health-data-standards 3.6.1 → 3.7.0

data/templates/cat1/r2/_reason.cat1.erb

@@ -0,0 +1,45 @@
+<%  if entry.negation_reason.present?
+      reason = entry.negation_reason
+    elsif entry.reason.present?
+      reason = entry.reason
+    end
+    
+    if reason.present?
+      vset = oid_for_code(reason,reason_oids, entry.record["bundle_id"])
+      if vset
+  -%>
+<entryRelationship typeCode="RSON">
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.88" <% if !r2_compatibility %>extension="2014-12-01"<%end%>/>
+    <id root="1.3.6.1.4.1.115" extension="<%= identifier_for([reason, entry.start_time]) %>" />
+    <% if !r2_compatibility %>
+    <code code="77301-0"
+          codeSystem="2.16.840.1.113883.6.1"
+          displayName="reason"
+          codeSystemName="LOINC"/>
+    <% else %>
+    <code code="410666004"
+          codeSystem="2.16.840.1.113883.6.96"
+          displayName="reason"
+          codeSystemName="SNOMED CT"/>
+    <% end %>
+    <statusCode code="completed"/>
+    <% if !r2_compatibility %>
+      <effectiveTime>
+        <low <%= value_or_null_flavor(entry.start_time) %>/>
+      </effectiveTime>
+    <% else %>
+      <effectiveTime <%= value_or_null_flavor(entry.start_time) %>/>
+    <% end %>
+    <value xsi:type="CD"
+         code="<%= reason['code'] %>"
+         codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(reason['codeSystem'] || reason['code_system']) %>"
+       <% if reason.respond_to?('title') || reason.has_key?('title') -%>
+         displayName="<%=reason['title']%>"
+       <% end -%>
+         sdtc:valueSet="<%= vset %>"
+         />
+  </observation>
+</entryRelationship>
+  <% end -%>
+<% end -%>

data/templates/cat1/{_record_target.cat1.erb → r2/_record_target.cat1.erb}

@@ -2,6 +2,9 @@
     <patientRole>
       <% if (patient.medical_record_number && patient.medical_record_assigner) %>
         <id extension="<%= patient.medical_record_number %>" root="<%= patient.medical_record_assigner %>"/>
+        <% if cms_compatibility %>
+          <id extension="<%= patient.medical_record_number %>" root="1.3.6.1.4.1.115" />
+        <% end %>
       <% else -%>
         <id extension="12345" root="PlaceholderOrganization" />
       <% end -%>

data/templates/cat1/r2/_reporting_parameters.cat1.erb

@@ -0,0 +1,31 @@
+      <component>
+        <section>
+          <!-- This is the templateId for Reporting Parameters section -->
+          <templateId root="2.16.840.1.113883.10.20.17.2.1" />
+          <% if cms_compatibility %>
+          <templateId root="2.16.840.1.113883.10.20.17.2.1" extension="2015-07-01" />
+          <% end %>
+          <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
+          <title>Reporting Parameters</title>
+          <text>
+            <list>
+              <item>Reporting period: <%= start_date.to_formatted_s(:long_ordinal) %> - <%= end_date.to_formatted_s(:long_ordinal) %></item>
+            </list>
+          </text>
+          <entry typeCode="DRIV">
+            <act classCode="ACT" moodCode="EVN">
+              <!-- This is the templateId for Reporting Parameteres Act -->
+              <templateId root="2.16.840.1.113883.10.20.17.3.8" />
+              <% if cms_compatibility %>
+              <templateId root="2.16.840.1.113883.10.20.17.3.8" extension="2015-07-01" />
+              <% end %>
+              <id root="1.3.6.1.4.1.115" extension="<%= identifier_for([start_date, end_date]) %>" />
+              <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
+              <effectiveTime>
+                <low value="<%= start_date.to_formatted_s(:number) %>"/>
+                <high value="<%= end_date.to_formatted_s(:number) %>"/>
+              </effectiveTime>
+            </act>
+          </entry>
+        </section>
+      </component>

data/templates/cat1/{_result_value.cat1.erb → r2/_result_value.cat1.erb}

@@ -14,7 +14,7 @@
 	<%== code_display(ev, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM'], 'tag_name' => 'value', 'extra_content' => extra_content) %>
 	<%   elsif ev.respond_to?(:scalar) -%>
 	<%     if is_num?(ev.scalar) -%>
-	<value xsi:type="PQ" value="<%= ev.scalar %>" <% if ev.units && (ev.units != "") -%>unit="<%= ev.units %>"<% end -%>/>
+	<value xsi:type="PQ" value="<%= ev.scalar %>" <% if ev.units && (ev.units != "") -%>unit="<%= ev.units %>"<% else -%>unit="1"<% end -%>/>
 	<%     elsif is_bool?(ev.scalar)%>
 	<value xsi:type="BL" value="<%= ev.scalar %>" />
 	<%     else -%>

data/templates/cat1/{show.cat1.erb → r2/show.cat1.erb}

@@ -1,4 +1,10 @@
 <?xml version="1.0" encoding="utf-8"?>
+<% if !measures.empty? %>
+<% reporting_program = if measures.first.type == 'ep'
+    'PQRS_MU_INDIVIDUAL'
+    else
+    'HQR_EHR'
+    end -%>
 <ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
  xmlns="urn:hl7-org:v3"
  xmlns:voc="urn:hl7-org:v3/voc"
@@ -7,11 +13,15 @@
   <realmCode code="US"/>
   <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
   <!-- US Realm Header Template Id -->
-  <templateId root="2.16.840.1.113883.10.20.22.1.1"/>
+  <templateId root="2.16.840.1.113883.10.20.22.1.1" <% if !r2_compatibility %>extension="2014-06-09"<%end%> />
   <!-- QRDA templateId -->
   <templateId root="2.16.840.1.113883.10.20.24.1.1" <% if !r2_compatibility %>extension="2014-12-01"<%end%> />
   <!-- QDM-based QRDA templateId -->
   <templateId root="2.16.840.1.113883.10.20.24.1.2" <% if !r2_compatibility %>extension="2014-12-01"<%end%> />
+  <% if cms_compatibility %>
+  <!-- CMS QRDA templateId -->
+  <templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2015-07-01" />
+  <% end %>
   <!-- This is the globally unique identifier for this QRDA document -->
   <id root="<%= UUID.generate %>"/>
   <!-- QRDA document type code -->
@@ -22,7 +32,7 @@
   <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
   <languageCode code="en"/>
   <!-- reported patient -->
-  <%== render :partial => 'record_target', :locals => {:patient => patient} %>
+  <%== render :partial => 'record_target', :locals => {:patient => patient, :cms_compatibility => cms_compatibility} %>
   <!-- Example of an author who is a device -->
   <% if header %>
     <%== render :partial=>"author", :collection=>header.authors %>
@@ -37,6 +47,14 @@
         <%== render :partial=>"organization", :locals=>{organization: header.custodian.organization, tag_name: "representedCustodianOrganization"} %>
       </assignedCustodian>
     </custodian>
+    <!-- This needs to take reporting program into account EH/EP-->
+    <% if cms_compatibility %>
+    <informationRecipient>
+      <intendedRecipient>
+        <id root="2.16.840.1.113883.3.249.7" extension="<%= reporting_program %>"/>
+      </intendedRecipient>
+    </informationRecipient>
+    <% end %>
     <!-- The legal authenticator of the CDA document is a single person who is at the
       same organization as the custodian in this example. This element must be present. -->
     <!-- SHALL -->
@@ -66,7 +84,17 @@
       <assignedAuthor>
         <!-- id extension="Cypress" root="2.16.840.1.113883.19.5"/ -->
         <!-- NPI -->
+        <% if cms_compatibility %>
+        <% patient.provider_performances.each do |pp| -%>
+        <% pp.provider.cda_identifiers.each do |cda_id| -%>
+            <% if cda_id.root.eql?('2.16.840.1.113883.4.6') -%>
+            <id root="2.16.840.1.113883.4.6" extension="<%= cda_id.extension %>" />
+            <% end -%>
+            <% end -%>
+            <% end -%>
+          <% else %>
         <id extension="FakeNPI" root="2.16.840.1.113883.4.6"/>
+        <% end %>
         <addr>
           <streetAddressLine>202 Burlington Rd.</streetAddressLine>
           <city>Bedford</city>
@@ -84,7 +112,12 @@
     <custodian>
       <assignedCustodian>
         <representedCustodianOrganization>
-          <id root="2.16.840.1.113883.19.5"/>
+          <!-- HQR Only -->
+          <% if cms_compatibility && reporting_program == 'HQR_EHR' %>
+            <id root="2.16.840.1.113883.4.336" extension="800890"/>
+          <% else %>
+            <id root="2.16.840.1.113883.19.5"/>
+          <% end %>
           <name>Cypress Test Deck</name>
           <telecom use="WP" value="tel:(781)271-3000"/>
           <addr>
@@ -97,6 +130,14 @@
         </representedCustodianOrganization>
       </assignedCustodian>
     </custodian>
+    <!-- This needs to take reporting program into account EH/EP-->
+    <% if cms_compatibility %>
+    <informationRecipient>
+      <intendedRecipient>
+        <id root="2.16.840.1.113883.3.249.7" extension="<%= reporting_program %>"/>
+      </intendedRecipient>
+    </informationRecipient>
+    <% end %>
     <legalAuthenticator>
       <time value="<%= Time.now.utc.to_formatted_s(:number) %>"/>
       <signatureCode code="S"/>
@@ -129,8 +170,14 @@
   <component>
     <structuredBody>
       <%== render :partial => 'measures', :locals => {:measures => measures} %>
-      <%== render :partial => 'reporting_parameters', :locals => {:start_date => start_date, :end_date => end_date} %>
-      <%== render :partial => 'patient_data', :locals => {:measures => measures, :patient => patient, :r2_compatibility => r2_compatibility} %>
+      <%== render :partial => 'reporting_parameters', :locals => {:start_date => start_date, :end_date => end_date, :cms_compatibility => cms_compatibility} %>
+      <%== render :partial => 'patient_data', :locals => {:measures => measures, :patient => patient, :r2_compatibility => r2_compatibility, :cms_compatibility => cms_compatibility, :qrda_version => qrda_version} %>
     </structuredBody>
   </component>
 </ClinicalDocument>
+<% else %>
+<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
+ xmlns="urn:hl7-org:v3"
+ xmlns:voc="urn:hl7-org:v3/voc"
+ xmlns:sdtc="urn:hl7-org:sdtc"/>
+<% end %>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.1.cat1.erb

@@ -0,0 +1,14 @@
+<entry>
+  <observation classCode="OBS" moodCode="GOL">
+    <!-- Conforms to C-CDA R2 Goal Observation -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.121" />
+    <templateId root="2.16.840.1.113883.10.20.24.3.1" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <%== code_display(entry,'value_set_map' => filtered_vs_map, 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <text><%= entry.description %></text>
+    <statusCode code="active"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+    </effectiveTime>
+  </observation>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.103.cat1.erb

@@ -0,0 +1,17 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.103" extension="2014-12-01"/> 
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
+    <statusCode code="completed" />
+    <effectiveTime>
+      <!-- Attribute: Start Datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <!-- Attribute: Stop Datetime -->
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <%== code_display(entry, 'preferred_code_sets' => ['*'],
+                             'tag_name' => 'value','value_set_map' => filtered_vs_map,
+                             'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+  </observation>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.105.cat1.erb

@@ -0,0 +1,68 @@
+<entry>
+  <act classCode="ACT" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Discharge Medication Entry -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.105" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="10183-2"
+          codeSystem="2.16.840.1.113883.6.1" 
+          codeSystemName="LOINC" 
+          displayName="Discharge medication"/> 
+    <statusCode code="active"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+    </effectiveTime>
+    <entryRelationship typeCode="SUBJ">
+      <substanceAdministration moodCode="EVN" classCode="SBADM">
+        <!-- Medication Activity (consolidation) template -->
+        <templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/> 
+        <!-- Medication, Active template -->
+        <templateId root="2.16.840.1.113883.10.20.24.3.41" extension="2014-12-01"/>
+        
+        <id root="<%= UUID.generate %>"/>
+        <text><%= entry.description %></text>
+        <statusCode code="active"/> 
+        <effectiveTime xsi:type="IVL_TS">
+            <low <%= value_or_null_flavor(entry.start_time) %>/>
+            <high <%= value_or_null_flavor(entry.end_time) %>/>
+        </effectiveTime>
+        <% if entry.administrationTiming.present?
+          period = entry.administrationTiming['period'] %>
+          <effectiveTime xsi:type="PIVL_TS" institutionSpecified="true" operator="A">
+            <period value="<%= period['value']%>" unit="<%= period['unit']%>"/>
+          </effectiveTime>
+        <% end %>
+        <% if entry.route.present? -%>
+        <!-- Attribute: route -->
+          <% vset = oid_for_code(entry.route.code,field_oids["ROUTE"], entry.record["bundle_id"]) %>
+          <% if vset %>
+            <routeCode code="<%= entry.route['code'] %>" codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.route['code_system']) %>" sdtc:valueSet="<%= vset %>"/>
+          <% end %>
+        <% end -%>
+        
+        <!-- Attribute: dose -->
+        <% if entry.dose.present? -%>
+          <doseQuantity value="<%= entry.dose['value']%>"/>
+        <% end -%>
+
+        <% if entry.product_form.present? -%>
+        <administrationUnitCode code="<%= entry.product_form['code'] %>" codeSystem="<%= entry.product_form['codeSystem'] %>"/>
+        <% end -%>
+
+        <consumable>
+          <manufacturedProduct classCode="MANU">
+            <!-- Medication Information (consolidation) template --> 
+            <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
+            <id root="<%= UUID.generate %>"/>
+            <manufacturedMaterial>
+              <%== code_display(entry,'preferred_code_sets' => ['RxNorm'],'value_set_map' => filtered_vs_map, 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+            </manufacturedMaterial>
+            <manufacturerOrganization>
+              <name>Medication Factory Inc.</name>
+            </manufacturerOrganization>
+          </manufacturedProduct>
+        </consumable>
+      </substanceAdministration>
+    </entryRelationship>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </act>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.11.cat1.erb

@@ -0,0 +1,58 @@
+<entry> 
+  <act classCode="ACT" moodCode="EVN">
+  <!-- Conforms to C-CDA Problem Concern Act (V2) -->
+  <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2014-06-09" />
+  <!-- Diagnosis Active Concern Act -->
+  <templateId root="2.16.840.1.113883.10.20.24.3.121" extension="2014-12-01" />
+  <id root="<%= UUID.generate %>" />
+  <code code="CONC" codeSystem="2.16.840.1.113883.5.6" displayName="Concern" />
+  <!-- The statusCode represents whether this is an active (active),       inactive (suspended) or resolved (completed) diagnosis -->    
+  <statusCode code="active" />
+  <effectiveTime>
+      <!-- Attribute: admission datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <!-- Attribute: discharge datetime -->
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+  <entryRelationship typeCode="SUBJ">
+  <observation classCode="OBS" moodCode="EVN">
+    <!--  Problem observation template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2014-06-09"/>
+    <!--  Diagnosis active template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.11" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="29308-4" displayName="diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
+    <text><%= entry.description %></text>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <!-- Attribute: admission datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <!-- Attribute: discharge datetime -->
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <%== render(:partial => 'ordinality', :locals => {:entry => entry, :ordinality_oids=>field_oids["ORDINAL"]}) %>
+    <%== code_display(entry, {'tag_name' => 'value', 'value_set_map' => filtered_vs_map,'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM'],
+                                                    'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"", 'laterality' => entry.laterality}) %>
+    <% if entry.severity %>
+    <entryRelationship typeCode="REFR">
+       <observation classCode="OBS" moodCode="EVN">
+          <templateId root="2.16.840.1.113883.10.20.22.4.8" extension="2014-06-09"/>
+          <code code="SEV" 
+                codeSystem="2.16.840.1.113883.5.4"/>
+           <statusCode code="completed"/>
+           <value xsi:type="CD"
+                code="<%= entry.severity['code'] %>"
+                codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.severity['codeSystem'] || entry.severity['code_system']) %>"
+              <% if entry.severity.has_key?('title') -%>
+                displayName="<%=entry.severity['title']%>"
+              <% end -%>
+                sdtc:valueSet="<%= oid_for_code(entry.severity,field_oids["SEVERITY"] || [], entry.record["bundle_id"]) %>"
+            />
+       </observation>
+
+    </entryRelationship>
+   <% end %> 
+  </observation>
+  </entryRelationship>
+  </act>
+</entry>

data/templates/cat1/{_2.16.840.1.113883.10.20.24.3.12.cat1.erb → r3/_2.16.840.1.113883.10.20.24.3.12.cat1.erb}

@@ -1,8 +1,8 @@
 <entry typeCode="DRIV">
   <organizer moodCode="EVN" classCode="CLUSTER">
-    <templateId root="2.16.840.1.113883.10.20.22.4.45"/>
+    <templateId root="2.16.840.1.113883.10.20.22.4.45" extension="2014-06-09"/>
     <!--    Family history organizer template   -->
-    <templateId root="2.16.840.1.113883.10.20.24.3.12"/>
+    <templateId root="2.16.840.1.113883.10.20.24.3.12" extension="2014-12-01"/>
     <statusCode code="completed"/>
     <effectiveTime>
       <low <%= value_or_null_flavor(entry.start_time) %>/>
@@ -30,7 +30,7 @@
     </subject>
     <component>
       <observation classCode="OBS" moodCode="EVN">
-        <templateId root="2.16.840.1.113883.10.20.22.4.46"/>
+        <templateId root="2.16.840.1.113883.10.20.22.4.46" extension="2014-06-09"/>
         <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
         <code code="55607006" displayName="Problem" 
               codeSystemName="SNOMED CT" 
@@ -40,7 +40,7 @@
           <low <%= value_or_null_flavor(entry.start_time) %>/>
           <high <%= value_or_null_flavor(entry.end_time) %>/>
         </effectiveTime>
-        <%== code_display(entry, 'value_set_map' => value_set_map,'preferred_code_sets' => ['SNOMED-CT'],
+        <%== code_display(entry, 'value_set_map' => filtered_vs_map,'preferred_code_sets' => ['SNOMED-CT'],
                          'tag_name' => 'value',
                          'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
         <text><%= entry.description %></text>
@@ -48,4 +48,3 @@
     </component>
   </organizer>
 </entry>
-

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.13.cat1.erb

@@ -0,0 +1,39 @@
+<entry>
+  <act classCode="ACT" moodCode="EVN">
+    <!-- Conforms to C-CDA Problem Concern Act (V2) -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2014-06-09" />
+    <!-- Diagnosis Resolved Concern Act -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.123" extension="2014-12-01" />
+    <id root="<%= UUID.generate %>"/>
+    <code code="CONC" codeSystem="2.16.840.1.113883.5.6" displayName="Concern" />
+    <statusCode code="suspended" />
+    <effectiveTime>
+      <!-- Attribute: Start Datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <!-- Attribute: Stop Datetime -->
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <entryRelationship typeCode="SUBJ">
+  <observation classCode="OBS" moodCode="EVN">
+  <!--  Problem observation template -->
+  <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2014-06-09"/>
+  <!-- Diagnosis, inactive template -->
+  <templateId root="2.16.840.1.113883.10.20.24.3.13" extension="2014-12-01"/>
+  <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+  <code code="29308-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="diagnosis"/>
+  
+  <statusCode code="completed"/>
+
+  <effectiveTime>
+    <!-- Attribute: Start Datetime -->
+    <low <%= value_or_null_flavor(entry.start_time) %>/>
+    <!-- Attribute: Stop Datetime -->
+    <high <%= value_or_null_flavor(entry.end_time) %>/>
+  </effectiveTime>
+  <%== render(:partial => 'ordinality', :locals => {:entry => entry, :ordinality_oids=>field_oids["ORDINAL"]}) %>
+
+  <%== code_display(entry, 'value_set_map' => filtered_vs_map,'tag_name' => 'value', 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM', 'LOINC'], 'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+  </observation>
+  </entryRelationship>
+  </act>
+</entry>