<?xml version="1.0" encoding="utf-8"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:sdtc="urn:hl7-org:sdtc">
	<!--

	Title: US_Realm_Patient_Generated_Document_Header_Template
	Original Filename: US_Realm_Patient_Generated_Document_Header_Template.xml
	Version: 2.0
	
	$LastChangedDate: 2014-06-19 18:55:19 -0400 (Thu, 19 Jun 2014) $ 
	$Author: eric.parapini $
	
	Revision History:
	11/26/2012 lrn vvb jrf created - version for patient for self
	08/02/2013 lrn vvb jrf updated 
-->
	<!--

********************************************************

  CDA Header for a Patient Generated Health Document

********************************************************

	-->
	<realmCode code="US"/>
	<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
	<!-- C-CDA US Realm Header Template -->
	<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2014-06-09"/>
	<!-- The document conforms to the Universal Realm PGD Header Template. -->
	<templateId root="2.16.840.1.113883.10.20.29"/>
	<!-- US General Patient Generated Document (PGD) Header Template - a further constraint on the general header. -->
	<templateId root="2.16.840.1.113883.10.20.29.1"/>
	<!-- The PGD Document Template Id -->
	<templateId root="2.16.840.1.113883.10.20.29.1.1"/>
	<id extension="999" root="2.16.840.1.113883.19"/>
	<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="51855-5" displayName="Patient Generated Document"/>
	<title>Patient Generated Document: My Health Summary</title>
	<effectiveTime value="20121126145000-0500"/>
	<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
	<languageCode code="en-US"/>
	<setId extension="20121126145000" root="2.16.840.1.113883.19"/>
	<versionNumber value="1"/>
	<recordTarget>
		<patientRole>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<!-- id using HL7 example OID. -->
			<id extension="999.1" root="2.16.840.1.113883.19"/>
			<!-- Fake Social Security Number using the actual SSN OID. -->
			<id extension="444333333" root="2.16.840.1.113883.4.1"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<!-- A secure e-mail address appropriate for healthcare communications-->
			<telecom value="mailto:adameveryman@direct.sampleHISP.com" use="H"/>
			<patient>
				<name use="L">
					<!-- L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 -->
					<prefix>Mr.</prefix>
					<given>Adam</given>
					<given>A.</given>
					<given qualifier="CL">Ace</given>
					<family>Everyman</family>
				</name>
				<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
				<birthTime value="19551125"/>
				<maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode"/>
				<religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystemName="HL7 Religious Affiliation " codeSystem="2.16.840.1.113883.1.11.19185"/>
				<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC"/>
				<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC"/>
				<!-- This person does not have a guardian -->
				<birthplace>
					<place>
						<addr>
							<city>Pointe-Claire</city>
							<state>QC</state>
							<postalCode>H9R 1E4</postalCode>
							<country>CAN</country>
						</addr>
					</place>
				</birthplace>
				<languageCommunication>
					<languageCode code="fr-CN" sdtc:valueSet="2.16.840.1.113883.1.11.11526"/>
					<modeCode code="RWR" displayName="Recieve Written" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
					<proficiencyLevelCode code="E" displayName="Excellent" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency"/>
					<preferenceInd value="true"/>
				</languageCommunication>
			</patient>
			<providerOrganization>
				<!-- The person receives care from this organization. -->
				<!-- id using HL7 example OID. -->
				<id extension="999.2" root="2.16.840.1.113883.19"/>
				<!-- NPI for the organization -->
				<id extension="1234567890" root="2.16.840.1.113883.4.6"/>
				<name>Good Health Internal Medicine</name>
				<telecom use="WP" value="tel:(781)555-1212"/>
				<addr>
					<streetAddressLine>100 Health Drive</streetAddressLine>
					<city>Boston</city>
					<state>MA</state>
					<postalCode>02368</postalCode>
					<country>USA</country>
				</addr>
			</providerOrganization>
		</patientRole>
	</recordTarget>
	<author>
		<time value="20121126145000-0500"/>
		<assignedAuthor>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<!-- 
				The PGD Header Template includes further conformance constraints on the code element to encode the personal or legal 
				relationship of the author when they are person who is not acting in the role of a clinician.. 
			-->
			<code code="ONESELF" displayName="Self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<assignedPerson>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</assignedPerson>
		</assignedAuthor>
	</author>
	<!-- The Author below documents the system used to create the Patient Generated Document.
		In this scenario the Patient is using a fictitious PHR Service called MyPersonalHealthRecord.com. 
		It is a service which consumers purchase to receive and create their electronic health records. 
		It is not a Patient Portal that is tethered to some other EMR or medical insurance records system.
		The service is developed by a company call ACME PHR Solutions,Inc. -->
	<author>
		<time value="20121126145000-0500"/>
		<assignedAuthor>
			<id extension="777.11" root="2.16.840.1.113883.19"/>
			<addr nullFlavor="NA"/>
			<telecom nullFlavor="NA"/>
			<assignedAuthoringDevice>
				<manufacturerModelName>ACME PHR</manufacturerModelName>
				<softwareName>MyPHR v1.0</softwareName>
			</assignedAuthoringDevice>
			<representedOrganization>
				<id extension="999" root="1.2.3.4.5.6.7.8.9.12345"/>
				<name>ACME PHR Solutions,Inc.</name>
				<telecom use="WP" value="tel:123-123-12345"/>
				<addr>
					<streetAddressLine>4 Future Way</streetAddressLine>
					<city>Provenance</city>
					<state>RI</state>
					<postalCode>02919</postalCode>
				</addr>
			</representedOrganization>
		</assignedAuthor>
	</author>
	<dataEnterer>
		<assignedEntity>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<code code="ONESELF" displayName="Self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<assignedPerson>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</dataEnterer>
	<informant>
		<assignedEntity>
			<!-- id using HL7 example OID. -->
			<id extension="999.1" root="2.16.840.1.113883.19"/>
			<code code="ONESELF" displayName="Self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<assignedPerson>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</informant>
	<informant>
		<relatedEntity classCode="NOK">
			<code code="SIS" displayName="Sister" codeSystem="2.16.840.1.113883.11.20.12.1" codeSystemName="Personal And Legal Relationship Role Type"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<relatedPerson>
				<!-- relatedPerson/id is invalid without the use of an stdc extension. 
					Patient Generated Document comittee elected to keep this id in as is for ballot -->
				<name>
					<given>Alice</given>
					<family>Everyman</family>
				</name>
			</relatedPerson>
		</relatedEntity>
	</informant>
	<!-- We got this far by 6/18/2013 -->
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<!-- id using HL7 example OID. -->
				<id extension="999.3" root="2.16.840.1.113883.19"/>
				<name>MyPersonalHealthRecord.Com</name>
				<telecom value="tel:(555)555-1212" use="WP"/>
				<addr use="WP">
					<streetAddressLine>123 Boylston Street</streetAddressLine>
					<city>Blue Hill</city>
					<state>MA</state>
					<postalCode>02368</postalCode>
					<country>USA</country>
				</addr>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<!-- Jessi and I got this far - on 6/24. -->
	<!-- The document is intended for multiple recipients, Adam himself and his PCP physician. -->
	<informationRecipient>
		<intendedRecipient>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<informationRecipient>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</informationRecipient>
			<receivedOrganization>
				<!-- id using HL7 example OID. -->
				<id extension="999.3" root="2.16.840.1.113883.19"/>
				<name>MyPersonalHealthRecord.Com</name>
			</receivedOrganization>
		</intendedRecipient>
	</informationRecipient>
	<informationRecipient>
		<intendedRecipient>
			<!-- Unique/Trusted id using HL7 example OID. -->
			<id extension="999.4" root="2.16.840.1.113883.19"/>
			<!-- The physician's NPI number -->
			<id extension="1122334455" root="2.16.840.1.113883.4.6"/>
			<!-- The physician's Direct Address -->
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="DrP@direct.sampleHISP2.com" root="2.16.123.123.12345.4321"/>
			<telecom use="WP" value="tel:(781)555-1212"/>
			<telecom use="WP" value="mailto:DrP@direct.sampleHISP2.com"/>
			<informationRecipient>
				<name>
					<prefix>Dr.</prefix>
					<given>Patricia</given>
					<family>Primary</family>
				</name>
			</informationRecipient>
			<receivedOrganization>
				<!-- Unique/Trusted id using HL7 example OID. -->
				<id extension="999.2" root="2.16.840.1.113883.19"/>
				<!-- NPI for the organization -->
				<id extension="1234567890" root="2.16.840.1.113883.4.6"/>
				<name>Good Health Internal Medicine</name>
				<telecom use="WP" value="tel:(781)555-1212"/>
				<addr>
					<streetAddressLine>100 Health Drive</streetAddressLine>
					<city>Boston</city>
					<state>MA</state>
					<postalCode>02368</postalCode>
					<country>USA</country>
				</addr>
			</receivedOrganization>
		</intendedRecipient>
	</informationRecipient>
	<legalAuthenticator>
		<time value="20121126145000-0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<assignedPerson>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</legalAuthenticator>
	<authenticator>
		<time value="20121126145000-0500"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
			<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234"/>
			<addr use="HP">
				<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
				<streetAddressLine>2222 Home Street</streetAddressLine>
				<city>Boston</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
				<country>US</country>
			</addr>
			<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
			<telecom value="tel:(555)555-2004" use="HP"/>
			<assignedPerson>
				<name>
					<given>Adam</given>
					<family>Everyman</family>
				</name>
			</assignedPerson>
		</assignedEntity>
	</authenticator>
	<participant typeCode="IND">
		<time xsi:type="IVL_TS">
			<low value="19551125"/>
			<high value="20121126"/>
		</time>
		<associatedEntity classCode="NOK">
			<code code="MTH" codeSystem="2.16.840.1.113883.5.111"/>
			<addr>
				<streetAddressLine>17 Daws Rd.</streetAddressLine>
				<city>Blue Bell</city>
				<state>MA</state>
				<postalCode>02368</postalCode>
				<country>US</country>
			</addr>
			<telecom value="tel:(555)555-2006" use="WP"/>
			<associatedPerson>
				<name>
					<prefix>Mrs.</prefix>
					<given>Martha</given>
					<family>Mum</family>
				</name>
			</associatedPerson>
		</associatedEntity>
	</participant>
	<inFulfillmentOf>
		<order>
			<!-- The root identifies the EMR system at the Good Health Internal Medicine Practice -->
			<id extension="Ord12345" root="2.16.840.1.113883.4.6.1234567890.4"/>
		</order>
	</inFulfillmentOf>
	<documentationOf typeCode="DOC">
		<!-- Service Event class code is no longer constrained to be PCPR as with CCD or C-CDA-CCD -->
		<serviceEvent classCode="ACT">
			<effectiveTime>
				<low value="19551125"/>
				<high value="20121126145000"/>
			</effectiveTime>
			<performer typeCode="PRF">
				<functionCode code="PCP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.5.88" codeSystemName="Participation Function">
					<originalText>Primary Care Provider (PCP)</originalText>
				</functionCode>
				<time>
					<low value="201101"/>
				</time>
				<assignedEntity>
					<!-- Unique/trusted id using HL7 example OID. -->
					<id extension="999.4" root="2.16.840.1.113883.19"/>
					<!-- The physician's NPI number -->
					<id extension="1122334455" root="2.16.840.1.113883.4.6"/>
					<!-- Type of Physician -->
					<code code="207R00000X" displayName="Internal Medicine" codeSystemName="NUCC Health Care Provider Taxonomy" codeSystem="2.16.840.1.113883.6.101"/>
					<addr>
						<streetAddressLine>100 Health Drive</streetAddressLine>
						<city>Boston</city>
						<state>MA</state>
						<postalCode>02368</postalCode>
						<country>USA</country>
					</addr>
					<telecom use="WP" value="tel:(781)555-1212"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Patricia</given>
							<family>Primary</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<!-- Unique/Trusted id using HL7 example OID. -->
						<id extension="999.2" root="2.16.840.1.113883.19"/>
						<name>Good Health Internal Medicine</name>
						<telecom use="WP" value="tel:(781)555-1212"/>
						<addr>
							<streetAddressLine>100 Health Drive</streetAddressLine>
							<city>Boston</city>
							<state>MA</state>
							<postalCode>02368</postalCode>
							<country>USA</country>
						</addr>
					</representedOrganization>
				</assignedEntity>
			</performer>
			<performer typeCode="PRF">
				<functionCode code="PCP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.5.88" codeSystemName="Participation Function">
					<originalText>Primary Care Provider (PCP)</originalText>
				</functionCode>
				<time>
					<low value="1971"/>
					<high value="201101"/>
				</time>
				<assignedEntity>
					<!-- Unique/trusted id using HL7 example OID. -->
					<id extension="99.5" root="2.16.840.1.113883.19"/>
					<!-- The physician's NPI number -->
					<id extension="1122334466" root="2.16.840.1.113883.4.6"/>
					<!-- Type of Physician -->
					<code code="207Q00000X" displayName="Family Medicine" codeSystemName="NUCC Health Care Provider Taxonomy" codeSystem="2.16.840.1.113883.6.101">
						<originalText>General Practitioner</originalText>
					</code>
					<addr>
						<streetAddressLine>103 Rue Champlain</streetAddressLine>
						<city>Roxboro</city>
						<state>QC</state>
						<postalCode>H8Y 3S6</postalCode>
						<country>CAN</country>
					</addr>
					<telecom use="WP" value="tel:514-555-1212"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Fay</given>
							<family>Family</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<!-- Unique/Trusted id using HL7 example OID. -->
						<id extension="999.5" root="2.16.840.1.113883.19"/>
						<name>Roxboro Family Practice</name>
						<telecom use="WP" value="tel:514-555-1212"/>
						<addr>
							<streetAddressLine>103 Rue Champlain</streetAddressLine>
							<city>Roxboro</city>
							<state>QC</state>
							<postalCode>H8Y 3S6</postalCode>
							<country>CAN</country>
						</addr>
					</representedOrganization>
				</assignedEntity>
			</performer>
			<performer typeCode="PRF">
				<functionCode code="PCP" displayName="Primary Care Provider" codeSystem="2.16.840.1.113883.5.88" codeSystemName="Participation Function">
					<originalText>Primary Care Provider (PCP)</originalText>
				</functionCode>
				<time>
					<low value="19551125"/>
					<high value="1971"/>
				</time>
				<assignedEntity>
					<!-- Unique/Trusted id using HL7 example OID. -->
					<id extension="999.6" root="2.16.840.1.113883.19"/>
					<!-- The physician's NPI number -->
					<id extension="1122334477" root="2.16.840.1.113883.4.6"/>
					<!-- Type of Physician -->
					<code code="208000000X" displayName="Pediatrics" codeSystemName="NUCC Health Care Provider Taxonomy" codeSystem="2.16.840.1.113883.6.101">
						<originalText>Pediatrician</originalText>
					</code>
					<addr>
						<streetAddressLine>10 Rue De Seville</streetAddressLine>
						<city>Pointe-Claire</city>
						<state>QC</state>
						<postalCode>H9R 1E9</postalCode>
						<country>CAN</country>
					</addr>
					<telecom use="WP" value="tel:514-333-1234"/>
					<assignedPerson>
						<name>
							<prefix>Dr.</prefix>
							<given>Karen</given>
							<family>Kidder</family>
						</name>
					</assignedPerson>
					<representedOrganization>
						<!-- Unique/Trusted id using HL7 example OID -->
						<id extension="999.7" root="2.16.840.1.113883.19"/>
						<name>Pointe-Claire Pediatrics</name>
						<telecom use="WP" value="tel:514-333-1234"/>
						<addr>
							<streetAddressLine>10 Rue De Seville</streetAddressLine>
							<city>Pointe-Claire</city>
							<state>QC</state>
							<postalCode>H9R 1E9</postalCode>
							<country>CAN</country>
						</addr>
					</representedOrganization>
				</assignedEntity>
			</performer>
		</serviceEvent>
	</documentationOf>
	<authorization typeCode="AUTH">
		<consent classCode="CONS" moodCode="EVN">
			<id root="629deb70-5306-11df-9879-0800200c9a66"/>
			<code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="64293-4" displayName="Procedure consent"/>
			<statusCode code="completed"/>
		</consent>
	</authorization>
	<!-- ********************************************************
		
		CDA Body – 
		Use sections and entries defined by templates in the HL7 Consolidate CDA 
		
		******************************************************** -->
	<component>
		<structuredBody>
			<component>
				<section/>
			</component>
		</structuredBody>
	</component>
</ClinicalDocument>
