1.3.6.1.4.1.19376.1.5.3.1.1.13.1.1: Difference between revisions

From IHE Wiki
Jump to navigation Jump to search
← Older editNewer edit →
Kboone (talk | contribs)
4,700 edits
Kboone (talk | contribs)
4,700 edits
mNo edit summary
Line 1: Line 1:
{{CDA Document|Triage Note|SampleDocumentOID|Draft|
{{CDA Document|Triage Note|1.3.6.1.4.1.19376.1.5.3.1.1.13.1.1|Comment|
Sample Document has one required section, and one entry that is required if known|
Fill this in|
Data=
Index={{T|Data Element|A|B|Rows=
{{CDA Document Content|Triage Note|Sample Section|R|SampleSectionOID|Comment on section}}
{{R|Chief Complaint||}}
{{CDA Document Content|Triage Note|Sample Entry|R2|SampleEntryOID|Comment on entry}}
{{R|History of Present Illness||}}
{{R|Acuity||}}
{{R|Vital Signs||}}
{{R|Assessment||}}
}}
|Data=
{{CDA Document Content||Chief Complaint|R||}}
{{CDA Document Content||History of Present Illness|R||}}
{{CDA Document Content||Acuity|R||}}
{{CDA Document Content||Vital Signs|R||}}
{{CDA Document Content||Assessment|R||}}
}}
}}

Revision as of 15:35, 17 May 2007

Development Only

The PCC Wiki Content is used only for development of IHE PCC Content. The Normative content of the PCC Technical Framework and the current supplements can be found at http://www.ihe.net/Technical_Framework/index.cfm#PCC

Triage Note Specification 1.3.6.1.4.1.19376.1.5.3.1.1.13.1.1

Fill this in



Data Element Index
Data Element A B
Chief Complaint
History of Present Illness
Acuity
Vital Signs
Assessment

Transition to new CDA Document template to support schematron-->>Data<<--

Specification
Data Element Name Opt Template ID
Chief Complaint R
History of Present Illness R
Acuity R
Vital Signs R
Assessment R


Conformance

CDA Release 2.0 documents that conform to the requirements of this content module shall indicate their conformance by the inclusion of the appropriate <templateId> elements in the header of the document. This is shown in the sample document below.

Sample Triage Note Document 
<ClinicalDocument xmlns='urn:hl7-org:v3'>
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root='1.3.6.1.4.1.19376.1.5.3.1.1.13.1.1'/>
  <id root=' ' extension=' '/>
  <code code=' ' displayName=' '
    codeSystem='2.16.840.1.113883.6.1' codeSystemName='LOINC'/>
  <title>Triage Note</title>
  <effectiveTime value='20260407012005'/>
  <confidentialityCode code='N' displayName='Normal' 
    codeSystem='2.16.840.1.113883.5.25' codeSystemName='Confidentiality' />
  <languageCode code='en-US'/>     
     :
  <component><structuredBody>
       
  </structuredBody></component>
</ClinicalDocument>

  

   <!-- Verify the document type code -->
   <assert test='cda:code[@code = "{{{LOINC}}}"]'>
     Error: The document type code of a Triage Note must be {{{LOINC}}}
   </assert>
   <assert test='cda:code[@codeSystem = "2.16.840.1.113883.6.1"]'>
     Error: The document type code must come from the LOINC code 
     system (2.16.840.1.113883.6.1).
   </assert>
Retrieved from "http://wiki.ihe.net/index.php?title=1.3.6.1.4.1.19376.1.5.3.1.1.13.1.1&oldid=5419"