" codeSystem="2.16.840.1.113883.6.96"
displayName="Distal RCA"/>
</procedure>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.13"/>
<!-- Procedure Activity Observation template -->
<id extension="proc1" root="2.16.840.1.113883.19"/>
<code code="500786010" codeSystem="2.16.840.1.113883.6.96"
displayName="Left Heart Cath Procedure" codeSystemName="SNOMED CT">
<originalText>
<reference value="#medhist5"/>
</originalText>
</code>
<statusCode code="completed"
codeSystem="2.16.840.1.113883.5.14"
codeSystemName="ActStatus"/>
<effectiveTime value="20110203"/>
<priorityCode code="CR" codeSystem="2.16.840.1.113883.5.7"
codeSystemName="ActPriority"
displayName="Callback results"/>
<value xsi:type="CD" code="" codeSystem="2.16.840.1.113883.6.96"/>
<methodCode nullFlavor="UNK"/>
<targetSiteCode code="91083009" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Proximal Right Coronary Artery" />
<performer>
<assignedEntity>
<id root="1.2.3.4" extension="1234"/>
<addr>
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Blue Bell</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="1(555)555-1234"/>
<representedOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>Good Health Clinic</name>
<telecom nullFlavor="UNK"/>
<addr nullFlavor="UNK"/>
</representedOrganization>
</assignedEntity>
</performer>
</observation>
</entry>
</section>
</component>
<!-- *** Allergies Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.6"/>
<code code="48765-2"
displayName="Allergies, adverse reactions, alerts"
codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<title>Allergies</title>
<text>
<content ID="allergies1">The patient has no known allergies.</content>
</text>
<entry typeCode="DRIV">
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
<!-Allergy Problem Act template
-->
<id root="36e3e930-7b14-11db-9fe1-0800200c9a66"/>
<code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
displayName="Allergies, adverse reactions, alerts"/>
<statusCode code="active"/>
<effectiveTime>
<low value="20130926"/>
</effectiveTime>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<!-- allergy observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
<id root="4adc1020-7b14-11db-9fe1-0800200c9a66"/>
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="20130926"/>
</effectiveTime>
<value xsi:type="CD" code="160244002" displayName="No known
allergies" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
<originalText>
<reference value="#allergies1"/>
</originalText>
</value>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- *** Family History - Cardiac Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.15"/>
<!-- Family history section template -->
<code code="10157-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>Family history</title>
<text>
<content ID="famhist1">There was no family history of cardiovascular
disease.</content>
</text>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.45"/>
<statusCode code="completed"/>
<subject>
<relatedSubject classCode="PRS">
<code code="FAMMEMB" codeSystem="2.16.840.1.113883.5.111">
<translation code="303071001"
codeSystem="2.16.840.1.113883.6.96"/>
</code>
</relatedSubject>
</subject>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.46"/>
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<code code="404684003" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Finding"/>
<text>
<reference value="#famhist1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
</effectiveTime>
<value xsi:type="CD" code="160270001"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="No family history of cardiovascular
disease"/>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!-- *** Social History Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.17"/>
<!-- ** Social history section template
** -->
<code code="29762-2" codeSystem="2.16.840.1.113883.6.1"
displayName="Social History"/>
<title>Social History</title>
<text>The patient never smoked.</text>
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.78"/>
<!-- ** Smoking status observation template
** -->
<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="2013"/>
</effectiveTime>
<value xsi:type="CD" code="266919005"
codeSystem="2.16.840.1.113883.6.96"
displayName="Never Smoker"/>
</observation>
</entry>
</section>
</component>
<!-- *** Physical Exam Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.2.10"/>
<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
code="29545-1" displayName="PHYSICAL FINDINGS"/>
<title>PHYSICAL EXAMINATION</title>
<text>
<paragraph>All normal to examination.</paragraph>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="27201600"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Chest Finding"/>
<text><reference value="#Chest Exam: Normal"/></text>
<statusCode code="completed"/>
<effectiveTime value="201309261000"/>
<value xsi:type="CD" code="275736000"
codeSystem="2.16.840.1.113883.6.96"
displayName="Chest Examination Normal"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</entry>
</section>
</component>
<!-- *** Vital Signs Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.4"/>
<code code="8716-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="VITAL SIGNS" />
<title>Vital Signs</title>
<text>These are the vital signs related to the procedure:
<list>
<item><content ID="height1">Height: 162.6 cm</content></item>
<item><content ID="weight1">Weight: 61 kg</content></item>
<item><content ID="temp1">Body temperature: 97 deg</content></item>
</list>
</text>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.26"/>
<!-- Vital signs organizer template -->
<id root="c6f88320-67ad-11db-bd13-0800200c9a66"/>
<code code="46680005" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Vital signs"/>
<statusCode code="completed"/>
<effectiveTime value="201309261000"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital sign observation for height -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8302-2"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Height"/>
<text><reference value="#height1"/></text>
<statusCode code="completed"/>
<effectiveTime value="201309261000"/>
<value xsi:type="PQ" value="162.6" unit="cm"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital sign observation for weight -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8336-0"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Weight"/>
<text><reference value="#weight1"/></text>
<statusCode code="completed"/>
<effectiveTime value="201309261000"/>
<value xsi:type="PQ" value="61.0" unit="kg"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.27"/>
<!-- Vital sign observation for body temperature -->
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="8310-5"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Body Temperature"/>
<text><reference value="#temp1"/></text>
<statusCode code="completed"/>
<effectiveTime value="201309261000"/>
<value xsi:type="PQ" value="97" unit="deg"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!-- *** Pre-Procedure Results - Cardiac Section *** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.23"/>
<templateId root="2.16.840.1.113883.10.20.22.2.3"/>
<code code="30954-2"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="RESULTS" />
<title>Results</title>
<text>
These are the pre-procedure results:
<list>
<item><content ID="PriorRes1">Left ventricular ejection fraction:
20%</content></item>
</list>
</text>
<entry typeCode="DRIV">
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.1"/>
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.11"/>
<id root="7d5a02b0-67a4-11db-bd13-0800200c9a66"/>
<code nullFlavor="OTH" displayName="Prior Cardiac Results"/>
<statusCode code="completed"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation template -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="107c2dc0-67a5-11db-bd13-0800200c9a66"/>
<code code="10230-1" displayName="Left Ventricular Ejection
Fraction"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"/>
<statusCode code="completed"/>
<effectiveTime value="201303231430"/>
<text><reference value="#PriorRes1"/></text>
<value xsi:type="PQ" value="20" unit="%"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
</observation>
</component>
<reference typeCode="REFR">
<externalDocument>
<id root="b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3"/>
<text mediaType="application/pdf">
<reference value="PreProcedureResults.pdf"/>
</text>
</externalDocument>
</reference>
</organizer>
</entry>
</section>
</component>
<!-- *** Planned Procedure Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.30"/>
<!-- ******** Planned Procedure Section template ******** -->
<code code="59772-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Planned Procedure"/>
<title>Planned Procedure</title>
<text>An implant of a single chamber ICD.</text>
<entry>
<procedure moodCode="RQO" classCode="PROC">
<templateId root="2.16.840.1.113883.10.20.22.4.41"/>
<!-- ** Plan of Care Activity Procedure Template ** -->
<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
<code code="425435003" codeSystem="2.16.840.1.113883.6.96"
displayName="An implant of a single chamber ICD"/>
<statusCode code="new"/>
<effectiveTime>
<center value="201309261000"/>
</effectiveTime>
</procedure>
</entry>
</section>
</component>
<!-- *** Procedure Indications Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.29"/>
<code code="59768-2" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="PROCEDURE INDICATIONS"/>
<title>Procedure Indications</title>
<text>The patient exhibited heart failure.</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<!-- Indication Entry -->
<templateId root="2.16.840.1.113883.10.20.22.4.19"/>
<id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>
<code code="55607006"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Problem"/>
<statusCode code="completed"/>
<effectiveTime value="20130323"/>
<value xsi:type="CD"
code="84114007" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Heart Failure"/>
</observation>
</entry>
</section>
</component>
<!-- *** Anesthesia Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.25"/>
<code code="59774-0"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="PROCEDURE ANESTHESIA"/>
<title>Procedure Anesthesia</title>
<text>
<content ID="Anesth1"> Local anesthesia using lidocaine was subcutaneously infiltrated
at the left infraclavicular area. </content>
</text>
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<!-- Medication activity template -->
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<id root="cdbd33f0-6cde-11db-9fe1-0800200c9a77"/>
<text>
<reference value="#Anesth1"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<low value="201309261000"/>
<high value="201309261015"/>
</effectiveTime>
<consumable>
<manufacturedProduct classCode="MANU">>
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<!-- Medication Information template -->
<manufacturedMaterial>
<code code="6387"
codeSystem="2.16.840.1.113883.6.88"
displayName="Lidocaine">
<originalText>
<reference value="#Anesth1"/>
</originalText>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entry>
</section>
</component>
<!-- *** Medications Administered Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.38" />
<code code="29549-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="MEDICATIONS ADMINISTERED" />
<title>Medications Administered</title>
<text>
<content ID="Med1">Ancef was administered for prophylaxis.</content>
</text>
<entry>
<substanceAdministration classCode="SBADM" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.16"/>
<!-- Medication Activity template -->
<id root="cdbd33f0-6cde-11db-9fe1-0800200c9a66"/>
<text>
<reference value="#Med1"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<low value="201309261000"/>
<high value="201309261015"/>
</effectiveTime>
<doseQuantity value="1"/>
<consumable>
<manufacturedProduct classCode="MANU">
<templateId root="2.16.840.1.113883.10.20.22.4.23"/>
<!-- Medication Information template -->
<manufacturedMaterial>
<code code="2180"
codeSystem="2.16.840.1.113883.6.88"
displayName="Ancef(Cefazolin)">
<originalText>
<reference value="#Med1"/>
</originalText>
</code>
</manufacturedMaterial>
</manufacturedProduct>
</consumable>
</substanceAdministration>
</entry>
</section>
</component>
<!-- *** Procedure Description - Cardiac EPIE Section *** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.24"/>
<templateId root="2.16.840.1.113883.10.20.22.2.27"/>
<!-- Procedure Description – Cardiac EPIE section template -->
<code code="29554-3"
codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="PROCEDURE DESCRIPTION"/>
<title>Procedure Description - 1 lead ICD implant</title>
<text>
<paragraph>Inventory of Equipment</paragraph>
<list>
<item>Medtronic Protecta (generator)</item>
<list>
<item>Device Characteristics: serial number, manufacturer, UDI</item>
</list>
<item>Medtronic Quattro (lead)</item>
<list>
<item>Device Characteristics: serial number, manufacturer, UDI</item>
</list>
</list>
<paragraph>Procedure Activity Procedures for all phases of the 1 lead ICD
implant</paragraph>
<list>
<item><content ID="Venogram1">Perform subclavian venogram</content></item>
<list>
<item>vein is patent and has a normal or abnormal course</item>
<item>images captured(DICOM) angiogram</item>
</list>
<item><content ID="AccVein1">Access vein with wire</content></item>
<item><content ID="Pocket1">Create pocket in pectoral muscle</content></item>
<list>
<item>Location on where is in relation to pectoral muscles, axillary or
subc</item>
</list>
<item><content ID="ImplLead1">Initial implantation of electrode into right
ventricle</content></item>
<list>
<item>Location</item>
</list>
<item><content ID="TestPace1">Test Pacing characteristics of lead with external
analyzer</content></item>
<list>
<item>Pacing Threshold for first test (width MS, amplitude (volts)
for min to pace</item>
look
<item>impedance if many tests are done (diff pulse widths) then they need
to be recorded independently</item>
<item>Sensing amplitude of returning signal over lead peak to peak, slew
rate V/S</item>
</list>
<item><content ID="AttachLead1">Attach lead to device</content></item>
<item><content ID="ImplGen1">Implant of Medtronic Protecta into
pocket</content></item>
<item><content ID="DFTresults1">DFT Results</content></item>
<list>
<item>Defibrillatory Results: threshold (joules) shocking vector</item>
<item>Note: if DFT not adequate, can change position of lead, changing the
shocking vector, or add a new lead.</item>
</list>
<item><content ID="CloseInc1">Close incision</content></item>
</list>
</text>
<entry>
<!-- Procedure Device Organizer - Cardiac EPIE for device inventory -->
<!-- closure devices can be included under this section
-->
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.20"/>
<statusCode code="completed"/>
<participant typecode="DEV">
<participantRole classCode="MANU">
<!-- MDC_IDC uses
"MDC_IDC_DEV_SERIAL" (code=720899) to identify the ICD serial number attribute -->
<id root="DEVICE-SERIAL-NUMBER-OID" extension="987654"/>
<!-- use
UDI in the future (when available)-->
<playingDevice classCode="DEV">
<!-- ICD -->
<code code="753666" codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_ENUM_DEV_TYPE_ICD"/>
<manufacturerModelName>2231-40Q Fortify(R)
DR</manufacturerModelName>
</playingDevice>
<scopingEntity>
<code code="753751" codeSystem="2.16.840.1.113883.6.24"
displayName="St. Jude"/>
<id root="2.16.840.1.113883.6.24"
extension="MDC_IDC_ENUM_MFG_STJ"/>
</scopingEntity>
</participantRole>
</participant>
</organizer>
<organizer classCode="CLUSTER" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.20"/>
<statusCode code="completed"/>
<participant typeCode="DEV">
<templateId root="2.16.840.1.113883.10.20.9.9"/>
<participantRole>
<id root="DEVICE-SERIAL-NUMBER-OID" extension="123456"/>
<!-MDC_IDC uses "MDC_IDC_LEAD_SERIAL" (code=720962) to identify the lead serial number attribute -->
<playingDevice>
<code code="753796"
displayName="MDC_IDC_ENUM_LEAD_POLARITY_TYPE_QUAD" codeSystem="2.16.840.1.113883.6.24">
<originalText>Lead</originalText>
</code>
<manufacturerModelName>Medtronic Sprint
Quattro(R)</manufacturerModelName>
</playingDevice>
<scopingEntity>
<id root="2.16.840.1.113883.6.24"
extension="MDC_IDC_ENUM_MFG_MDT"/>
<code code="753744" codeSystem="2.16.840.1.113883.6.24"
displayName="Medtronic"/>
</scopingEntity>
</participantRole>
</participant>
</organizer>
</entry>
<!--' VENOGRAM
fluoro and contrast record in results
-->
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<!-- Procedure Activity Procedure - Cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.19"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c" ext="VENOGRAM"/>
<code code="312731002" codeSystem="2.16.840.1.113883.6.96"
displayName="Subclavian Venography">
<originalText>
<reference value="#Venogram1"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<targetSiteCode code="181388005"
codeSystem="2.16.840.1.113883.6.96"
displayName="Subclavian Vein"/>
</procedure>
</entry>
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<!-- Procedure Activity Procedure - Cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.19"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c" ext="POCKET"/>
<code code="83333004" codeSystem="2.16.840.1.113883.6.96"
displayName="Creation of Cardiac Device Pocket">
<originalText>Creation of Cardiac Device Pocket
<reference value="#Pocket1"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<targetSiteCode code="81802002"
codeSystem="2.16.840.1.113883.6.96"
displayName="Pectoral Muscle">
<qualifier>
<name code="272741003"
codeSystem="2.16.840.1.113883.6.96"
displayName="laterality"/>
<value code="7771000"
codeSystem="2.16.840.1.113883.6.96"
displayName="left"/>
</qualifier>
</targetSiteCode>
</procedure>
</entry>
<!-- This is the Procedure Activity Procedure - Cardiac EPIE which describes the actual lead
implant.
-->
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<!-- Procedure Activity Procedure - Cardiac template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.19"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c" ext="CPAC1"/>
<code code="88722002" codeSystem="2.16.840.1.113883.6.96"
displayName="Initial Implantation of Electrode into cardiac right
ventricle">
<originalText>Lead Placement RV
<reference value="#ImpLead1"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<targetSiteCode code="753860"
codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_ENUM_LEAD_LOCATION_CHAMBER_RV Right Ventricle" />
<participant typeCode="STJ">
<templateId root="2.16.840.1.113883.10.20.9.9"/>
<participantRole>
<id root="DEVICE-SERIAL-NUMBER-OID" extension="123456"/>
<playingDevice>
<code code="753796"
displayName="MDC_IDC_ENUM_LEAD_POLARITY_TYPE_QUAD" codeSystem="2.16.840.1.113883.6.24">
<originalText>Lead</originalText>
</code>
<manufacturerModelName>Medtronic Sprint
Quattro(R)</manufacturerModelName>
</playingDevice>
<scopingEntity>
<id root="2.16.840.1.113883.6.24"
extension="MDC_IDC_ENUM_MFG_MDT"/>
<code code="753744" codeSystem="2.16.840.1.113883.6.24"
displayName="Medtronic"/>
</scopingEntity>
</participantRole>
</participant>
<!--'
guide wire could be included here if wanted in this report -->
<!--' check to see if this is an entry or entryRelationship -->
<entry typeCode="REFR">
<organizer classCode="CLUSTER" moodCode="EVN">
<!-- Procedure Device organizer - Cardiac EPIE template - to include
all dynamic lead (device) attributes -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.20"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c"/>
<statusCode code="completed"/>
<participant typeCode="SBJ">
<participantRole classCode="MANU">
<id root="DEVICE-SERIAL-NUMBER-OID" extension="123456"/>
<playingDevice classCode="MMAT">
<code code="753796"
displayName="MDC_IDC_ENUM_LEAD_POLARITY_TYPE_QUAD"
codeSystem="2.16.840.1.113883.6.24">
<originalText>Lead</originalText>
</code>
</playingDevice>
</participantRole>
</participant>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Device observation EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.18"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6b"/>
<code code="729537"
displayName="MDC_IDC_SET_LEADCHNL_RV_SENSING_SENSITIVITY - Sensing Amplitude"
codeSystem="2.16.840.1.113883.6.24"
codeSystemName="MDC"/>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<value xsi:type="PQ" value="12.0" unit="mV"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Device observation EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.18"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6b"/>
<code code="722433"
displayName="MDC_IDC_MSMT_LEADCHNL_RV_IMPEDANCE_VALUE"
codeSystem="2.16.840.1.113883.6.24"
codeSystemName="IEEE 11073"/>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<value xsi:type="PQ" value="699" unit="ohms"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Device observation EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.18"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c"/>
<code code="722177"
displayName="MDC_IDC_MSMT_LEADCHNL_RV_PACING_THRESHOLD_AMPLITUDE"
codeSystem="2.16.840.1.113883.6.24"
codeSystemName="IEEE 11073"/>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<value xsi:type="PQ" value="0.8" unit="V"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Device observation EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.18"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c"/>
<code code="722241"
displayName="MDC_IDC_MSMT_LEADCHNL_RV_PACING_THRESHOLD_PULSEWIDTH"
codeSystem="2.16.840.1.113883.6.24"
codeSystemName="IEEE 11073"/>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<value xsi:type="PQ" value="0.5" unit="ms"/>
</observation>
</component>
</organizer>
</entry>
</procedure>
</entry>
<!-- For implant devices, attaching devices to generator is part of the implant procedure. What exactly does this SNOMED
code include in its scope? -->
<!-- When available, these new codes should be added to the Cardiac Activity Procedures Vocabulary Constraints. -->
procedure performed.
<!-- This is the Procedure Activity Procedure - Cardiac which describes the specific
There will be a separate entry for each procedure. -->
<entry typeCode="DRIV">
<procedure classCode="PROC" moodCode="EVN">
<!-- Procedure Activity Procedure - Cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.19"/>
<templateId root="2.16.840.1.113883.10.20.22.4.14"/>
<id root="ICD1"/>
<code code="425435003" codeSystem="2.16.840.1.113883.6.96"
displayName="Implantation of Cardioverter Defibrillator with one
electrode lead">
<originalText>
<reference value="#Implead1"/>
</originalText>
</code>
<statusCode code="completed"/>
<effectiveTime value="201309261015"/>
<targetSiteCode code="81802002"
codeSystem="2.16.840.1.113883.6.96"
displayName="Pectoral Muscle">
<!-- Qualifier enables further specification of the target site. Device is always above
PM but is etiher in the left or right part of the chest. -->
<qualifier>
<name code="272741003"
codeSystem="2.16.840.1.113883.6.96"
displayName="laterality"/>
<value code="7771000"
codeSystem="2.16.840.1.113883.6.96"
displayName="left"/>
</qualifier>
</targetSiteCode>
<participant typecode="SBJ">
<participantRole classCode="MANU">
<id root="DEVICE-SERIAL-NUMBER-OID" extension="987654"/>
<!-????????????????????open UDI for the future -->
<playingDevice classCode="MMAT">
<!-- ICD -->
<code code="753666" codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_ENUM_DEV_TYPE_ICD - St. Jude
Fortify (generator)"/>
<manufacturerModelName>2231-40Q Fortify(R)
DR</manufacturerModelName>
</playingDevice>
<scopingEntity>
<id root="2.16.840.1.113883.6.24"
extension="MDC_IDC_ENUM_MFG_STJ"/>
</scopingEntity>
</participantRole>
</participant>
<!-- these are dynamic attributes of the devices used during this procedure.. Are there any attributes we need to record
here? -->
<entryRelationship typeCode="REFR">
<organizer classCode="CLUSTER" moodCode="EVN">
<!-- Procedure Device organizer - Cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.20"/>
<id root=" eb936010-7b17-11db-9fe1-0800200c9b6c"/>
<statusCode code="completed"/>
<participant typecode="SBJ">
<participantRole classCode="MANU">
<id root="DEVICE-SERIAL-NUMBER-OID" extension="987654"/>
<!-- can use UDI for the future -->
<playingDevice classCode="MMAT">
<!-- ICD -->
<code code="753666"
codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_ENUM_DEVICE_TYPE_ICD St. Jude Fortify (generator)"/>
</playingDevice>
</participantRole>
</participant>
</organizer>
</entryRelationship>
</procedure>
</entry>
</section>
</component>
<!-- *** Procedure Disposition Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.18.2.12"/>
<code code="59775-7" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="PROCEDURE DISPOSITION"/>
<title>PROCEDURE DISPOSITION</title>
<text>The patient was taken to the ICU Recovery Unit in stable condition.</text>
</section>
</component>
<!-- *** Procedure Results - Cardiac EPIE Section *** -->
<!-- DFT Results -->
<!-- Final Device Programming -->
<component>
<section>
<templateId root="21.3.6.1.4.1.19376.1.4.1.2.25" />
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<code code="30954-2"
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codeSystemName="LOINC"
displayName="RESULTS" />
<title>Procedure results</title>
<text>
<paragraph>DFT Results</paragraph>
<list>
<item>Induction Method: T-Wave Shock</item>
<item>Induced Rhythm: V Fib</item>
<item>Shock Energy: 16J</item>
<item>Impedance: 70 ohms</item>
<item>Configuration: SVC/ICD to RV</item>
<item>Sensitivity: Least</item>
<item>Post DFT Rhythm: NSR</item>
</list>
<paragraph>FINAL DEVICE PROGRAMMING:</paragraph>
<paragraph>Ventricular Fibrillation Zone</paragraph>
<list>
<item>Detection: 190 bpm</item>
<item>Therapy: ATP before charging, Defib 41 J (x6)</item>
</list>
<paragraph>Ventricular Tachycardia Zone</paragraph>
<list>
<item>Detection: 170 bpm</item>
<item>Therapy: ATP ï‚® CV 26 J ï‚® CV 41 J (x5)</item>
</list>
<paragraph>Bradycardia Parameters</paragraph>
<list>
<item>Mode: VVI</item>
<item>LRL: 40</item>
<item>RV Output: 4.0 V @ 0.4 ms</item>
<item>RV Sens: Nominal</item>
</list>
<paragraph>Monitor Zone</paragraph>
<list>
<item>Detection
150 bpm</item>
</list>
</text>
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<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
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<value xsi:type="PQ" value="16" unit="J"/>
<interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83"/>
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<statusCode code="completed"/>
<effectiveTime value="201309261400"/>
<value xsi:type="PQ" value="1.2" unit="mV"/>
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<code nullFlavor="OTH" displayName="Zone VT"/>
<statusCode code="completed"/>
<effectiveTime value="201309261400"/>
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<component>
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<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<component>
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<!-- Result observation - cardiac EPIE template -->
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<!-- Procedure Results Organizer - Cardiac EPIE -->
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<!-- Result observation - cardiac EPIE template -->
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<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIC template -->
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<!-- Procedure Results Organizer - Cardiac EPIE -->
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
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<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
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<!-- Procedure Results Organizer - Cardiac EPIE -->
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<code nullFlavor="OTH" displayName="Bradycardia Parameters" />
<statusCode code="completed"/>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
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codeSystem="2.16.840.1.113883.6.24" displayName="MDC_IDC_ENUM_BRADY_MODE_VVI"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
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<code code="730880" codeSystem="2.16.840.1.113883.6.24"
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<statusCode code="completed"/>
<value xsi:type="PQ" value="40" unit="bpm"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
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<code code="729985" codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_SET_LEADCHNL_RV_PACING_AMPLITUDE"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="4.0" unit="V"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="730049" codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_SET_LEADCHNL_RV_PACING_PULSEWIDTH"/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="0.4" unit="ms"/>
</observation>
</component>
<component>
<observation classCode="OBS" moodCode="EVN">
<!-- Result observation - cardiac EPIE template -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.22"/>
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<id root="c6f88321-67ad-11db-bd13-0800200c9a66"/>
<code code="729537" codeSystem="2.16.840.1.113883.6.24"
displayName="MDC_IDC_SET_LEADCHNL_RV_SENSING_SENSITIVITY "/>
<statusCode code="completed"/>
<value xsi:type="PQ" value="0.5" unit="mV"/>
</observation>
</component>
</organizer>
</entry>
</section>
</component>
<!-- *** Complications Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.37"/>
<code code="55109-3" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Complications"/>
<title>Complications</title>
<text>Complications for the ICD procedure for patient included:
<list>
<item><content ID="Compl1">Pericardial tamponade</content></item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<code code="404684003" codeSystem="2.16.840.1.113883.6.96"
displayName="Finding"/>
<text>
<reference value="#Compl1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="201309261400"/>
</effectiveTime>
<value xsi:type="CD" code="35304003"
codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"
displayName="Pericardial Tamponade"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<!-- Problem Status template -->
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Active"/>
</observation>
</entryRelationship>
</observation>
</entry>
</section>
</component>
<!-- *** Post-procedure Diagnosis Section *** -->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.22.2.36"/>
<code code="59769-0" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="POSTPROCEDURE DIAGNOSIS"/>
<title>Postprocedure Diagnosis</title>
<text>
It was observed that post procedurally the patient has <content ID="PostDiag1">Brugada
Syndrome</content>
</text>
<entry>
<act moodCode="EVN" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.22.4.51"/>
<!-- ** Postprocedure Diagnosis Entry ** -->
<code code="59769-0" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
displayName="Postprocedure Diagnosis"/>
<entryRelationship typeCode="SUBJ">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.4"/>
<!-- Problem Observation template -->
<id root="d11275e7-67ae-11db-bd13-0800200c9a66"/>
<code code="404684003" codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Finding"/>
<text>
<reference value="#PostDiag1"/>
</text>
<statusCode code="completed"/>
<effectiveTime>
<low value="201309261400"/>
</effectiveTime>
<value xsi:type="CD" code="418818005"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT"
displayName="Brugada Syndrome"/>
<entryRelationship typeCode="REFR">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.6"/>
<!-- Problem Status template -->
<code code="33999-4" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Status"/>
<statusCode code="completed"/>
<value xsi:type="CD" code="55561003"
codeSystem="2.16.840.1.113883.6.96"
codeSystemName="SNOMED CT" displayName="Active"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</act>
</entry>
</section>
</component>
<!-- *** Plan of Care - Cardiac Section *** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.22" />
<templateId root="2.16.840.1.113883.10.20.22.2.10" />
<!-- **** Plan of Care - Cardiac section template **** -->
<code code="18776-5" codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC" displayName="Treatment plan"/>
<title>Plan of Care</title>
<text>The recommendations include:
<list>
<item>Avoid functional activity</item>
<item>Avoid lifting elbow above shoulder</item>
</list>
</text>
<entry>
<act moodCode="RQO" classCode="ACT">
<!-- **** Plan of Care Activity Act - Cardiac template
**** -->
<templateId root="1.3.6.1.4.1.19376.1.4.1.4.17"/>
<templateId root="2.16.840.1.113883.10.20.22.4.39"/>
<id root="9a6d1bac-17d3-4195-89a4-1121bc809a5c"/>
<code code="304508008" codeSystem="2.16.840.1.113883.6.96"
displayName="Recommendation to avoid functional activity: Avoid lifting elbow
above shoulder"/>
<statusCode code="new"/>
<effectiveTime>
<center value="201309261430"/>
</effectiveTime>
</act>
</entry>
</section>
</component>
<!-- *** Key Images - Cardiac Section *** -->
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.21"/>
<code code="121180" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Key
Images"/>
<title>Key Images - Cardiac</title>
<text>
There is a single key image of the heart.
</text>
<entry>
<observation classCode="DGIMG" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.8"/>
<id root="1.2.840.113619.2.62.994044785528.20060823.200608232232322.3"/>
<code code="1.2.840.10008.5.1.4.1.1.1" codeSystem="1.2.840.10008.2.6.1"
codeSystemName="DCMUID" displayName="Computed Radiography Image Storage"/>
<text mediaType="application/dicom">
<reference
value="http://www.example.org/wado?requestType=WADO&amp;studyUID=1.2.840.113619.2.62.994044785528.114289542805&amp;seriesU
ID=1.2.840.113619.2.62.994044785528.20060823223142485051&amp;objectUID=1.2.840.113619.2.62.994044785528.20060823.200608232
232322.3&amp;contentType=application/dicom"/>
<!--reference to image 1 (PA) -->
</text>
<effectiveTime value="20060823223232"/>
</observation>
</entry>
</section>
</component>
<!-- *** DICOM Object Catalog Section *** -->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.1.1"/>
<code code="121181" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM"
displayName="DICOM Object Catalog"/>
<entry>
<!-- Study
-->
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.6"/>
<id root="1.2.840.113619.2.62.994044785528.114289542805"/>
<code code="113014" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM"
displayName="Study"/>
<!-- Series
-->
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<id root="1.2.840.113619.2.62.994044785528.20060823223142485051"/>
<code code="113015" codeSystem="1.2.840.10008.2.16.4"
codeSystemName="DCM" displayName="Series">
<qualifier>
<name code="121139" codeSystem="1.2.840.10008.2.16.4"
codeSystemName="DCM" displayName="Modality"/>
<value code="CR" codeSystem="1.2.840.10008.2.16.4"
codeSystemName="DCM" displayName="Computed Radiography"/>
</qualifier>
</code>
<!-- SopInstance UID -->
<!-- 2 References (chest PA and LAT) -->
<entryRelationship typeCode="COMP">
<observation classCode="DGIMG" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.8"/>
<id
root="1.2.840.113619.2.62.994044785528.20060823.200608232232322.3"/>
<code code="1.2.840.10008.5.1.4.1.1.1"
codeSystem="1.2.840.10008.2.6.1" codeSystemName="DCMUID" displayName="Computed Radiography Image Storage"> </code>
<text mediaType="application/dicom">
<reference
value="http://www.example.org/wado?requestType=WADO&amp;studyUID=1.2.840.113619.2.62.994044785528.114289542805&amp;seriesU
ID=1.2.840.113619.2.62.994044785528.20060823223142485051&amp;objectUID=1.2.840.113619.2.62.994044785528.20060823.200608232
232322.3&amp;contentType=application/dicom"/>
<!--reference to image 1 (PA) -->
</text>
<effectiveTime value="201309261300"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="DGIMG" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.8"/>
<id
root="1.2.840.113619.2.62.994044785528.20060823.200608232231422.3"/>
<code code="1.2.840.10008.5.1.4.1.1.1"
codeSystem="1.2.840.10008.2.6.1" codeSystemName="DCMUID" displayName="Computed Radiography Image Storage"> </code>
<text mediaType="application/dicom">
<reference
value="http://www.example.org/wado?requestType=WADO&amp;studyUID=1.2.840.113619.2.62.994044785528.114289542805&amp;seriesU
ID=1.2.840.113619.2.62.994044785528.20060823223142485051&amp;objectUID=1.2.840.113619.2.62.994044785528.20060823.200608232
231422.3&amp;contentType=application/dicom"/>
<!--reference to image 2 (LAT) -->
</text>
<effectiveTime value="201309261300"/>
</observation>
</entryRelationship>
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>
</structuredBody>
</component>
<!-- End of CDA Body -->
</ClinicalDocument>