qrda_generator 1.0.0

data/Gemfile

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+source "http://rubygems.org"
+
+gemspec
+
+gem 'pry'
+gem 'pry-nav'
+gem 'rake'
+
+group :test do
+  gem 'mocha'
+  gem 'simplecov', :require => false
+end

data/Rakefile

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+require 'rake/testtask'
+require "simplecov"
+
+Rake::TestTask.new(:test_unit) do |t|
+  t.libs << "test"
+  t.test_files = FileList['test/**/*_test.rb']
+  t.verbose = true
+end
+
+task :test => [:test_unit] do
+  system("open coverage/index.html")
+end

data/lib/qrda_generator/export/cat_1.rb

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+module QrdaGenerator
+  module Export
+    module Cat1
+      include HealthDataStandards::Export::TemplateHelper
+      include HealthDataStandards::Util
+      include HealthDataStandards::SVS
+
+      @@vs_map = nil
+      def export(patient, measures, start_date, end_date)
+        self.template_format = "cat1"
+        self.template_directory = File.dirname(__FILE__)
+        render(:template => 'show', :locals => {:patient => patient, :measures => measures, 
+                                                :start_date => start_date, :end_date => end_date})
+      end
+
+      def value_set_map
+        @@vs_map ||= Hash[*ValueSet.all.map{ |p| [p.oid, p] }.flatten]
+      end
+
+      # Find all of the entries on a patient that match the given data criteria
+      def entries_for_data_criteria(data_criteria, patient)
+        data_criteria_oid = HQMFTemplateHelper.template_id_by_definition_and_status(data_criteria.definition, 
+                                                                                    data_criteria.status || '',
+                                                                                    data_criteria.negation)
+        filtered_entries = []
+        case data_criteria_oid
+        when '2.16.840.1.113883.3.560.1.404'
+          filtered_entries = handle_patient_expired(patient)
+        when '2.16.840.1.113883.3.560.1.401'
+          filtered_entries = handle_clinical_trial_participant(patient)
+        else
+          entries = patient.entries_for_oid(data_criteria_oid)
+          codes = []
+          vs = value_set_map[data_criteria.code_list_id]
+          if vs
+            codes = vs.code_set_map
+          else
+            QrdaGenerator.logger.warn("No codes for #{data_criteria.code_list_id}")
+          end
+          filtered_entries = entries.find_all do |entry|
+            # This special case is for when the code list is a reason
+            if data_criteria.code_list_id =~ /2\.16\.840\.1\.113883\.3\.526\.3\.100[7-9]/
+              entry.negation_reason.present? && codes.first['values'].include?(entry.negation_reason['code'])
+            else
+              # The !! hack makes sure that negation_ind is a boolean
+              entry.is_in_code_set?(codes) && !!entry.negation_ind == data_criteria.negation
+            end
+          end
+        end
+        if filtered_entries.empty?
+          QrdaGenerator.logger.debug("No entries for #{data_criteria.title}")
+        end
+
+        filtered_entries
+      end
+
+      # Given a set of measures, find the data criteria/value set pairs that are unique across all of them
+      # Returns an Array of Hashes. Hashes will have a three key/value pairs. One for the data criteria oid,
+      # one for the value set oid and one for the data criteria itself
+      def unique_data_criteria(measures)
+        all_data_criteria = measures.map {|measure| measure.all_data_criteria}.flatten
+        dc_oids_and_vs_oids = all_data_criteria.map do |data_criteria|
+          data_criteria_oid = HQMFTemplateHelper.template_id_by_definition_and_status(data_criteria.definition, 
+                                                                            (data_criteria.status || ""),
+                                                                            data_criteria.negation)
+          value_set_oid = data_criteria.code_list_id
+          {'data_criteria_oid' => data_criteria_oid, 'value_set_oid' => value_set_oid, 'data_criteria' => data_criteria}
+        end
+        dc_oids_and_vs_oids.uniq_by {|thingy| [thingy['data_criteria_oid'], thingy['value_set_oid']]}
+      end
+
+      def render_data_criteria(dc_oid, vs_oid, entries)
+        html_array = entries.map do |entry|
+          if dc_oid == '2.16.840.1.113883.3.560.1.1001'
+            # This is a special case. This HQMF OID maps to more than one QRDA OID.
+            # So we need to try to figure out what template we should use based on the
+            # content of the entry
+            if vs_oid == '2.16.840.1.113883.3.526.3.1279'
+              # Patient Characteristic Observation Assertion template for
+              # Patient Characteristic: ECOG Performance Status-Poor
+              render(:partial => '2.16.840.1.113883.10.20.24.3.103', :locals => {:entry => entry,
+                                                                                 :value_set_oid => vs_oid})
+            elsif vs_oid == "2.16.840.1.113883.3.117.1.7.1.402" || vs_oid == "2.16.840.1.113883.3.117.1.7.1.403" 
+              # Patient Charasteristic Gestational Age
+              render(:partial => '2.16.840.1.113883.10.20.24.3.101', :locals => {:entry => entry,
+                                                                                 :value_set_oid => vs_oid})
+            end
+          else
+            render(:partial => EntryTemplateResolver.partial_for(dc_oid), :locals => {:entry => entry,
+                                                                                      :value_set_oid => vs_oid})
+          end
+        end
+        html_array.join("\n")
+      end
+
+      def render_patient_data(patient, measures)
+        udcs = unique_data_criteria(measures)
+        data_criteria_html = udcs.map do |udc|
+          entries = entries_for_data_criteria(udc['data_criteria'], patient)
+          render_data_criteria(udc['data_criteria_oid'], udc['value_set_oid'], entries)          
+        end
+        data_criteria_html.compact.join("\n")
+      end
+
+      def negation_indicator(entry)
+        if entry.negation_ind
+          'negationInd="true"'
+        else
+          ''
+        end
+      end
+
+      def handle_clinical_trial_participant(patient)
+        if patient.clinical_trial_participant
+          [{dummy_entry: true}]
+        else
+          []
+        end
+      end
+
+      def handle_patient_expired(patient)
+        if patient.expired
+          [OpenStruct.new(start_date: patient.deathdate)]
+        else
+          []
+        end
+      end
+
+      extend self
+    end
+  end
+end
+
+HealthDataStandards::Export::RenderingContext.class_eval do
+  include QrdaGenerator::Export::Cat1
+end

data/lib/qrda_generator/export/entry_template_resolver.rb

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+module QrdaGenerator
+  module Export
+    module EntryTemplateResolver
+      def hqmf_qrda_oid_map
+        if @hqmf_qrda_oid_map.blank?
+          template_id_file = File.expand_path('../hqmf-qrda-oids.json', __FILE__)
+          @hqmf_qrda_oid_map = JSON.parse(File.read(template_id_file))  
+        end
+        @hqmf_qrda_oid_map
+      end
+
+      def qrda_oid_exist?(oid)
+        hqmf_qrda_oid_map.any? {|map_tuple| map_tuple['qrda_oid'] == oid}
+      end
+
+      def qrda_oid_for_hqmf_oid(hqmf_oid)
+        oid_tuple = hqmf_qrda_oid_map.find {|map_tuple| map_tuple['hqmf_oid'] == hqmf_oid }
+        if oid_tuple.nil?
+          puts "no qrda oid for #{hqmf_oid}"
+        end
+        oid_tuple['qrda_oid']
+      end
+
+      alias :partial_for :qrda_oid_for_hqmf_oid
+
+      extend self
+    end
+  end
+end

data/lib/qrda_generator/railtie.rb

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+module QrdaGenerator
+  class Railtie < Rails::Railtie
+    initializer 'Rails logger' do
+      QrdaGenerator.logger = Rails.logger
+    end
+  end
+end

data/lib/qrda_generator.rb

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+require 'health-data-standards'
+require 'hqmf-parser'
+require 'ostruct'
+require 'log4r'
+
+require_relative 'qrda_generator/export/cat_1'
+require_relative 'qrda_generator/export/entry_template_resolver'
+
+module QrdaGenerator
+  class << self
+    attr_accessor :logger
+  end
+end
+
+if defined?(Rails)
+  require_relative 'qrda_generator/railtie' 
+else
+  QrdaGenerator.logger = Log4r::Logger.new("QRDA Generator")
+  QrdaGenerator.logger.outputters = Log4r::Outputter.stdout
+end

data/templates/_2.16.840.1.113883.10.20.24.3.1.cat1.erb

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+<entry>
+  <observation classCode="OBS" moodCode="GOL">
+    <!-- 2.16.840.1.113883.10.20.22.4.44 Plan of Care Activity Observation -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.44"/>
+    <templateId root="2.16.840.1.113883.10.20.24.3.1"/>
+    <id root="<%= entry.id %>"/>
+    <%== code_display(entry, :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/_2.16.840.1.113883.10.20.24.3.101.cat1.erb

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+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.101"/>
+    <id root="<%= entry.id %>"/>
+    <code code="57036006" 
+          codeSystem="2.16.840.1.113883.6.96" 
+          codeSystemName="SNOMED-CT" 
+          displayName="length of gestation"/>
+
+    <statusCode code="completed"/>
+    <effectiveTime <%= value_or_null_flavor(entry.as_point_in_time) %>/>
+    <!-- ?Note: valueSet of PQ "d" and "wk"-->
+    <value xsi:type="PQ" 
+    <% if entry.codes['SNOMED-CT'].include?('80487005')-%>
+           value="39"
+    <% elsif entry.codes['SNOMED-CT'].include?('931004')-%>
+           value="36"
+    <% elsif entry.codes['SNOMED-CT'].include?('43697006')-%>
+           value="37"
+    <% else -%>
+           nullFlavor="UNK"
+    <% end -%>
+           unit="wk"/>   
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.103.cat1.erb

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+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <templateId root="2.16.840.1.113883.10.20.24.3.103"/> 
+    <id root="<%= entry.id %>"/>
+    <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
+    <statusCode code="completed" />
+    <effectiveTime <%= value_or_null_flavor(entry.start_time) %>/>
+    <%== code_display(entry, 'preferred_code_sets' => ['SNOMED-CT'],
+                             'tag_name' => 'value',
+                             'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.105.cat1.erb

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+<entry>
+  <act classCode="ACT" moodCode="EVN">
+    <!-- Discharge Medication Entry -->
+    <templateId root="2.16.840.1.113883.10.20.24.4.105"/>
+    <id root="<%= 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"/> 
+        <!-- Medication, Active template -->
+        <templateId root="2.16.840.1.113883.10.20.24.3.41"/>
+        
+        <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.route.present? -%>
+        <!-- Attribute: route -->
+        <routeCode code="<%= entry.route['code'] %>" codeSystem="<%= entry.route['codeSystem'] %>"/>
+        <% 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"/>
+            <id root="<%= UUID.generate %>"/>
+            <manufacturedMaterial>
+              <%== code_display(entry, :extra_content => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+            </manufacturedMaterial>
+            <manufacturerOrganization>
+              <name>Medication Factory Inc.</name>
+            </manufacturerOrganization>
+          </manufacturedProduct>
+        </consumable>
+      </substanceAdministration>
+    </entryRelationship>
+  </act>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.11.cat1.erb

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+<entry>
+  <!--Diagnosis active: diabetes-->
+  <observation classCode="OBS" moodCode="EVN">
+    <!--  Problem observation template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.4"/>
+    <!--  Diagnosis active template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.11"/>
+    <id root="<%= entry.id %>"/>
+    <code code="282291009" displayName="diagnosis" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
+    <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>
+    <%== code_display(entry, {'tag_name' => 'value', 'preferred_code_sets' => ['LOINC', 'SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM'],
+                                                    'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\""}) %>
+
+    <entryRelationship typeCode="REFR">
+      <observation classCode="OBS" moodCode="EVN">
+        <!-- Problem Status (consolidation) template -->
+        <templateId root="2.16.840.1.113883.10.20.22.4.6"/>
+        <!-- Problem Status, Active template -->
+        <templateId root="2.16.840.1.113883.10.20.24.3.94"/>
+        <id root="<%= UUID.generate %>"/>  
+        <code code="33999-4" 
+          codeSystem="2.16.840.1.113883.6.1"
+          codeSystemName="LOINC" 
+          displayName="status"/>
+        <statusCode code="completed"/>
+        <value xsi:type="CD" code="55561003" 
+           displayName="active"
+           codeSystem="2.16.840.1.113883.6.96" 
+           codeSystemName="SNOMED CT"/>
+      </observation>
+    </entryRelationship>
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.12.cat1.erb

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+<entry typeCode="DRIV">
+  <organizer moodCode="EVN" classCode="CLUSTER">
+    <templateId root="2.16.840.1.113883.10.20.22.4.45"/>
+    <!--    Family history organizer template   -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.12"/>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <!-- The subject is currently hardcoded to father -->
+    <subject>
+      <relatedSubject classCode="PRS">
+        <code code="FTH" displayName="Father" 
+              codeSystemName="HL7RoleCode" 
+              codeSystem="2.16.840.1.113883.5.111">
+          <translation code="9947008" 
+                displayName="Biological father" 
+                codeSystemName="SNOMED CT" 
+                codeSystem="2.16.840.1.113883.6.96"/>
+        </code>
+        <subject>
+          <administrativeGenderCode 
+               code="M" codeSystem="2.16.840.1.113883.5.1"
+               codeSystemName="HL7AdministrativeGender" 
+               displayName="Male"/>
+            <birthTime value="1912"/>
+        </subject>
+      </relatedSubject>
+    </subject>
+    <component>
+      <observation classCode="OBS" moodCode="EVN">
+        <templateId root="2.16.840.1.113883.10.20.22.4.46"/>
+        <id root="<%= entry.id %>"/>
+        <code code="55607006" displayName="Problem" 
+              codeSystemName="SNOMED CT" 
+              codeSystem="2.16.840.1.113883.6.96"/>
+        <statusCode code="completed"/>
+        <effectiveTime>
+          <low <%= value_or_null_flavor(entry.start_time) %>/>
+          <high <%= value_or_null_flavor(entry.end_time) %>/>
+        </effectiveTime>
+        <%== code_display(entry, 'preferred_code_sets' => ['SNOMED-CT'],
+                         'tag_name' => 'value',
+                         'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+      </observation>
+    </component>
+  </organizer>
+</entry>
+

data/templates/_2.16.840.1.113883.10.20.24.3.13.cat1.erb

@@ -0,0 +1,37 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+  <!--  Problem observation template -->
+  <templateId root="2.16.840.1.113883.10.20.22.4.4"/>
+  <!-- Diagnosis, inactive template -->
+  <templateId root="2.16.840.1.113883.10.20.24.3.13"/>
+  <id root="<%= entry.id %>"/>
+  <code code="282291009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" 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}) %>
+
+  <%== code_display(entry, '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}\"") %>
+  <!-- Status -->
+  <entryRelationship typeCode="REFR">
+    <observation classCode="OBS" moodCode="EVN">
+      <!-- Problem Status (consolidation) template -->
+      <templateId root="2.16.840.1.113883.10.20.22.4.6"/>
+      <!-- Problem Status, Inactive template -->
+      <templateId root="2.16.840.1.113883.10.20.24.3.95"/>
+      <id root="<%= UUID.generate %>"/>
+      <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="status"/>  
+      <statusCode code="completed"/>  
+      <value code="73425007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="inactive" xsi:type="CD"/>
+    </observation>
+
+  </entryRelationship>
+  
+</observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.14.cat1.erb

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+<entry>
+  <observation classCode="OBS" moodCode="EVN">
+    <!--  Problem observation template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.4"/>
+    <!-- Diagnosis, resolved template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.14"/>
+    <id root="<%= entry.id %>"/>
+    <code code="282291009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" 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}) %>
+
+    <%== code_display(entry, 'tag_name' => 'value', 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM', 'CPT'],
+                             'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <!-- Status -->
+    <entryRelationship typeCode="REFR">
+      <observation classCode="OBS" moodCode="EVN">
+        <!-- Problem Status (consolidation) template -->
+        <templateId root="2.16.840.1.113883.10.20.22.4.6"/>
+        <!-- Problem Status, Resolved template -->
+        <templateId root="2.16.840.1.113883.10.20.24.3.96"/>
+        <id root="<%= UUID.generate %>"/>
+        <code code="33999-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="status"/>
+        <statusCode code="completed"/>
+        <value code="413322009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="resolved" xsi:type="CD"/>
+      </observation>
+    </entryRelationship>
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.17.cat1.erb

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+<entry>
+  <observation classCode="OBS" moodCode="RQO">
+  <!-- Consolidated Plan of Care Activity Observation 
+       templateId (Implied Template) -->
+  <templateId root="2.16.840.1.113883.10.20.22.4.44"/>
+  <!-- Diagnostic Study, Order template -->
+  <templateId root="2.16.840.1.113883.10.20.24.3.17"/>
+  <id root="<%= entry.id %>"/>
+  <%== code_display(entry, 'preferred_code_sets' => ['LOINC'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+  <text><%= entry.description %></text>
+  <statusCode code="new"/>
+
+  <!-- Attribute: datetime -->
+  <author>
+    <time <%= value_or_null_flavor(entry.as_point_in_time) %>/>
+    <assignedAuthor>
+      <id nullFlavor="NA" root="<%= UUID.generate %>"/>
+    </assignedAuthor>
+  </author>
+
+</observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.18.cat1.erb

@@ -0,0 +1,21 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Consolidated Procedure Activity Observation templateId 
+       (Implied Template) -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.13"/>
+    <!-- Diagnostic Study, Performed template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.18"/>
+    <id root="<%= entry.id %>"/>
+    <%== code_display(entry, 'preferred_code_sets' => ['SNOMED-CT', 'ICD-9-CM', 'ICD-10-CM'], 'extra_content' => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <text><%= entry.description %></text>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <!-- Attribute: Start Datetime -->
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+      <!-- Attribute: End Datetime -->
+      <high <%= value_or_null_flavor(entry.end_time) %>/>
+    </effectiveTime>
+    <%== render(:partial => 'result_value', :locals => {:entry => entry}) %>
+    <%== render(:partial => 'reason', :locals => {:entry => entry}) %>
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.2.cat1.erb

@@ -0,0 +1,28 @@
+<entry>
+  <act classCode="ACT" moodCode="EVN">
+    <!-- Communication from patient to provider -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.2"/>
+    <id root="<%= entry.id %>"/>  
+    <%== code_display(entry, :extra_content => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <text>
+       <%= entry.description %>
+    </text>
+    <statusCode code="completed"/>
+    <effectiveTime>
+      <low <%= value_or_null_flavor(entry.start_time) %>/>
+    </effectiveTime>
+
+    <participant typeCode="AUT">
+      <participantRole classCode="PAT">
+        <code code="116154003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Patient"/>
+      </participantRole>
+    </participant>
+
+    <participant typeCode="IRCP">
+      <participantRole classCode="ASSIGNED">
+        <code code="158965000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Medical Practitioner"/>
+      </participantRole>
+    </participant>
+
+  </act>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.20.cat1.erb

@@ -0,0 +1,20 @@
+<entry>
+  <observation classCode="OBS" moodCode="EVN" <%== negation_indicator(entry) %>>
+    <!-- Consolidated Result Observation templateId (Implied Template) -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.2"/>
+    <!-- Diagnostic Study, Result template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.20"/>
+    <id root="<%= entry.id %>"/>
+    <%== code_display(entry, 'preferred_code_sets' => ['SNOMED-CT', 'LOINC'],
+                             'extra_content' => "xsi:type=\"CD\" sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <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 => {:entry => entry}) %>
+    <%== render(:partial => 'reason', :locals => {:entry => entry}) %>
+  </observation>
+</entry>

data/templates/_2.16.840.1.113883.10.20.24.3.22.cat1.erb

@@ -0,0 +1,21 @@
+<entry>
+  <encounter classCode="ENC" moodCode="RQO">
+    <!--  Plan of Care Activity Encounter template -->
+    <templateId root="2.16.840.1.113883.10.20.22.4.40"/>
+    <!-- Encounter order template -->
+    <templateId root="2.16.840.1.113883.10.20.24.3.22"/>
+    <id root="<%= entry.id %>"/>
+    <%== code_display(entry, :extra_content => "sdtc:valueSet=\"#{value_set_oid}\"") %>
+    <text><%= entry.description %></text>
+    <statusCode code="new"/>
+  
+    <!-- Attribute: datetime -->
+    <author>
+      <time <%= value_or_null_flavor(entry.start_time) %>/>
+      <assignedAuthor>
+        <id root="<%= UUID.generate %>"/>
+      </assignedAuthor>
+    </author>
+
+  </encounter>
+</entry>