Przykłady - [1] Dokument recepty spełniający wymagania związane z refundacją
Dokument recepty spełniający wymagania związane z refundacją 1
<ClinicalDocument>
<!-- Recepta na Enarenal zgodna z profilem IHE PRE -->
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
<templateId root="1.3.6.1.4.1.19376.1.9.1.1.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.2.2"/>
<id extension="de343d" root="2.16.840.1.113883.3.4424.2.7.99999.2.1" displayable="true"/>
<code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
<translation code="04.01" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Recepta">
<qualifier>
<name code="KDLEK" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Kategoria dostępności leku"/>
<value code="Rpz" 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> </translation> </code>
<title>Recepta</title>
<effectiveTime value="20130412"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="pl-PL"/>
<setId extension="ff543" root="2.16.840.1.113883.3.4424.2.7.99999.2.1"/>
<versionNumber value="1"/>
<recordTarget>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.3.4424.2.7.99999.17.1" displayable="false"/>
<id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
<addr>
<country>Polska</country>
<postalCode xsi:type="extPL:adxp.postalCode" postCity="Piaseczno">03-134</postalCode>
<city>Warszawa</city>
<streetName>Odkryta</streetName>
<houseNumber>41</houseNumber>
<unitID>12</unitID>
<censusTract>TERYT SIMC: 987654</censusTract>
</addr>
<patient>
<name>
<given>Jan</given>
<given>Franciszek</given>
<family>Kowalski</family>
</name>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/>
<birthTime value="19620915"/>
</patient> </patientRole> </recordTarget>
<author>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.79"/>
<functionCode code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
<assignedAuthor xsi:type="extPL:AssignedAuthor">
<id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
<code code="0718_0726" codeSystem="2.16.840.1.113883.3.4424.11.3.3.1" displayName="neurologia, radiologia i diagnostyka obrazowa"/>
<assignedPerson>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
<name>
<prefix>lek.</prefix>
<given>Piotr</given>
<family>Nowak</family>
</name> </assignedPerson>
<representedOrganization>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.18"/>
<id extension="1007-008" root="2.16.840.1.113883.3.4424.2.3.3" displayable="true"/>
<name>Poradnia neurologiczna</name>
<telecom use="PUB" value="tel:22-1111123"/>
<addr>
<postalCode>00-950</postalCode>
<city>Warszawa</city>
<streetName>Marszałkowska</streetName>
<houseNumber>320</houseNumber>
</addr>
<asOrganizationPartOf>
<wholeOrganization>
<id extension="12345678901234" root="2.16.840.1.113883.3.4424.2.2.2" displayable="true"/>
<asOrganizationPartOf>
<wholeOrganization>
<id extension="1007" root="2.16.840.1.113883.3.4424.2.3.1" displayable="true"/>
<id extension="123456789" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
</wholeOrganization> </asOrganizationPartOf> </wholeOrganization> </asOrganizationPartOf> </representedOrganization>
<extPL:boundedBy typeCode="PART">
<extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>
<extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
<extPL:id extension="3329978" root="2.16.840.1.113883.3.4424.8.6.1.7"/>
<extPL:bounding typeCode="PART">
<extPL:reimburser classCode="UNDWRT">
<extPL:id extension="07" root="2.16.840.1.113883.3.4424.3.1" displayable="true"/>
</extPL:reimburser> </extPL:bounding> </extPL:reimbursementRelatedContract> </extPL:boundedBy> </assignedAuthor> </author>
<custodian>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.20"/>
<assignedCustodian>
<representedCustodianOrganization>
<id root="2.16.840.1.113883.3.4424" assigningAuthorityName="CSIOZ" displayable="false"/>
</representedCustodianOrganization> </assignedCustodian> </custodian>
<legalAuthenticator>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.6"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="7724513" root="2.16.840.1.113883.3.4424.1.6.2" displayable="false"/>
<code code="LEK" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz"/>
</assignedEntity> </legalAuthenticator>
<component>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
<structuredBody>
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.9.1.2.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
<id extension="9876" root="2.16.840.1.113883.3.4424.2.7.99999.2.4"/>
<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<title>Rp. (Cito)</title>
<text>
<paragraph ID="SBADM_1">
Rilutek 50mg tabletki ( <content ID="ACT_1">NZ</content>
)
1 op. po 56 tabl.
D.S. 2 x 1 tabl.
<content ID="ACT_2">Odpłatność: 100%</content>
</paragraph> </text>
<entry>
<substanceAdministration classCode="SBADM" moodCode="INT">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.2"/>
<templateId root="2.16.840.1.113883.10.20.1.24"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7"/>
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.6"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.3"/>
<id extension="de343d-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
<text>
<reference value="#SBADM_1"/>
</text>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
</effectiveTime>
<repeatNumber value="1"/>
<doseQuantity value="1"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.1.53"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2"/>
<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="7897" codeSystem="2.16.840.1.113883.3.4424.6.1" displayName="Rilutek 50mg tabl. powl."/>
<name>Rilutek 50mg tabl. powl.; 0,05 g 56 tabl. </name>
<pharm:asContent classCode="CONT">
<pharm:containerPackagedMedicine classCode="CONT" determinerCode="INSTANCE">
<pharm:code code="5909990760619" codeSystem="1.3.160" codeSystemName="GS1"/>
<pharm:name>Rilutek 50mg tabl. powl. (56 tabl.)</pharm:name>
<pharm:formCode code="ORTAB" codeSystem="2.16.840.1.113883.5.1127" displayName="Oral Tablet"/>
<pharm:capacityQuantity value="56"/>
</pharm:containerPackagedMedicine> </pharm:asContent> </manufacturedMaterial> </manufacturedProduct> </consumable>
<entryRelationship typeCode="COMP">
<supply classCode="SPLY" moodCode="RQO">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.8"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.55"/>
<effectiveTime value="20130412"/>
<priorityCode code="UR" codeSystem="2.16.840.1.113883.5.7"/>
<independentInd value="false"/>
<product>
<manufacturedProduct>
<manufacturedLabeledDrug>
<code code="5909990760619" codeSystem="1.3.160" codeSystemName="GS1"/>
</manufacturedLabeledDrug> </manufacturedProduct> </product>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="DEF">
<templateId root="2.16.840.1.113883.3.4424.13.10.4.57"/>
<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">
<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
<qualifier>
<name code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Poziomy odpłatności leków refundowanych"/>
<value code="100%" codeSystem="2.16.840.1.113883.3.4424.11.1.1" displayName="pełnopłatne"/>
</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> </act> </entryRelationship> </act> </entryRelationship> </supply> </entryRelationship>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="DEF">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.9.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.4.56"/>
<code code="N" codeSystem="2.16.840.1.113883.5.1070" codeSystemName="HL7 Substance Admin Substitution"/>
<text>
<reference value="#ACT_1"/>
</text>
<statusCode code="completed"/>
</act> </entryRelationship> </substanceAdministration> </entry> </section> </component>
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.1.9"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.5.3.7"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.69"/>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1"/>
<title>Dane o ubezpieczeniu i uprawnieniach</title>
<text>
<paragraph ID="ACT_3"> Oddział NFZ: 07 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"/>
<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
<text>
<reference value="#ACT_3"/>
</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"/>
<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="IB" displayName="IB" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
</qualifier> </code>
<text>
<reference value="#ACT_3"/>
</text>
<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"/>
<entryRelationship typeCode="SUBJ">
<substanceAdministration classCode="SBADM" moodCode="PRMS">
<id extension="de343d-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
<consumable>
<manufacturedProduct>
<manufacturedMaterial nullFlavor="NA"/>
</manufacturedProduct> </consumable> </substanceAdministration> </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.: 234/1992</text>
</externalDocument> </reference> </act> </entryRelationship> </act> </entry> </section> </component> </structuredBody> </component> </ClinicalDocument>
Dokument recepty spełniający wymagania zwiazane z refundacją 2
<ClinicalDocument>
<!-- Recepta na Enarenal zgodna z profilem IHE PRE -->
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
<templateId root="1.3.6.1.4.1.19376.1.9.1.1.1"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.1.26" extension="1.2.2"/>
<id extension="aa2321" root="2.16.840.1.113883.3.4424.2.7.99999.2.1" displayable="true"/>
<code code="57833-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescription for medication Document">
<translation code="04.01" codeSystem="2.16.840.1.113883.3.4424.11.1.32" codeSystemName="KLAS_DOK_P1" displayName="Recepta">
<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> </translation> </code>
<title>Recepta</title>
<effectiveTime value="20130412"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="pl-PL"/>
<setId extension="64324" root="2.16.840.1.113883.3.4424.2.7.99999.2.1"/>
<versionNumber value="1"/>
<recordTarget>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.23"/>
<patientRole>
<id extension="12345" root="2.16.840.1.113883.3.4424.2.7.99999.17.1" displayable="false"/>
<id extension="62091599999" root="2.16.840.1.113883.3.4424.1.1.616" displayable="true"/>
<addr>
<country>Polska</country>
<postalCode xsi:type="extPL:adxp.postalCode" postCity="Piaseczno">03-134</postalCode>
<city>Warszawa</city>
<streetName>Odkryta</streetName>
<houseNumber>41</houseNumber>
<unitID>12</unitID>
<censusTract>TERYT SIMC: 987654</censusTract>
</addr>
<patient>
<name>
<given>Jan</given>
<given>Franciszek</given>
<family>Kowalski</family>
</name>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/>
<birthTime value="19620915"/>
</patient> </patientRole> </recordTarget>
<author>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.79"/>
<functionCode code="LEKD" codeSystem="2.16.840.1.113883.3.4424.11.3.18" displayName="Lekarz dentysta"/>
<assignedAuthor xsi:type="extPL:AssignedAuthor">
<id extension="2321123" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
<assignedPerson>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.1"/>
<name>
<prefix>lek. dent.</prefix>
<given>Damian</given>
<family>Kowalski</family>
</name> </assignedPerson>
<representedOrganization>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.15"/>
<id extension="000000054325-01" root="2.16.840.1.113883.3.4424.2.4.68.1"/>
<name>Prywatna praktyka dentystyczna Damian Kowalski</name>
<telecom use="PUB" value="tel:22-4325678"/>
<addr>
<country>Polska</country>
<postalCode>03-135</postalCode>
<city>Warszawa</city>
<streetName>Książkowa</streetName>
<houseNumber>9F</houseNumber>
<unitID>1</unitID>
</addr>
<asOrganizationPartOf>
<code code="L" codeSystem="2.16.840.1.113883.3.4424.11.3.19" codeSystemName="RODZ_PRAKTYKI" displayName="Praktyka lekarska"/>
<wholeOrganization>
<id extension="54325" root="2.16.840.1.113883.3.4424.2.4.68"/>
<id extension="987654321" root="2.16.840.1.113883.3.4424.2.2.1" displayable="true"/>
<name>Prywatna praktyka dentystyczna Damian Kowalski</name>
<telecom use="PUB" value="tel:22-4325678"/>
<addr>
<country>Polska</country>
<postalCode>03-135</postalCode>
<city>Warszawa</city>
<streetName>Książkokwa</streetName>
<houseNumber>9F</houseNumber>
<unitID>1</unitID>
</addr> </wholeOrganization> </asOrganizationPartOf> </representedOrganization>
<extPL:boundedBy typeCode="PART">
<extPL:templateId root="2.16.840.1.113883.3.4424.13.10.2.44"/>
<extPL:reimbursementRelatedContract moodCode="EVN" classCode="CNTRCT">
<extPL:id extension="72419" root="2.16.840.1.113883.3.4424.8.6.2.7"/>
<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"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="2321123" root="2.16.840.1.113883.3.4424.1.6.2" displayable="true"/>
</assignedEntity> </legalAuthenticator>
<component>
<templateId root="2.16.840.1.113883.3.4424.13.10.2.25"/>
<structuredBody>
<component>
<section>
<templateId root="1.3.6.1.4.1.19376.1.9.1.2.1"/>
<templateId root="2.16.840.1.113883.3.4424.13.10.3.4"/>
<id extension="65432" root="2.16.840.1.113883.3.4424.2.7.99999.2.4"/>
<code code="57828-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Prescriptions"/>
<title>Rp. (Cito)</title>
<text>
<paragraph ID="SBADM_1">
Enarenal 5mg tabletki
1 op. po 60 tabl.
D.S. 2 x 1 tabl.
<content ID="ACT_1">Odpłatność: R</content>
</paragraph> </text>
<entry>
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<id extension="aa2321-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
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<reference value="#SBADM_1"/>
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<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
</effectiveTime>
<repeatNumber value="1"/>
<doseQuantity value="1"/>
<consumable>
<manufacturedProduct>
<templateId root="2.16.840.1.113883.10.20.1.53"/>
<templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2"/>
<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>
</manufacturedMaterial> </manufacturedProduct> </consumable>
<entryRelationship typeCode="COMP">
<supply classCode="SPLY" moodCode="RQO">
<templateId root="1.3.6.1.4.1.19376.1.9.1.3.8"/>
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<effectiveTime value="20130505"/>
<priorityCode code="UR" codeSystem="2.16.840.1.113883.5.7"/>
<independentInd value="false"/>
<product>
<manufacturedProduct>
<manufacturedLabeledDrug>
<code code="5909990014958" codeSystem="1.3.160" codeSystemName="GS1"/>
</manufacturedLabeledDrug> </manufacturedProduct> </product>
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<act classCode="ACT" moodCode="DEF">
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<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/>
<text>
<reference value="#ACT_1"/>
</text>
<statusCode code="completed"/>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
<qualifier>
<name code="RLPO" codeSystem="2.16.840.1.113883.3.4424.13.5.1" codeSystemName="PolskieKlasyfikatoryHL7v3" displayName="Poziomy odpłatności leków refundowanych"/>
<value code="R" codeSystem="2.16.840.1.113883.3.4424.11.1.1" displayName="ryczałt"/>
</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> </act> </entryRelationship> </act> </entryRelationship> </supply> </entryRelationship> </substanceAdministration> </entry> </section> </component>
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<section>
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<title>Dane o ubezpieczeniu i uprawnieniach</title>
<text>
<paragraph ID="ACT_2"> Oddział NFZ: 07 Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015) </paragraph> </text>
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<reference value="#ACT_2"/>
</text>
<statusCode code="completed"/>
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<!-- Uprawnienie dodatkowe -->
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<code code="PUBLICPOL" codeSystem="2.16.840.1.113883.5.4">
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<name code="RLUD" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Refundacja leków wynikająca z uprawnień dodatkowych"/>
<value code="IB" displayName="IB" codeSystem="2.16.840.1.113883.3.4424.11.3.1"/>
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<text>
<reference value="#ACT_2"/>
</text>
<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"/>
<entryRelationship typeCode="SUBJ">
<substanceAdministration classCode="SBADM" moodCode="PRMS">
<id extension="aa2321-1" root="2.16.840.1.113883.3.4424.2.7.99999.2.3"/>
<consumable>
<manufacturedProduct>
<manufacturedMaterial nullFlavor="NA"/>
</manufacturedProduct> </consumable> </substanceAdministration> </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.: 234/1992</text>
</externalDocument> </reference> </act> </entryRelationship> </act> </entry> </section> </component> </structuredBody> </component> </ClinicalDocument>