health-data-standards 3.6.1 → 3.7.0

data/templates/cat1/{_2.16.840.1.113883.10.20.24.3.69.cat1.erb → r3_1/_2.16.840.1.113883.10.20.24.3.69.cat1.erb}

@@ -6,9 +6,9 @@
     <!-- Consolidation Assessment Scale Observation templateId -->
     <templateId root="2.16.840.1.113883.10.20.22.4.69"/>
     <!-- Risk Category Assessment -->
-    <templateId root="2.16.840.1.113883.10.20.24.3.69"/>
+    <templateId root="2.16.840.1.113883.10.20.24.3.69" extension="2016-02-01"/>
     <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
-    <%== code_display(entry, 'value_set_map' => value_set_map,'preferred_code_sets' => ['LOINC', 'SNOMED-CT'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <%== code_display(entry, 'value_set_map' => filtered_vs_map,'preferred_code_sets' => ['*'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
     <text><%= entry.description %></text>
     <statusCode code="completed"/>
 

data/templates/cat1/{_2.16.840.1.113883.10.20.24.3.7.cat1.erb → r3_1/_2.16.840.1.113883.10.20.24.3.7.cat1.erb}

@@ -1,30 +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"/>
+    <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"/>
+    <templateId root="2.16.840.1.113883.10.20.24.3.7" extension="2016-02-01"/>
     <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_structure) && entry.anatomical_structure.present? -%>
-    <targetSiteCode code="<%= entry.anatomical_structure['code'] %>" 
-                    codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.anatomical_structure['code_system']) %>"/>
+
+    <% if entry.respond_to?(:anatomical_target) && entry.anatomical_target.present? -%>
+      <% vset = oid_for_code(entry.anatomical_target.code,field_oids["ANATOMICAL_LOCATION_SITE"], 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' => value_set_map, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-PCS', 'ICD-10-PCS', 'CPT'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['*'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
         </playingDevice>
       </participantRole>
     </participant>
     <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
   </procedure>
-</entry>
+</entry>

data/templates/cat1/r3_1/_2.16.840.1.113883.10.20.24.3.81.cat1.erb

@@ -0,0 +1,33 @@
+<entry>
+  <act classCode="ACT" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Transfer From Act -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.141"/>
+    <id root="<%= UUID.generate %>" />
+    <code code="ENC" codeSystem="2.16.840.1.113883.5.6" displayName="Encounter" codeSystemName="ActClass"/>
+    <entryRelationship typeCode="SUBJ">
+    	<encounter classCode="ENC" moodCode="EVN">
+    		<templateId root="2.16.840.1.113883.10.20.24.3.81" extension="2016-02-01"/>
+    		<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>
+    </entryRelationship>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"], :r2_compatibility => r2_compatibility}) %>
+  </act>
+</entry>

data/templates/cat1/r3_1/_2.16.840.1.113883.10.20.24.3.82.cat1.erb

@@ -0,0 +1,33 @@
+<entry>
+  <act classCode="ACT" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Transfer To Act -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.142"/>
+    <id root="<%= UUID.generate %>" />
+    <code code="ENC" codeSystem="2.16.840.1.113883.5.6" displayName="Encounter" codeSystemName="ActClass"/>
+    <entryRelationship typeCode="SUBJ">
+      <encounter classCode="ENC" moodCode="EVN">
+        <templateId root="2.16.840.1.113883.10.20.24.3.82" extension="2016-02-01"/>
+        <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>
+    </entryRelationship>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"], :r2_compatibility => r2_compatibility}) %>
+  </act>
+</entry>

data/templates/cat1/r3_1/_2.16.840.1.113883.10.20.24.3.9.cat1.erb

@@ -0,0 +1,41 @@
+<entry>
+  <act classCode="ACT" moodCode="RQO" <%== negation_indicator(entry) %>>
+    <templateId root="2.16.840.1.113883.10.20.24.3.130"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="SPLY" codeSystem="2.16.840.1.113883.5.6" displayName="Supply" codeSystemName="ActClass"/>
+
+    <entryRelationship typeCode="SUBJ">
+      <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="2016-02-01"/>
+        <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' => ['*'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+            </playingDevice>
+          </participantRole>
+        </participant>
+      </supply>
+    </entryRelationship>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </act>
+</entry>

data/templates/cat1/r3_1/_2.16.840.1.113883.10.20.28.3.6.cat1.erb

@@ -0,0 +1,17 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.51" extension="2016-02-01"/>
+    <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="active" />
+    <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_1/_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_1/_author.cat1.erb

@@ -0,0 +1,28 @@
+ <!-- SHALL have 1..* author. MAY be device or person. 
+    The author of the CDA document in this example is a device at a data submission vendor/registry. -->
+  <author>
+    <time value="<%= author.time.to_formatted_s(:number) %>"/>
+    <assignedAuthor>
+      <!-- Registry author ID -->
+      <%== render :partial=>"id", :collection=>author.ids, :id=>"identifier" %>
+      <%== render :partial=>"address" , :collection=>author.addresses %>
+      <%== render :partial=>"telecom" , :collection=>author.telecoms %>
+
+      <% if author.person %>
+        <assignedPerson>
+        <name>
+           <given><%= author.person.given %></given>
+           <family><%= author.person.family %></family>
+        </name>
+        </assignedPerson> 
+      <% elsif author.device %>
+       <assignedAuthoringDevice>
+         <manufacturerModelName><%= author.device.model %></manufacturerModelName>
+         <softwareName><%= author.device.name %></softwareName>
+       </assignedAuthoringDevice>
+      <% end %> 
+     
+     <%== render :partial=>"organization", :locals=>{organization: author.organization, tag_name: "representedOrganization"} %>
+
+    </assignedAuthor>
+  </author>

data/templates/cat1/r3_1/_fulfills.cat1.erb

@@ -0,0 +1,14 @@
+<% if entry.references.present? 
+  -%>
+  <% entry.references.each do |reference| 
+    resolved_reference = reference.resolve_reference %>
+  <% if reference.type == "fulfills" %>
+  <sdtc:inFulfillmentOf1 typeCode="FLFS">
+    <sdtc:templateId root="2.16.840.1.113883.10.20.24.3.126" extension="2014-12-01"/>
+      <sdtc:actReference classCode="ACT" moodCode="<%= resolved_reference.mood_code %>">
+        <sdtc:id root="1.3.6.1.4.1.115" extension="<%= reference.referenced_id %>"/>
+      </sdtc:actReference>
+    </sdtc:inFulfillmentOf1>
+    <% end %>
+  <% end %>
+<% end -%>

data/templates/cat1/r3_1/_id.cat1.erb

@@ -0,0 +1 @@
+<id <%== identifier.root.nil? ? "" : "root='#{identifier.root}'" -%> extension="<%= identifier.extension %>"/>

data/templates/cat1/r3_1/_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_1/_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/r3_1/_medication_dispense.cat1.erb

@@ -0,0 +1,22 @@
+
+<entryRelationship typeCode="REFR">
+  <supply classCode="SPLY" moodCode="EVN">
+    <!-- Medication Dispense template -->
+    <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) %>/>
+    <repeatNumber value="1"/>
+    <quantity <%= fulfillment_quantity(entry.codes, medication_dispense, entry.dose) %>/>
+    <product>
+      <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>
+      </manufacturedProduct>
+    </product>
+  </supply>
+</entryRelationship>

data/templates/cat1/r3_1/_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_1/_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_1/_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="2016-02-01" />
+          <% 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_1/_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>