Consolidated CDA (C-CDA)
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Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions

: History and Physical Complete Header Example - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

# 
 Title:        History and Physical
 Based on:     C-CDA_R2_History_and_Physical.xml

 Updated for C-CDA R3.0 with a focus on header elements
  - required/suggested sections are populated with nullFlavor="NI"
	  to demonstrate WHICH sections should be included, but they
		all contain "No information" as this is an example of the header
  
 ********************************************************
 Disclaimer: This sample file contains representative data elements to represent a History and Physical. 
 The file depicts a fictional character's health data. Any resemblance to a real person is coincidental. 
 To illustrate as many data elements as possible, the clinical scenario may not be plausible. 
 The data in this sample file is not intended to represent real patients, people or clinical events. 
 This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide.
 ********************************************************
 

 a fhir:ClinicalDocument ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:realmCode ( [
fhir:code [ fhir:v "US" ]
  ] ) ; # 
#********************************************************
#  CDA Header
#********************************************************
#	
  fhir:typeId [
fhir:extension [ fhir:v "POCD_HD000040" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.1.3" ]
  ] ; # 
  fhir:templateId ( [
fhir:extension [ fhir:v "2024-05-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.1" ]
  ] [
fhir:extension [ fhir:v "2024-05-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.3" ]
  ] ) ; #  US General Header Template 
  fhir:id [
fhir:extension [ fhir:v "TT988" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5.99999.1" ]
  ] ; # 
  fhir:sdtcCategory ( [
fhir:code [ fhir:v "34117-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:displayName [ fhir:v "History and physical note" ]
  ] ) ; # 
  fhir:code [
fhir:code [ fhir:v "34117-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "History and Physical Note" ]
  ] ; # 
  fhir:title [
fhir:xmlText [ fhir:v "Community Health and Hospitals: History & Physical" ]
  ] ; # 
  fhir:effectiveTime [
fhir:value [ fhir:v "2012-09-16T19:05:00-04:00"^^xsd:dateTime ]
  ] ; # 
  fhir:confidentialityCode [
fhir:code [ fhir:v "N" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.25" ]
  ] ; # 
  fhir:languageCode [
fhir:code [ fhir:v "en-US" ]
  ] ; # 
  fhir:setId [
fhir:extension [ fhir:v "sTT988" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5.99999.19" ]
  ] ; # 
  fhir:versionNumber [
fhir:value [ fhir:v "1"^^xsd:integer ]
  ] ; # 
  fhir:recordTarget ( [
fhir:patientRole [
      ( fhir:id [
fhir:extension [ fhir:v "998991" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5.99999.2" ]       ] [
fhir:extension [ fhir:v "111-00-2330" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.1" ]       ] ) ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "HP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1357 Amber Drive" ]           ] #  HP is \"primary home\" from codeSystem 2.16.840.1.113883.5.1119          ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ; #  Fake Social Security Number using the actual SSN OID. ,  US is \"United States\" from ISO 3166-1 Country Codes: 1.0.3166.1 
      ( fhir:telecom [
        ( fhir:use [ fhir:v "HP" ] ) ;
fhir:value [ fhir:v "tel:(816)276-6909"^^xsd:anyURI ]       ] ) ;
fhir:patient [
        ( fhir:name [
          ( fhir:use [ fhir:v "L" ] ) ;
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Isabella" ]             ] ) #  L is \"Legal\" from HL7 EntityNameUse 2.16.840.1.113883.5.45            ] [
            ( fhir:given [
fhir:xmlText [ fhir:v "Isa" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Jones" ]             ] ) #  CL is \"Call me\" from HL7 EntityNamePartQualifier 2.16.840.1.113883.5.43            ] )         ] ) ;
fhir:administrativeGenderCode [
fhir:code [ fhir:v "F" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1" ] ;
fhir:displayName [ fhir:v "Female" ]         ] ;
fhir:birthTime [
fhir:value [ fhir:v "2005-05-01"^^xsd:date ]         ] ;
fhir:maritalStatusCode [
fhir:code [ fhir:v "M" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.2" ] ;
fhir:codeSystemName [ fhir:v "MaritalStatusCode" ] ;
fhir:displayName [ fhir:v "Married" ]         ] ;
fhir:religiousAffiliationCode [
fhir:code [ fhir:v "1013" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1076" ] ;
fhir:codeSystemName [ fhir:v "HL7 Religious Affiliation" ] ;
fhir:displayName [ fhir:v "Christian (non-Catholic, non-specific)" ]         ] ;
fhir:raceCode [
fhir:code [ fhir:v "1002-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "American Indian or Alaska Native" ]         ] ;
        ( fhir:sdtcRaceCode [
fhir:code [ fhir:v "1966-1" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "Aleut" ]         ] ) ;
fhir:ethnicGroupCode [
fhir:code [ fhir:v "2186-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "Not Hispanic or Latino" ]         ] ;
        ( fhir:guardian [
fhir:code [
fhir:code [ fhir:v "GRPRN" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ] ;
fhir:codeSystemName [ fhir:v "HL7 Role code" ] ;
fhir:displayName [ fhir:v "Grandparent" ]           ] ;
          ( fhir:addr [
            ( fhir:use [ fhir:v "HP" ] ) ;
            ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1357 Amber Drive" ]               ] #  HP is \"primary home\" from codeSystem 2.16.840.1.113883.5.1119              ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ]               ]             ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]               ]             ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ]               ]             ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]               ]             ] )           ] ) ; #  US is \"United States\" from ISO 3166-1 Country Codes: 1.0.3166.1 
          ( fhir:telecom [
            ( fhir:use [ fhir:v "HP" ] ) ;
fhir:value [ fhir:v "tel:(816)276-6909"^^xsd:anyURI ]           ] ) ;
fhir:guardianPerson [
            ( fhir:name [
              ( fhir:item [
                ( fhir:given [
fhir:xmlText [ fhir:v "Ralph" ]                 ] )               ] [
                ( fhir:family [
fhir:xmlText [ fhir:v "Jones" ]                 ] )               ] )             ] )           ]         ] ) ;
fhir:birthplace [
fhir:place [
fhir:addr [
              ( fhir:item [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ]                 ]               ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]                 ]               ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ]                 ]               ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]                 ]               ] )             ]           ]         ] ;
        ( fhir:languageCommunication [
fhir:languageCode [
fhir:code [ fhir:v "en" ]           ] ;
fhir:modeCode [
fhir:code [ fhir:v "ESP" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.60" ] ;
fhir:codeSystemName [ fhir:v "LanguageAbilityMode" ] ;
fhir:displayName [ fhir:v "Expressed spoken" ]           ] ;
fhir:proficiencyLevelCode [
fhir:code [ fhir:v "G" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.61" ] ;
fhir:codeSystemName [ fhir:v "LanguageAbilityProficiency" ] ;
fhir:displayName [ fhir:v "Good" ]           ] ;
fhir:preferenceInd [
fhir:value [ fhir:v "true"^^xsd:boolean ]           ]         ] )       ] ; #  HP is \"primary home\" from HL7 AddressUse 2.16.840.1.113883.5.1119 
fhir:providerOrganization [
        ( fhir:id [
fhir:root [ fhir:v "2.16.840.1.113883.19.5.9999.1393" ]         ] ) ;
        ( fhir:name [
          ( fhir:item [
fhir:xmlText [ fhir:v "Community Health and Hospitals" ]           ] )         ] ) ;
        ( fhir:telecom [
          ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-5000"^^xsd:anyURI ]         ] ) ;
        ( fhir:addr [
          ( fhir:use [ fhir:v "WP" ] ) ;
          ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1001 Village Avenue" ]             ]           ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]             ]           ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]             ]           ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]             ]           ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]             ]           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:author ( [
fhir:time [
fhir:value [ fhir:v "2005-03-29T22:44:11+05:00"^^xsd:dateTime ]     ] ;
fhir:assignedAuthor [
      ( fhir:id [
fhir:extension [ fhir:v "99999999" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ]       ] ) ;
fhir:code [
fhir:code [ fhir:v "200000000X" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ;
fhir:displayName [ fhir:v "Allopathic & Osteopathic Physicians" ]       ] ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1002 Healthcare Drive" ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]       ] ) ;
fhir:assignedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:dataEnterer [
fhir:assignedEntity [
      ( fhir:id [
fhir:extension [ fhir:v "999999943252" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ]       ] ) ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1001 Village Avenue" ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]       ] ) ;
fhir:assignedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ]     ]
  ] ; # 
  fhir:informant ( [
fhir:assignedEntity [
      ( fhir:id [
fhir:extension [ fhir:v "KP00017" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5" ]       ] ) ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1001 Village Avenue" ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]       ] ) ;
fhir:assignedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ]     ]
  ] [
fhir:relatedEntity [
fhir:classCode [ fhir:v "PRS" ] ;
fhir:code [
fhir:code [ fhir:v "SPS" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.1.11.19563" ] ;
fhir:codeSystemName [ fhir:v "Personal Relationship Role Type Value Set" ] ;
fhir:displayName [ fhir:v "SPOUSE" ]       ] ; #  classCode PRS represents a person with personal relationship with the patient. 
fhir:relatedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Frank" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Jones" ]             ] )           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:custodian [
fhir:assignedCustodian [
fhir:representedCustodianOrganization [
        ( fhir:id [
fhir:extension [ fhir:v "99999999" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ]         ] ) ;
fhir:name [
          ( fhir:item [
fhir:xmlText [ fhir:v "Community Health and Hospitals" ]           ] )         ] ;
fhir:telecom [
          ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]         ] ;
fhir:addr [
          ( fhir:use [ fhir:v "WP" ] ) ;
          ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1002 Healthcare Drive" ]             ]           ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]             ]           ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]             ]           ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]             ]           ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]             ]           ] )         ]       ]     ]
  ] ; # 
  fhir:informationRecipient ( [
fhir:intendedRecipient [
fhir:informationRecipient [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ] ;
fhir:receivedOrganization [
        ( fhir:name [
          ( fhir:item [
fhir:xmlText [ fhir:v "Community Health and Hospitals" ]           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:legalAuthenticator [
fhir:time [
fhir:value [ fhir:v "2009-02-27T13:00:00+05:00"^^xsd:dateTime ]     ] ;
fhir:signatureCode [
fhir:code [ fhir:v "S" ]     ] ;
fhir:assignedEntity [
      ( fhir:id [
fhir:extension [ fhir:v "999999999" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ]       ] ) ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1001 Village Avenue" ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]       ] ) ;
fhir:assignedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ]     ]
  ] ; # 
  fhir:authenticator ( [
fhir:time [
fhir:value [ fhir:v "2009-02-27T13:00:00+05:00"^^xsd:dateTime ]     ] ;
fhir:signatureCode [
fhir:code [ fhir:v "S" ]     ] ;
fhir:assignedEntity [
      ( fhir:id [
fhir:extension [ fhir:v "999999999" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ]       ] ) ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1001 Village Avenue" ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ]       ] ) ;
fhir:assignedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:given [
fhir:xmlText [ fhir:v "Henry" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Seven" ]             ] )           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:participant ( [
fhir:typeCode [ fhir:v "IND" ] ;
fhir:time [
fhir:low [
fhir:value [ fhir:v "1959-01-01"^^xsd:date ]       ] ;
fhir:high [
fhir:value [ fhir:v "2011-10-25"^^xsd:date ]       ]     ] ;
fhir:associatedEntity [
fhir:classCode [ fhir:v "NOK" ] ;
fhir:code [
fhir:code [ fhir:v "MTH" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ]       ] ;
      ( fhir:addr [
        ( fhir:use [ fhir:v "WP" ] ) ;
        ( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "17 Daws Rd." ]           ]         ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ]           ]         ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ]           ]         ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ]           ]         ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ]           ]         ] )       ] ) ;
      ( fhir:telecom [
        ( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [ fhir:v "tel:(999)555-1212"^^xsd:anyURI ]       ] ) ;
fhir:associatedPerson [
        ( fhir:name [
          ( fhir:item [
            ( fhir:prefix [
fhir:xmlText [ fhir:v "Mrs." ]             ] )           ] [
            ( fhir:given [
fhir:xmlText [ fhir:v "Martha" ]             ] )           ] [
            ( fhir:family [
fhir:xmlText [ fhir:v "Jones" ]             ] )           ] )         ] )       ]     ]
  ] ) ; # 
  fhir:inFulfillmentOf ( [
fhir:typeCode [ fhir:v "FLFS" ] ;
fhir:order [
fhir:classCode [ fhir:v "ACT" ] ;
fhir:moodCode [ fhir:v "RQO" ] ;
      ( fhir:id [
fhir:extension [ fhir:v "12345-67890" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19" ]       ] )     ]
  ] ) ; # 
  fhir:componentOf [
fhir:encompassingEncounter [
      ( fhir:id [
fhir:extension [ fhir:v "9937012" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19" ]       ] ) ;
fhir:code [
fhir:code [ fhir:v "99213" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.12" ] ;
fhir:codeSystemName [ fhir:v "CPT-4" ]       ] ;
fhir:effectiveTime [
fhir:low [
fhir:value [ fhir:v "2009-02-27T13:00:00+05:00"^^xsd:dateTime ]         ] ;
fhir:high [
fhir:value [ fhir:v "2009-02-27T13:00:00+05:00"^^xsd:dateTime ]         ]       ] ;
fhir:location [
fhir:healthCareFacility [
          ( fhir:id [
fhir:root [ fhir:v "2.16.540.1.113883.19.2" ]           ] )         ]       ]     ]
  ] ; # 
  fhir:component [
fhir:structuredBody [
      ( fhir:component [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.6.1" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "48765-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "ALLERGIES AND ADVERSE REACTIONS" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.5.1" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "11450-4" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "PROBLEM LIST" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "PROBLEMS" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.1.1" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "10160-0" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "HISTORY OF MEDICATION USE" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "MEDICATIONS" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.9" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "51847-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Evaluation + Plan note" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Assessment and Plan" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:root [ fhir:v "1.3.6.1.4.1.19376.1.5.3.1.3.4" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "10164-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "History of Present illness Narrative" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "History of Present Illness" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.3.1" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "30954-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "RESULTS" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "RESULTS" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.12" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "29299-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Reason for visit Narrative" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Reason for Visit" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.2.10" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "29545-1" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Physical Findings" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Physical Examination" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.4.1" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "8716-3" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "VITAL SIGNS" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "VITAL SIGNS" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.17" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "29762-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Social History" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "SOCIAL HISTORY" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.15" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "10157-6" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "History of family member diseases Narrative" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Family History" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.20" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "11348-0" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "History of Past illness Narrative" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Past Medical History" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:root [ fhir:v "2.16.840.1.113883.10.20.2.5" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "10210-3" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Physical findings of General status Narrative" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "General Status" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
          ( fhir:templateId [
fhir:root [ fhir:v "1.3.6.1.4.1.19376.1.5.3.1.3.18" ]           ] ) ;
fhir:code [
fhir:code [ fhir:v "10187-3" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Review of systems Narrative - Reported" ]           ] ;
fhir:title [
fhir:xmlText [ fhir:v "Review of Systems" ]           ] ;
fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"         ]       ] )     ] #  All sections are set to nullFlavor \/ text = No information, \n        as this is a header example, not a complete body example 
  ] . #