Polska Implementacja Krajowa HL7 CDA (plcda-)

eZdrowie - Projekt P1

Przykłady - [1] Realizacja recepty

Realizacja recepty farmaceutycznej

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  <!-- Realizacja recepty na Enarenal zgodna z profilem IHE DIS -->
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      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="F" displayName="Farmaceutyczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>
        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>
  <effectiveTime value="20150301122300"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
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      <addr>
        <country>Polska</country>
        <postalCode>58-200</postalCode>
        <city>Dzierżoniów</city>
        <streetName>Szpitalna</streetName>
        <houseNumber>3a</houseNumber>
        <unitID>10</unitID>
      </addr>
      <patient>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <given>Anna</given>
          <given>Maria</given>
          <family>Nowak</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19960130"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.81"/>
    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>
    <time value="20150301122300"/>
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        <name>
          <prefix>mgr</prefix>
          <given>Miłosz</given>
          <family>Najman</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>
        <name>Apteka porcelanowa</name>
        <telecom use="PUB" value="tel:32123456"/>
        <addr>
          <country>Polska</country>
          <postalCode>31-867</postalCode>
          <city>Kraków</city>
          <streetName>Mikołaja Kopernika</streetName>
          <houseNumber>36</houseNumber>
        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
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  <relatedDocument typeCode="RPLC">
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    <parentDocument classCode="DOCCLIN" moodCode="EVN">
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      <component>
        <section>
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          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>
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          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>
          <title>Wydanie leku</title>
          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>
               Nazwa: Enarenal
              <br/>
               Postać: tabletki
              <br/>
               Dawka: 5mg
              <br/>
               Opakowanie: 60 tabl.
              <br/>
               Ilość: 1
              <br/>
               Nr serii: 123/456
              <br/>
               Data ważności: 1 stycznia 2018 r.
              <br/>
               Identyfikator produktu: 5909990014958 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>
               Wartość wydanego leku: 12,00
              <br/>
               Limit urzędowy: 8,40
              <br/>
               Poziom odpłatności leku refundowanego: 100%
              <br/>
               Kwota refundacji: 0,00
              <br/>
               Zapłacono: 12,00             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
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              <text>
                <reference value="#SPLY_1"/>
              </text>
              <quantity value="1"/>
              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>
                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Enarenal 5mg tabl."/>
                    <name>Enarenal 5mg tabletki</name>
                    <lotNumberText>123/456</lotNumberText>
                    <pharm:expirationTime value="20180101"/>
                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990014958" codeSystem="1.3.160" codeSystemName="GS1"/>
                        <pharm:name>Enarenal 5mg (60 tabl.)</pharm:name>
                        <pharm:formCode code="ORTAB" codeSystem="2.16.840.1.113883.5.1127" displayName="Oral Tablet"/>
                        <pharm:capacityQuantity value="60"/>
                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>
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                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>
                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>
                    </manufacturedProduct>
                  </consumable>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>
                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
                  <text>
                    <reference value="#ACT_1"/>
                  </text>
                  <statusCode code="completed"/>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="12.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="8.40"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <statusCode code="completed"/>
                      <value xsi:type="CV" code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="0.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="12.00"/>
                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>
          <text>
            <paragraph>
              <caption>Powód wydania leku</caption>
              Zagrożenie życia             </paragraph>
          </text>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Realizacja recepty na import docelowy

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  <!-- Realizacja recepty na Enarenal zgodna z profilem IHE DIS -->
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        <value code="Lz" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="I" displayName="Import docelowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>
        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
        <value code="P" displayName="papierowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty papierowej</title>
  <effectiveTime value="20150301122300"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
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  <versionNumber value="1"/>
  <recordTarget>
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    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <country>Polska</country>
        <postalCode>58-200</postalCode>
        <city>Dzierżoniów</city>
        <streetName>Szpitalna</streetName>
        <houseNumber>3a</houseNumber>
        <unitID>10</unitID>
      </addr>
      <patient>
        <name>
          <given>Anna</given>
          <given>Maria</given>
          <family>Nowak</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19960130"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
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        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>mgr</prefix>
          <given>Miłosz</given>
          <family>Najman</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>
        <name>Apteka porcelanowa</name>
        <telecom use="PUB" value="tel:32123456"/>
        <addr>
          <country>Polska</country>
          <postalCode>31-867</postalCode>
          <city>Kraków</city>
          <streetName>Mikołaja Kopernika</streetName>
          <houseNumber>36</houseNumber>
        </addr>
      </representedOrganization>
    </assignedAuthor>
  </author>
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  </custodian>
  <legalAuthenticator>
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          <title>Taksacja</title>
          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>
               Nazwa: Morphini Sulfas WZF 0,1% Spinal
              <br/>
               Postać: roztwór do wstrzykiwań
              <br/>
               Moc: 0,1%
              <br/>
               Opakowanie: 10 amp. po 2 ml
              <br/>
               Ilość: 1
              <br/>
               Nr serii: 123/456
              <br/>
               Data ważności: 1 stycznia 2018 r.
              <br/>
               Identyfikator produktu: 5909990014958 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
               Wartość wydanego leku: 50,00
              <br/>
               Poziom odpłatności leku refundowanego: 100%
              <br/>
               Kwota refundacji: 0,00
              <br/>
               Zapłacono: 50,60             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
              <templateId root="2.16.840.1.113883.10.20.1.34"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>
              <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
              <text>
                <reference value="#SPLY_1"/>
              </text>
              <quantity value="1"/>
              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>
                    <code code="232121" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Morphini Sulfas WZF 0,1% Spinal roztwór do wstrzykiwań"/>
                    <name>Morphini Sulfas WZF 0,1% Spinal</name>
                    <pharm:formCode code="IVSOL" codeSystem="2.16.840.1.113883.5.1127" displayName="Intravenous Solution"/>
                    <lotNumberText>123/456</lotNumberText>
                    <pharm:expirationTime value="20180101"/>
                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909991040123" codeSystem="1.3.160" codeSystemName="GS1"/>
                        <pharm:name>Morphini Sulfas WZF 0,1% Spinal (10 amp. 2ml)</pharm:name>
                        <pharm:formCode code="30001000" codeSystem="0.4.0.127.0.16.1.1.2.1" displayName="Ampoule"/>
                        <pharm:capacityQuantity value="2" unit="ml"/>
                        <pharm:asSuperContent classCode="CONT">
                          <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                            <pharm:capacityQuantity value="10"/>
                          </pharm:containerPackagedMedicine>
                        </pharm:asSuperContent>
                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>
                  <id extension="gg3432-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>
                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>
                    </manufacturedProduct>
                  </consumable>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>
                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
                  <text>
                    <reference value="#ACT_1"/>
                  </text>
                  <statusCode code="completed"/>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="50.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <statusCode code="completed"/>
                      <value xsi:type="CV" code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="0.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="50.00"/>
                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
              <reference typeCode="REFR">
                <externalDocument>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.72"/>
                  <id extension="12342/2017" root="2.16.840.1.113883.3.4424.8.11"/>
                </externalDocument>
              </reference>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
          <title>Dane o ubezpieczeniu i uprawnieniach</title>
          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07
              <br/>
               Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015)             </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>
              <id nullFlavor="NA"/>
              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
              <text>
                <reference value="#ACT_2"/>
              </text>
              <statusCode code="completed"/>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>
                  <id nullFlavor="NA"/>
                  <id nullFlavor="NA"/>
                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
                    </qualifier>
                  </code>
                  <statusCode code="completed"/>
                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>
                      <id nullFlavor="NA"/>
                      <code nullFlavor="NA"/>
                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
                      <text>Nr leg.: 238/2015</text>
                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Realizacja recepty na lek recepturowy

<ClinicalDocument>
  <!-- Realizacja recepty na Enarenal zgodna z profilem IHE DIS -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.2.2"/>
  <id extension="5432345" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>
  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="R" displayName="Lek recepturowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>
        <value code="Z" displayName="zamykająca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>
  <effectiveTime value="20150301122300"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="8765456765" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>
  <versionNumber value="1"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <country>Polska</country>
        <postalCode>58-200</postalCode>
        <city>Dzierżoniów</city>
        <streetName>Szpitalna</streetName>
        <houseNumber>3a</houseNumber>
        <unitID>10</unitID>
      </addr>
      <patient>
        <name>
          <given>Anna</given>
          <given>Maria</given>
          <family>Nowak</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19960130"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.81"/>
    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>
    <time value="20150301122300"/>
    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>
      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>mgr</prefix>
          <given>Miłosz</given>
          <family>Najman</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>
        <name>Apteka porcelanowa</name>
        <telecom use="PUB" value="tel:32123456"/>
        <addr>
          <country>Polska</country>
          <postalCode>31-867</postalCode>
          <city>Kraków</city>
          <streetName>Mikołaja Kopernika</streetName>
          <houseNumber>36</houseNumber>
        </addr>
      </representedOrganization>
    </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="20150301122300"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>
    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>
          <id extension="234565432345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>
          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>
          <title>Wydanie leku</title>
          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydanie leku recepturowego</caption>
               Receptura:
              <br/>
               Lanolini 25,0
              <br/>
               Vaselini albi 25,0
              <br/>
               Paraffini liq. 10,0
              <br/>
               Aquae aa ad 100,0
              <br/>
               Postać: maść
              <br/>
               Ilość: 100 g
              <br/>
            </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>
               Wartość wydanego leku: 30,00
              <br/>
               Poziom odpłatności leku refundowanego: 30%
              <br/>
               Kwota refundacji: 21,00
              <br/>
               Zapłacono: 9,00
              <br/>
               Taksa laborum: 12,33             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
              <templateId root="2.16.840.1.113883.10.20.1.34"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>
              <id extension="3243432" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
              <text>
                <reference value="#SPLY_1"/>
              </text>
              <quantity value="100" unit="g"/>
              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.70"/>
                    <code nullFlavor="NA"/>
                    <name>Maść pośladkowa</name>
                    <pharm:formCode code="TOPOINT" codeSystem="2.16.840.1.113883.5.1127" displayName="Topical Ointment"/>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="25" unit="g"/>
                        <denominator xsi:type="PQ" value="1"/>
                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="23432" codeSystem="2.16.1.113383.3.4424.6.3" displayName="Wazelina biała"/>
                        <pharm:name>Vaselinum album</pharm:name>
                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="25" unit="g"/>
                        <denominator xsi:type="PQ" value="1"/>
                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="34543" codeSystem="2.16.1.113383.3.4424.6.3" displayName="Lanolina"/>
                        <pharm:name>Lanolinum</pharm:name>
                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
                      <pharm:quantity>
                        <numerator xsi:type="PQ" value="10" unit="g"/>
                        <denominator xsi:type="PQ" value="1"/>
                      </pharm:quantity>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="45654" codeSystem="2.16.1.113383.3.4424.6.3" displayName="Parafina ciekła"/>
                        <pharm:name>Paraffinum liquidum</pharm:name>
                      </pharm:ingredient>
                    </pharm:ingredient>
                    <pharm:ingredient classCode="ACTI">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.71"/>
                      <pharm:ingredient classCode="MMAT" determinerCode="KIND">
                        <pharm:code code="56765" codeSystem="2.16.1.113383.3.4424.6.3" displayName="Woda do receptury aptecznej FP"/>
                        <pharm:name>Aqua</pharm:name>
                      </pharm:ingredient>
                    </pharm:ingredient>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>
                  <id extension="656789-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>
                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>
                    </manufacturedProduct>
                  </consumable>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>
                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
                  <text>
                    <reference value="#ACT_1"/>
                  </text>
                  <statusCode code="completed"/>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="30.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <statusCode code="completed"/>
                      <value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="21.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="9.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="TAKL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksa laborum"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="12.33"/>
                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
          <title>Dane o ubezpieczeniu i uprawnieniach</title>
          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07
              <br/>
               Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015)             </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>
              <id nullFlavor="NA"/>
              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
              <text>
                <reference value="#ACT_2"/>
              </text>
              <statusCode code="completed"/>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>
                  <id nullFlavor="NA"/>
                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
                    </qualifier>
                  </code>
                  <statusCode code="completed"/>
                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>
                      <id nullFlavor="NA"/>
                      <code nullFlavor="NA"/>
                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="3243432" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
                      <text>Nr leg.: 238/2015</text>
                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Realizacja recepty spełniającej wymagania związane z refundacją

<ClinicalDocument>
  <!-- Realizacja recepty na Enarenal zgodna z profilem IHE DIS -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.2.2"/>
  <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>
  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rp" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>
        <value code="C" displayName="częściowa" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>
  <effectiveTime value="20150301122300"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="24543234" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>
  <versionNumber value="1"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <country>Polska</country>
        <postalCode>58-200</postalCode>
        <city>Dzierżoniów</city>
        <streetName>Szpitalna</streetName>
        <houseNumber>3a</houseNumber>
        <unitID>10</unitID>
      </addr>
      <patient>
        <name>
          <given>Anna</given>
          <given>Maria</given>
          <family>Nowak</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19960130"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.81"/>
    <functionCode code="TFARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Technik farmaceutyczny"/>
    <time value="20150301122300"/>
    <assignedAuthor xsi:type="extPL:AssignedAuthor">
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>
      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>tech. farm.</prefix>
          <given>Jerzy</given>
          <family>Miarka</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>
        <name>Apteka porcelanowa</name>
        <telecom use="PUB" value="tel:32123456"/>
        <addr>
          <country>Polska</country>
          <postalCode>31-867</postalCode>
          <city>Kraków</city>
          <streetName>Mikołaja Kopernika</streetName>
          <houseNumber>36</houseNumber>
        </addr>
      </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="2.16.840.1.113883.3.4424.8.6.3.7"/>
          <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="20150301122300"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>
    </assignedEntity>
  </legalAuthenticator>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>
          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>
          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>
          <title>Wydanie leku</title>
          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>
               Nazwa: Enarenal
              <br/>
               Postać: tabletki
              <br/>
               Dawka: 5mg
              <br/>
               Opakowanie: 60 tabl.
              <br/>
               Ilość: 1
              <br/>
               Nr serii: 123/890
              <br/>
               Data ważności: 1 stycznia 2018 r.
              <br/>
               Identyfikator produktu: 5909990014958 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja</caption>
               Wartość wydanego leku: 12,00
              <br/>
               Limit urzędowy: 8,40
              <br/>
               Poziom odpłatności leku refundowanego: 30%
              <br/>
               Kwota refundacji: 8,40
              <br/>
               Zapłacono: 3,60             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
              <templateId root="2.16.840.1.113883.10.20.1.34"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>
              <id extension="543223454" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
              <text>
                <reference value="#SPLY_1"/>
              </text>
              <quantity value="1"/>
              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>
                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Enarenal 5mg tabl."/>
                    <name>Enarenal 5mg tabletki</name>
                    <lotNumberText>123/890</lotNumberText>
                    <pharm:expirationTime value="20180101"/>
                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990014958" codeSystem="1.3.160" codeSystemName="GS1"/>
                        <pharm:name>Enarenal 5mg (60 tabl.)</pharm:name>
                        <pharm:formCode code="ORTAB" codeSystem="2.16.840.1.113883.5.1127" displayName="Oral Tablet"/>
                        <pharm:capacityQuantity value="60"/>
                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>
                  <id extension="2343aab-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>
                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>
                    </manufacturedProduct>
                  </consumable>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>
                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
                  <text>
                    <reference value="#ACT_1"/>
                  </text>
                  <statusCode code="completed"/>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="12.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="8.40"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <statusCode code="completed"/>
                      <value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="8.40"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="3.60"/>
                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
          <title>Dane o ubezpieczeniu i uprawnieniach</title>
          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07
              <br/>
               Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015)             </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>
              <id nullFlavor="NA"/>
              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
              <text>
                <reference value="#ACT_2"/>
              </text>
              <statusCode code="completed"/>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>
                  <id nullFlavor="NA"/>
                  <id nullFlavor="NA"/>
                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
                    </qualifier>
                  </code>
                  <statusCode code="completed"/>
                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>
                      <id nullFlavor="NA"/>
                      <code nullFlavor="NA"/>
                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="543212345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>
                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
                      <text>Nr leg.: 238/2015</text>
                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Annotation comment"/>
          <text>
            <paragraph>
              <caption>Adnotacja farmaceuty</caption>
              Wydano zamiennik             </paragraph>
          </text>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>

Realizacja wycofująca recepty

<ClinicalDocument>
  <!-- Realizacja recepty na Enarenal zgodna z profilem IHE DIS -->
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.9.1.1.3"/>
  <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
  <templateId root="2.16.840.1.113883.3.4424.13.10.1.27" extension="1.2.2"/>
  <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>
  <code code="60593-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Medication dispensed extended">
    <translation code="04.12" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Realizacja recepty elektronicznej">
      <qualifier>
        <name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
        <value code="Rpw" codeSystem="2.16.840.1.113883.3.4424.11.1.25"/>
      </qualifier>
      <qualifier>
        <name code="RLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj leku"/>
        <value code="G" displayName="Lek gotowy" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TWREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb wystawienia recepty"/>
        <value code="Z" displayName="Zwykła" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="TRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Tryb realizacji recepty"/>
        <value code="Z" displayName="Zwykły" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="RRREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Rodzaj realizacji recepty"/>
        <value code="W" displayName="wycofująca" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
      <qualifier>
        <name code="PREC" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Postać recepty"/>
        <value code="E" displayName="elektroniczna" codeSystem="2.16.840.1.113883.3.4424.13.5.1"/>
      </qualifier>
    </translation>
  </code>
  <title>Realizacja recepty elektronicznej</title>
  <effectiveTime value="20150301122300"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
  <languageCode code="pl-PL"/>
  <setId extension="432321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>
  <versionNumber value="2"/>
  <recordTarget>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
    <patientRole>
      <id extension="1234567" root="2.16.840.1.113883.3.4424.2.7.0.17.1" displayable="false"/>
      <id extension="96013002256" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
      <addr>
        <country>Polska</country>
        <postalCode>58-200</postalCode>
        <city>Dzierżoniów</city>
        <streetName>Szpitalna</streetName>
        <houseNumber>3a</houseNumber>
        <unitID>10</unitID>
      </addr>
      <patient>
        <name>
          <given>Anna</given>
          <given>Maria</given>
          <family>Nowak</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"/>
        <birthTime value="19960130"/>
      </patient>
    </patientRole>
  </recordTarget>
  <author>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.81"/>
    <functionCode code="FARM" codeSystem="2.16.840.1.113883.3.4424.11.3.18" codeSystemName="ZAWODY_MED" displayName="Farmaceuta"/>
    <time value="20150301122300"/>
    <assignedAuthor>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="true"/>
      <assignedPerson>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
        <name>
          <prefix>mgr</prefix>
          <given>Miłosz</given>
          <family>Najman</family>
        </name>
      </assignedPerson>
      <representedOrganization>
        <templateId root="2.16.840.1.113883.3.4424.13.10.2.31"/>
        <id extension="12003" root="2.16.840.1.113883.3.4424.2.6"/>
        <name>Apteka porcelanowa</name>
        <telecom use="PUB" value="tel:32123456"/>
        <addr>
          <country>Polska</country>
          <postalCode>31-867</postalCode>
          <city>Kraków</city>
          <streetName>Mikołaja Kopernika</streetName>
          <houseNumber>36</houseNumber>
        </addr>
      </representedOrganization>
    </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="20150301122300"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="712178" root="2.16.840.1.113883.3.4424.1.6.1" displayable="false"/>
    </assignedEntity>
  </legalAuthenticator>
  <relatedDocument typeCode="RPLC">
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.83"/>
    <parentDocument classCode="DOCCLIN" moodCode="EVN">
      <id extension="232123" root="2.16.840.1.113883.3.4424.2.7.99999.5.1" displayable="true"/>
      <code code="60593-1" codeSystem="2.16.840.1.113883.6.1"/>
      <setId extension="432321" root="2.16.840.1.113883.3.4424.2.7.99999.5.2"/>
      <versionNumber value="1"/>
    </parentDocument>
  </relatedDocument>
  <component>
    <templateId root="2.16.840.1.113883.3.4424.13.10.2.80"/>
    <structuredBody>
      <component>
        <section>
          <templateId root="1.3.6.1.4.1.19376.1.9.1.2.3"/>
          <templateId root="2.16.840.1.113883.3.4424.13.10.3.70"/>
          <id extension="12345" root="2.16.840.1.113883.3.4424.2.7.99999.5.3"/>
          <code code="60590-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Dispensation"/>
          <title>Wydanie leku</title>
          <text>
            <paragraph ID="SPLY_1">
              <caption>Wydano lek gotowy</caption>
               Nazwa: MST Continus
              <br/>
               Postać: tabletki
              <br/>
               Dawka: 100mg
              <br/>
               Opakowanie: 30 tabl.
              <br/>
               Ilość: 1
              <br/>
               Identyfikator produktu: 5909990476527 (GS1/EAN)             </paragraph>
            <paragraph ID="ACT_1">
              <caption>Taksacja:</caption>
              s Wartość wydanego leku: 0,00
              <br/>
               Limit urzędowy: 7,01
              <br/>
               Poziom odpłatności leku refundowanego: R
              <br/>
               Kwota refundacji: 7,01
              <br/>
               Zapłacono: 0,00             </paragraph>
          </text>
          <entry>
            <supply classCode="SPLY" moodCode="EVN">
              <templateId root="1.3.6.1.4.1.19376.1.9.1.3.4"/>
              <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.3"/>
              <templateId root="2.16.840.1.113883.10.20.1.34"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.62"/>
              <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
              <text>
                <reference value="#SPLY_1"/>
              </text>
              <quantity value="0"/>
              <product>
                <manufacturedProduct>
                  <manufacturedMaterial>
                    <templateId root="1.3.6.1.4.1.19376.1.9.1.3.1"/>
                    <templateId root="2.16.840.1.113883.3.4424.13.10.4.54"/>
                    <code code="4321" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="MST Continus 100mg tabl. powl. o zmod. uwalnianiu"/>
                    <name>MST Continus 100mg tabletki</name>
                    <pharm:asContent classCode="CONT">
                      <pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
                        <pharm:code code="5909990476527" codeSystem="1.3.160" codeSystemName="GS1"/>
                        <pharm:name>MST Continus 100mg tabl. powl. o zmod. uwalnianiu (30 tabl.)</pharm:name>
                        <pharm:formCode code="ORTAB" codeSystem="2.16.840.1.113883.5.1127" displayName="Oral Tablet"/>
                        <pharm:capacityQuantity value="30"/>
                      </pharm:containerPackagedMedicine>
                    </pharm:asContent>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </product>
              <entryRelationship typeCode="REFR">
                <substanceAdministration classCode="SBADM" moodCode="INT">
                  <templateId root="1.3.6.1.4.1.19376.1.9.1.3.11"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.63"/>
                  <id extension="ff3432b-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
                  <code code="PREItem" codeSystem="1.3.6.1.4.1.19376.1.9.2.2"/>
                  <consumable>
                    <manufacturedProduct>
                      <manufacturedMaterial nullFlavor="NA"/>
                    </manufacturedProduct>
                  </consumable>
                </substanceAdministration>
              </entryRelationship>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.67"/>
                  <code code="TAKSL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Taksacja leku"/>
                  <text>
                    <reference value="#ACT_1"/>
                  </text>
                  <statusCode code="completed"/>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="0.00"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="LIMU" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Limit urzędowy"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="7.01"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="DEF">
                      <code code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Poziomy odpłatności leków refundowanych"/>
                      <statusCode code="completed"/>
                      <value xsi:type="CV" code="R" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="INT">
                      <code code="KREF" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Kwota refundacji"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="7.01"/>
                    </observation>
                  </entryRelationship>
                  <entryRelationship typeCode="COMP">
                    <observation classCode="OBS" moodCode="EVN">
                      <code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
                      <statusCode code="completed"/>
                      <value xsi:type="REAL" value="0.00"/>
                    </observation>
                  </entryRelationship>
                </act>
              </entryRelationship>
            </supply>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
          <title>Dane o ubezpieczeniu i uprawnieniach</title>
          <text>
            <paragraph ID="ACT_2">
               Oddział NFZ: 07
              <br/>
               Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015)             </paragraph>
          </text>
          <entry>
            <act classCode="ACT" moodCode="DEF">
              <templateId root="2.16.840.1.113883.10.20.1.20"/>
              <templateId root="2.16.840.1.113883.3.4424.13.10.4.51"/>
              <id nullFlavor="NA"/>
              <code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
              <text>
                <reference value="#ACT_2"/>
              </text>
              <statusCode code="completed"/>
              <entryRelationship typeCode="COMP">
                <act classCode="ACT" moodCode="EVN">
                  <!-- Uprawnienie dodatkowe -->
                  <templateId root="2.16.840.1.113883.10.20.1.26"/>
                  <templateId root="2.16.840.1.113883.3.4424.13.10.4.61"/>
                  <id nullFlavor="NA"/>
                  <id nullFlavor="NA"/>
                  <code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
                    <qualifier>
                      <name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
                      <value code="ZK" displayName="ZK" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
                    </qualifier>
                  </code>
                  <statusCode code="completed"/>
                  <performer typeCode="PRF">
                    <!-- Dane ubezpieczyciela/płatnika -->
                    <assignedEntity>
                      <id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
                    </assignedEntity>
                  </performer>
                  <entryRelationship typeCode="REFR">
                    <act classCode="ACT" moodCode="EVN">
                      <templateId root="2.16.840.1.113883.10.20.1.19"/>
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.53"/>
                      <id nullFlavor="NA"/>
                      <code nullFlavor="NA"/>
                      <entryRelationship typeCode="SUBJ">
                        <supply classCode="SPLY" moodCode="PRMS">
                          <id extension="bc34221ax" root="2.16.840.1.113883.3.4424.2.7.99999.5.1"/>
                        </supply>
                      </entryRelationship>
                    </act>
                  </entryRelationship>
                  <reference typeCode="REFR">
                    <externalDocument classCode="DOC" moodCode="EVN">
                      <!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
                      <templateId root="2.16.840.1.113883.3.4424.13.10.4.59"/>
                      <text>Nr leg.: 238/2015</text>
                    </externalDocument>
                  </reference>
                </act>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>