health-data-standards 3.6.1 → 3.7.0

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.7.cat1.erb

@@ -0,0 +1,33 @@
+<entry>
+  <procedure classCode="PROC" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Procedure Activity Procedure -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
+    <!-- Device Applied -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.7" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="360030002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="application of device"/>
+    <text><%= entry.description %></text>
+    <statusCode code="completed"/>
+    
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <high <%= value_or_null_flavor(entry.removal_time || entry.end_time) %>/>
+    </effectiveTime>
+    
+    <% if entry.respond_to?(:anatomical_target) && entry.anatomical_target.present? -%>
+      <% vset = oid_for_code(entry.anatomical_target.code,field_oids["LATERALITY"], entry.record["bundle_id"]) %>
+      <% if vset %>
+        <targetSiteCode code="<%= entry.anatomical_target['code'] %>" 
+          codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.anatomical_target['code_system']) %>" sdtc:valueSet="<%= vset %>"/>
+      <% end %>
+    <% end -%>
+    <participant typeCode="DEV">
+      <participantRole classCode="MANU">
+        <playingDevice classCode="DEV">
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-PCS', 'ICD-10-PCS', 'CPT'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+        </playingDevice>
+      </participantRole>
+    </participant>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </procedure>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.76.cat1.erb

@@ -0,0 +1,19 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <!--  Problem observation template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2014-06-09"/>
+    <!-- Symptom, active template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.76" extension="2014-12-01"/>  
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="418799008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Symptom"/>
+    <text><%= entry.description %></text>
+    <statusCode code="completed"/> 
+   
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    
+     <%== 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}\"") %>
+  </observation>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.81.cat1.erb

@@ -0,0 +1,24 @@
+<entry>
+	<encounter classCode="ENC" moodCode="EVN">
+		<templateId root="2.16.840.1.113883.10.20.24.3.81" extension="2014-12-01"/>
+		<id root="1.3.6.1.4.1.115" extension="<%= "#{entry.transferFrom.id}#{entry.id}".hash.abs.to_s(16) %>"/>
+		<code code="77305-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="transferred from"/>
+		<statusCode code="completed"/>
+		<participant typeCode="ORG">
+	    <time>
+        <low <%= value_or_null_flavor(entry.transferFrom.time) %>/>
+        <high <%= value_or_null_flavor(entry.transferFrom.time) %>/>
+      </time>
+	    <participantRole classCode="LOCE">
+	      <% 
+	        entry.transferFrom.codes[entry.transferFrom.code_system] = [entry.transferFrom.code]
+	        transfer_vs_map = [{"set"=>entry.transferFrom.code_system, "values"=>[entry.transferFrom.code]}]
+	        transfer_oid = (data_criteria.field_values || {})['TRANSFER_FROM'].try(:code_list_id)
+	        options = {'value_set_map' => transfer_vs_map, 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM', 'CPT']}
+	        options['extra_content'] = "sdtc:valueSet=\"#{transfer_oid}\"" if transfer_oid
+	        %>
+	        <%== code_display(entry.transferFrom, options) %>
+	      </participantRole> 
+	    </participant>
+	</encounter>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.82.cat1.erb

@@ -0,0 +1,24 @@
+<entry>
+  <encounter classCode="ENC" moodCode="EVN">
+  	<templateId root="2.16.840.1.113883.10.20.24.3.82" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= "#{entry.transferTo.id}#{entry.id}".hash.abs.to_s(16) %>"/>
+  	<code code="77306-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Discharge disposition"/>
+  	<statusCode code="completed"/>
+  	<participant typeCode="DST">
+      <time>
+        <low <%= value_or_null_flavor(entry.transferTo.time) %>/>
+        <high <%= value_or_null_flavor(entry.transferTo.time) %>/>
+      </time>
+      <participantRole classCode="LOCE">
+      <% 
+        entry.transferTo.codes[entry.transferTo.code_system] = [entry.transferTo.code]
+        transfer_vs_map = [{"set"=>entry.transferTo.code_system, "values"=>[entry.transferTo.code]}]
+        transfer_oid = (data_criteria.field_values || {})['TRANSFER_TO'].try(:code_list_id)
+        options = {'value_set_map' => transfer_vs_map, 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM', 'CPT']}
+        options['extra_content'] = "sdtc:valueSet=\"#{transfer_oid}\"" if transfer_oid
+        %>
+        <%== code_display(entry.transferTo, options) %>
+      </participantRole> 
+    </participant>
+  </encounter>
+</entry>

data/templates/cat1/r3/_2.16.840.1.113883.10.20.24.3.9.cat1.erb

@@ -0,0 +1,57 @@
+<entry>
+  <% if !negation_indicator(entry) %>
+  <supply classCode="SPLY" moodCode="RQO">
+    <!-- Plan of Care Activity Supply -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.43" extension="2014-06-09"/>
+    <!-- Device, Order -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.9" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <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.removal_time || entry.end_time) %>/>
+    </effectiveTime>
+    <author>
+      <templateId root="2.16.840.1.113883.10.20.22.4.119"/>
+      <time <%= value_or_null_flavor(entry.as_point_in_time) %>/>
+      <assignedAuthor>
+        <id nullFlavor="NA" root="<%= UUID.generate %>"/>
+      </assignedAuthor>
+    </author>
+    <participant typeCode="DEV">
+      <participantRole classCode="MANU">
+        <playingDevice classCode="DEV">
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-PCS', 'ICD-10-PCS', 'CPT'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+        </playingDevice>
+      </participantRole>
+    </participant>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </supply>
+  <% else %>
+  <!--  Submitters are advised to submit “Device, Applied not done” instead of “Device, Order not done” for the VTE-1, VTE-2, and VTE-6 eCQM measures. -->
+  <procedure classCode="PROC" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Procedure Activity Procedure -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
+    <!-- Device Applied -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.7" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="360030002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="application of device"/>
+    <text><%= entry.description %></text>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <high <%= value_or_null_flavor(entry.removal_time || entry.end_time) %>/>
+    </effectiveTime>
+    <participant typeCode="DEV">
+      <participantRole classCode="MANU">
+        <playingDevice classCode="DEV">
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-PCS', 'ICD-10-PCS', 'CPT'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+        </playingDevice>
+      </participantRole>
+    </participant>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </procedure>
+<% end %>
+</entry>

data/templates/cat1/r3/_address.cat1.erb

@@ -0,0 +1,9 @@
+<addr use="<%= address.use %>">
+  <% address.street.each do |street| %>
+  <streetAddressLine><%= street %></streetAddressLine>
+  <% end %>
+  <city><%= address.city %></city>
+  <state><%= address.state %></state>
+  <postalCode><%= address.zip %></postalCode>
+  <country><%= address.country %></country>
+</addr>

data/templates/cat1/r3/_measures.cat1.erb

@@ -0,0 +1,93 @@
+      <component>
+        <section>
+          <!-- 
+            *****************************************************************
+            Measure Section
+            *****************************************************************
+          -->
+          <!-- This is the templateId for Measure Section -->
+          <templateId root="2.16.840.1.113883.10.20.24.2.2"/>
+          <!-- This is the templateId for Measure Section QDM -->
+          <templateId root="2.16.840.1.113883.10.20.24.2.3"/>
+          <!-- This is the LOINC code for "Measure document". This stays the same for all measure section required by QRDA standard -->
+          <code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
+          <title>Measure Section</title>
+          <text>
+            <table border="1" width="100%">
+              <thead>
+                <tr>
+                  <th>eMeasure Title</th>
+                  <th>Version neutral identifier</th>
+                  <th>eMeasure Version Number</th>
+                  <th>Version specific identifier</th>
+                </tr>
+              </thead>
+              <tbody>
+                <% measures.each do |measure| -%>
+                <tr>
+                  <td><%= measure.title %></td>
+                  <td><%= measure.hqmf_set_id %></td>
+                  <td><%= measure.hqmf_version_number %></td>
+                  <td><%= measure.hqmf_id %></td>
+                  <td></td>
+                </tr>
+                <% end -%>
+              </tbody>
+            </table>
+          </text>
+          <!-- 1..* Organizers, each containing a reference to an eMeasure -->
+          <% measures.each do |measure| -%>
+          <entry>
+            <organizer classCode="CLUSTER" moodCode="EVN">
+              <!-- This is the templateId for Measure Reference -->
+              <templateId root="2.16.840.1.113883.10.20.24.3.98"/>
+              <!-- This is the templateId for eMeasure Reference QDM -->
+              <templateId root="2.16.840.1.113883.10.20.24.3.97"/>
+              <id root="1.3.6.1.4.1.115" extension="<%= measure['id'] %>"/>
+              <statusCode code="completed"/>
+              <!-- Containing isBranch external references -->
+              <reference typeCode="REFR">
+                <externalDocument classCode="DOC" moodCode="EVN">
+                  <!-- SHALL: This is the version specific identifier for eMeasure: QualityMeasureDocument/id it is a GUID-->
+                  <id root="2.16.840.1.113883.4.738" extension="<%= measure.hqmf_id %>"/>
+                  <!-- SHOULD This is the title of the eMeasure -->
+                  <text><%= measure.title %></text>
+                  <!-- SHOULD: setId is the eMeasure version neutral id  -->
+                  <setId root="<%= measure.hqmf_set_id %>"/>
+                  <!-- This is the sequential eMeasure Version number -->
+                  <versionNumber value="<%= measure.hqmf_version_number %>"/>                  
+                </externalDocument>
+              </reference>
+            </organizer>
+            
+            <% # Only want the epxected values when running from Bonnie
+            if patient.respond_to?('expected_values_for_qrda_export') -%>
+            <component>
+              <%
+              #     # Going to assume that any expected_value > 0 is a TRUE
+              #     # As per HL7 CDA R2:QRDA I, R1, STU Release 3.1, US Realm, Vol. 2 —Templates and Supporting Material
+              #     # Set negationInd="false" to assert true (that the criteria are met by the included data). Set negationInd="true" to assert false (that the criteria are not met by the included data).
+              #     # QRDA expects IPOP instead of IPP.
+              qrda_expected_values = patient.expected_values_for_qrda_export(measure)
+              qrda_expected_values.each do |qev| -%>
+                <observation classCode="OBS" moodCode="EVN" negationInd="<%= qev[:expected_value] == '0' ? 'true' : 'false' %>">
+                  <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
+                  <value xsi:type="CD"
+                    code="<%= qev[:code] == 'IPP' ? 'IPOP' : qev[:code] %>"
+                    codeSystem="2.16.840.1.113883.5.4"
+                    codeSystemName="ActCode"
+                    displayName="<%= qev[:display_name] %>"/>
+                  <!-- Explicit reference to the eMeasure population (because some eMeasures have multiple Numerators, etc -->
+                  <reference typeCode="REFR">
+                    <externalObservation classCode="OBS" moodCode="EVN">
+                      <id root="<%= qev[:hqmf_id] %>"/>
+                    </externalObservation>
+                  </reference>
+                </observation>
+              <% end -%>
+            </component>
+            <% end -%>
+          </entry>
+          <% end -%>
+        </section>
+      </component>

data/templates/cat1/r3/_medication_details.cat1.erb

@@ -0,0 +1,16 @@
+<% if entry.respond_to?(:route) && entry.route.present? 
+      # hard coded to NCI Thesaurus for the code system since Cat I mandates that
+      vset = oid_for_code(entry.route,route_oids, entry.record["bundle_id"])
+-%>
+<routeCode code="<%= entry.route['code'] %>" 
+           codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.route['code_system']) %>" 
+            <% if vset -%>
+              sdtc:valueSet="<%= vset %>"
+            <% end -%>
+           />
+<% end -%>
+<% if entry.negationInd %>
+	<doseQuantity nullFlavor="NA"/>
+<% elsif entry.respond_to?(:dose) && entry.dose.present? -%>
+<doseQuantity <%= dose_quantity(entry.codes, entry.dose) %>/>
+<% end -%>

data/templates/cat1/{_medication_dispense.cat1.erb → r3/_medication_dispense.cat1.erb}

@@ -2,7 +2,7 @@
 <entryRelationship typeCode="REFR">
   <supply classCode="SPLY" moodCode="EVN">
     <!-- Medication Dispense template -->
-    <templateId root="2.16.840.1.113883.10.20.22.4.18"/>
+    <templateId root="2.16.840.1.113883.10.20.22.4.18" extension="2014-06-09"/>
     <id root="1.3.6.1.4.1.115" extension="<%= UUID.generate %>"/>
     <statusCode code="completed"/>
     <effectiveTime <%= value_or_null_flavor(medication_dispense.dispense_date) %>/>
@@ -11,10 +11,10 @@
     <product>
       <manufacturedProduct classCode="MANU">
         <!-- Medication Information (consolidation) template -->
-        <templateId root="2.16.840.1.113883.10.20.22.4.23"/>
+        <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' => value_set_map, 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+          <%== code_display(entry, 'preferred_code_sets' =>["RxNorm"], 'value_set_map' => filtered_vs_map, 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
         </manufacturedMaterial>
       </manufacturedProduct>
     </product>

data/templates/cat1/r3/_ordinality.cat1.erb

@@ -0,0 +1,10 @@
+<% if entry.respond_to?(:ordinality) && entry.ordinality.present? 
+  vset = oid_for_code(entry.ordinality,ordinality_oids || [], entry.record["bundle_id"]) 
+  -%>
+<priorityCode  code="<%= entry.ordinality['code'] %>" 
+              codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.ordinality['codeSystem'] || entry.ordinality['code_system']) %>"
+              <% if vset -%>
+              sdtc:valueSet="<%= vset %>"
+              <% end -%>
+              />
+<% end -%>

data/templates/cat1/r3/_organization.cat1.erb

@@ -0,0 +1,9 @@
+<<%=tag_name %>>
+  <!-- Represents unique registry organization TIN -->
+   <%== render :partial => "id", :collection => organization.ids, :id => "identifier" %>
+  <!-- Contains name - specific registry not required-->
+  <name><%= organization.name %></name>
+  <%== render :partial => "telecom", :collection => organization.telecoms %>
+  <%== render :partial => "address", :collection => organization.addresses %>
+  
+</<%=tag_name %>>

data/templates/cat1/r3/_patient_data.cat1.erb

@@ -0,0 +1,17 @@
+      <component>
+        <section>
+          <!-- This is the templateId for Patient Data section -->
+          <templateId root="2.16.840.1.113883.10.20.17.2.4"/>
+          <!-- This is the templateId for Patient Data QDM section -->
+	         <templateId root="2.16.840.1.113883.10.20.24.2.1" extension="2014-12-01" />
+          <% if cms_compatibility %>
+            <templateId root="2.16.840.1.113883.10.20.24.2.1" extension="2015-07-01"/>
+          <% end %>
+          <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
+          <title>Patient Data</title>
+          <text>
+
+          </text>
+          <%== render_patient_data(patient, measures, false, qrda_version) %>
+        </section>
+      </component>

data/templates/cat1/r3/_providers.cat1.erb

@@ -0,0 +1,76 @@
+<documentationOf typeCode="DOC">
+  <serviceEvent classCode="PCPR"> <!-- care provision -->
+  <% if patient.provider_performances.empty? -%>
+    <!-- No provider data found in the patient record
+         putting in a fake provider -->
+    <effectiveTime>
+      <low value="20020716"/>
+      <high value="<%= Time.now.utc.to_formatted_s(:number) %>"/>
+    </effectiveTime>
+    <!-- You can include multiple performers, each with an NPI, TIN, CCN. -->
+    <performer typeCode="PRF"> 
+      <time>
+        <low value="20020716"/>
+        <high value="<%= Time.now.utc.to_formatted_s(:number) %>"/>
+      </time>
+      <assignedEntity>
+        <!-- This is the provider NPI -->
+        <id root="2.16.840.1.113883.4.6" extension="111111111" /> 
+        <representedOrganization>
+          <!-- This is the organization TIN -->
+          <id root="2.16.840.1.113883.4.2" extension="1234567" /> 
+          <!-- This is the organization CCN -->
+          <id root="2.16.840.1.113883.4.336" extension="54321" /> 
+        </representedOrganization>
+      </assignedEntity>
+    </performer>
+  <% else -%>
+    <% patient.provider_performances.each do |pp| -%>
+      <effectiveTime>
+        <low <%= value_or_null_flavor(pp.start_date) %>/>
+        <high <%= value_or_null_flavor(pp.end_date) %>/>
+      </effectiveTime>
+      <!-- You can include multiple performers, each with an NPI, TIN, CCN. -->
+      <performer typeCode="PRF"> 
+        <time>
+          <low <%= value_or_null_flavor(pp.start_date) %>/>
+          <high <%= value_or_null_flavor(pp.end_date) %>/>
+        </time>
+        <assignedEntity>
+          <% pp.provider.cda_identifiers.each do |cda_id| -%>
+            <% unless cda_id.root.eql? '2.16.840.1.113883.4.2' -%>
+          <id root="<%= cda_id.root %>" extension="<%= cda_id.extension %>" />
+            <% end -%>
+          <% end -%>
+          <% if pp.provider.specialty %>
+          <code code="<%= pp.provider.specialty %>" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101"/>
+          <% end %>
+          <%== render :partial=>"address" , :collection=>pp.provider.addresses %>
+          <%== render :partial=>"telecom", :collection=>pp.provider.telecoms %>
+          <assignedPerson>
+          <name>
+             <given><%= pp.provider.given_name %></given>
+             <family><%= pp.provider.family_name %></family>
+          </name>
+          </assignedPerson>
+          <representedOrganization>
+            <% pp.provider.cda_identifiers.each do |cda_id| -%>
+            <% if cda_id.root.eql?('2.16.840.1.113883.4.2') -%>
+            <id root="2.16.840.1.113883.4.2" extension="<%= cda_id.extension %>" />
+            <% end -%>
+            <% end -%>
+            <%if pp.provider.organization %>
+              <name><%= pp.provider.organization.name %></name>
+              <%== render :partial=>"address" , :collection=>pp.provider.organization.addresses %>
+              <%== render :partial=>"telecom", :collection=>pp.provider.organization.telecoms %>
+            <% else %>
+              <%== render :partial=>"address" , :collection=>pp.provider.addresses %>
+              <%== render :partial=>"telecom", :collection=>pp.provider.telecoms %>
+            <% end %>
+          </representedOrganization>
+        </assignedEntity>
+      </performer>
+    <% end -%>
+  <% end -%>
+  </serviceEvent>
+</documentationOf>

data/templates/cat1/r3/_reason.cat1.erb

@@ -0,0 +1,34 @@
+<%  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" extension="2014-12-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= identifier_for([reason, entry.start_time]) %>" />
+    <code code="77301-0"
+          codeSystem="2.16.840.1.113883.6.1"
+          displayName="reason"
+          codeSystemName="LOINC"/>
+    <statusCode code="completed"/>
+      <effectiveTime>
+        <low <%= value_or_null_flavor(entry.start_time) %>/>
+      </effectiveTime>
+    <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 -%>