health-data-standards 4.0.6 → 4.1.0

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.51.cat1.erb

@@ -0,0 +1,14 @@
+<entry>
+  <!-- Clinical Trial Participant -->
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.51" extension="2017-08-01"/>
+    <id root="<%= UUID.generate %>"/>
+    <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
+    <statusCode code="active"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <%== code_display(entry, {'tag_name' => 'value', 'value_set_map' => filtered_vs_map,'preferred_code_sets' => ['*'], 'extra_content' => "xsi:type=\"CD\""}) %>
+  </observation>
+</entry>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.54.cat1.erb

@@ -0,0 +1,32 @@
+<entry>
+  <!-- Patient characteristic expired -->
+  <observation classCode="OBS" moodCode="EVN">
+    <!-- Consolidation Deceased Observation templateId -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.79" extension="2015-08-01"/>
+    <!-- Patient Characteristic Expired -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.54" 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" codeSystemName="HL7ActCode"/>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+    </effectiveTime>
+    <value code="419099009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Dead" xsi:type="CD"/>
+    <% if entry.respond_to? :code 
+       # Currently, Record does not support coded cause of death, but this should allow it to work
+       # when Record supports it.
+    -%>
+    <entryRelationship typeCode="CAUS">
+      <observation classCode="OBS" moodCode="EVN">
+        <id root="<%= UUID.generate %>"/>
+        <code code="ASSERTION" 
+              codeSystem="2.16.840.1.113883.5.4"
+              codeSystemName="HL7ActCode"/>
+        <statusCode code="completed"/>
+        <%== code_display(entry, 'tag_name' => 'value', 'preferred_code_sets' => ['SNOMED-CT'], 'extra_content' => "xsi:type=\"CD\"") %>
+        <text><%= entry.description %></text>
+      </observation>
+    </entryRelationship>
+    <% end -%>
+  </observation>
+</entry>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.55.cat1.erb

@@ -0,0 +1,18 @@
+<entry>
+  <!-- Patient Characteristic Payer -->
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.55"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <code code="48768-6" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/> 
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <!-- Attribute: Start Datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <% if entry.end_time %>
+        <high value="<%= time_if_not_nil(entry.end_time) %>" />
+      <% end %>
+    </effectiveTime>
+    <%== code_display(entry, 'preferred_code_sets' =>["SOP","Source of Payment Typology"] , 'tag_name' => 'value', 'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"2.16.840.1.114222.4.11.3591\"") %>
+
+  </observation>            
+</entry>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.57.cat1.erb

@@ -0,0 +1,23 @@
+<% vals = entry.values.empty? ? [nil] : entry.values 
+   vals.each do |value| 
+ %>   
+<entry>
+  <!-- Physical Exam Finding -->
+  <observation classCode="OBS" moodCode="EVN">
+    <!--  Result observation template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2014-06-09"/>
+    <!-- Physical Exam, Finding template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.57" 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, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT']) %>    
+    <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>
+    <%== render(:partial => 'result_value', :locals => {:values => [value], :result_oids=>result_oids}) %>
+  </observation>
+</entry>
+<% end %>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.59.cat1.erb

@@ -0,0 +1,25 @@
+<% vals = entry.values.empty? ? [nil] : entry.values
+   vals.each do |value|
+ %>
+<entry>
+  <observation classCode="OBS" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Procedure Activity Procedure (Consolidation) template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.13" extension="2014-06-09"/>
+    <!-- Physical Exam, Performed template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.59" extension="2017-08-01"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM', 'LOINC']) %>
+    <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>
+    <%== render(:partial => 'result_value', :locals => {:values => [value], :result_oids=>result_oids}) %>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+    <% if entry.components -%>
+      <%== render(:partial => 'components', :locals => {:entry => entry} ) %>
+    <% end %>
+  </observation>
+</entry>
+<% end %>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.63.cat1.erb

@@ -0,0 +1,15 @@
+<entry>
+  <procedure classCode="PROC" moodCode="RQO" <%== negation_indicator(entry) %>>
+    <!-- Consolidated Plan of Care Activity Procedure TemplateId (Implied Template) -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.41" extension="2014-06-09"/> 
+    <!-- QRDA Procedure, Order TemplateId --> 
+    <templateId root="2.16.840.1.113883.10.20.24.3.63" extension="2017-08-01"/> 
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-PCS', 'ICD-10-PCS']) %>
+    <text><%= entry.description %></text>
+    <statusCode code="active"/>
+    <!-- Attribute: datetime --> 
+    <%== render(:partial => 'author_qdm', :locals => {:entry => entry}) %>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </procedure>
+</entry>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.64.cat1.erb

@@ -0,0 +1,55 @@
+<entry>
+  <procedure classCode="PROC" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!--  Procedure performed template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.64" extension="2017-08-01"/>
+    <!-- Procedure Activity Procedure-->
+    <templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
+    <id root="1.3.6.1.4.1.115" extension="<%= entry.id %>"/>
+    <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['*']) %>
+    <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>
+    <%== render(:partial => 'ordinality', :locals => {:entry => entry, :ordinality_oids=>field_oids["ORDINAL"]}) %>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+    <% if entry.respond_to?(:incision_time) && entry.incision_time.present? -%>
+    <entryRelationship typeCode="REFR">
+      <procedure classCode="PROC" moodCode="EVN">
+        <templateId root="2.16.840.1.113883.10.20.24.3.89"/>
+        <id root="1.3.6.1.4.1.115" extension="<%= identifier_for([entry.id, entry.incision_time]) %>" />
+        <code code="34896006" 
+              codeSystem="2.16.840.1.113883.6.96"
+              codeSystemName="SNOMED CT" 
+              displayName="incision"/>
+              <effectiveTime <%= value_or_null_flavor(entry.incision_time) %>/>
+      </procedure>
+    </entryRelationship>
+    <% end -%>
+
+    <% entry.values.each do |value| %>
+      <entryRelationship typeCode="REFR">
+       <observation classCode="OBS" moodCode="EVN">
+         <!-- Conforms to C-CDA R2 Result Observation (V2) -->
+         <templateId root="2.16.840.1.113883.10.20.22.4.2" extension="2015-08-01"/>
+         <!-- Result (QRDA I R3) -->
+         <templateId root="2.16.840.1.113883.10.20.24.3.87" extension="2016-02-01"/>
+         <id root="1.3.6.1.4.1.115" extension="<%= identifier_for(value) %>"/>
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['*']) %>
+          <statusCode code="completed"/>
+          <effectiveTime>
+            <low <%= value_or_null_flavor(entry.start_time) %>/>
+            <high <%= value_or_null_flavor(entry.end_time) %>/>
+          </effectiveTime>
+         <%== render(:partial=> 'result_value', :locals => {:values => [value]}) %>
+        
+       </observation>
+     </entryRelationship>
+   <% end %>
+   <% if entry.components -%>
+      <%== render(:partial => 'components', :locals => {:entry => entry} ) %>
+    <% end %>
+  </procedure>
+</entry>
+

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.7.cat1.erb

@@ -0,0 +1,31 @@
+<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="2017-08-01"/>
+    <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? -%>
+        <targetSiteCode code="<%= entry.anatomical_target['code'] %>"
+          codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(entry.anatomical_target['code_system']) %>"/>
+    <% end -%>
+    <%== render(:partial => 'author_qdm', :locals => {:entry => entry}) %>
+    <participant typeCode="DEV">
+      <participantRole classCode="MANU">
+        <playingDevice classCode="DEV">
+          <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['*']) %>
+        </playingDevice>
+      </participantRole>
+    </participant>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </procedure>
+</entry>

data/templates/cat1/r5/_2.16.840.1.113883.10.20.24.3.9.cat1.erb

@@ -0,0 +1,35 @@
+<entry>
+  <act classCode="ACT" moodCode="RQO" <%== negation_indicator(entry) %>>
+    <templateId root="2.16.840.1.113883.10.20.24.3.130" extension="2017-08-01"/>
+    <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="2017-08-01"/>
+        <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>
+
+        <%== render(:partial => 'author_qdm', :locals => {:entry => entry}) %>
+
+        <participant typeCode="DEV">
+          <participantRole classCode="MANU">
+            <playingDevice classCode="DEV">
+              <%== code_display(entry, 'value_set_map' => filtered_vs_map, 'preferred_code_sets' => ['*']) %>
+            </playingDevice>
+          </participantRole>
+        </participant>
+      </supply>
+    </entryRelationship>
+    <%== render(:partial => 'reason', :locals => {:entry => entry, :reason_oids=>field_oids["REASON"]}) %>
+  </act>
+</entry>

data/templates/cat1/r5/_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\"") %>
+  </observation>
+</entry>

data/templates/cat1/r5/_address.cat1.erb

@@ -0,0 +1,7 @@
+<addr use="<%= address.use %>">
+  <streetAddressLine><%= address.street.join(' ') %></streetAddressLine>
+  <city><%= address.city %></city>
+  <state><%= address.state %></state>
+  <postalCode><%= address.zip %></postalCode>
+  <country><%= address.country %></country>
+</addr>

data/templates/cat1/r5/_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/r5/_author_qdm.cat1.erb

@@ -0,0 +1,8 @@
+<author>
+  <templateId root="2.16.840.1.113883.10.20.24.3.155" extension="2017-08-01"/>
+  <time <%= value_or_null_flavor(entry.as_point_in_time) %>/>
+  <assignedAuthor>
+    <id nullFlavor="NA"/>
+  </assignedAuthor>
+</author>
+

data/templates/cat1/r5/_component_value.cat1.erb

@@ -0,0 +1,5 @@
+<% if result['code'] -%>
+  <value xsi:type="CD" code="<%= result['code'].code %>" codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(result['code'].code_system) %>" />
+<% elsif result['scalar'] %>
+  <value xsi:type="PQ" value="<%= result['scalar'] %>" unit="<%= result['units'] %>"/>
+<% end %>

data/templates/cat1/r5/_components.cat1.erb

@@ -0,0 +1,11 @@
+<% entry.components['values'].each do |component| %>
+  <entryRelationship typeCode="REFR">
+       <observation classCode="OBS" moodCode="EVN">
+          <!-- Component -->
+          <templateId root="2.16.840.1.113883.10.20.24.3.149" extension="2017-08-01" />
+          <id root="1.3.6.1.4.1.115" extension="<%= identifier_for(component) %>"/>
+          <code code="<%= component.code['code'] %>" codeSystem="<%= HealthDataStandards::Util::CodeSystemHelper.oid_for_code_system(component.code['code_system']) %>" />
+          <%== render(:partial => 'component_value', :locals => {:result => component.result} ) %>
+      </observation>
+  </entryRelationship>
+<% end %>

data/templates/cat1/r5/_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="2016-08-01"/>
+      <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/r5/_id.cat1.erb

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

data/templates/cat1/r5/_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>