This page is part of the CCDA: Consolidated CDA Release (v5.0.0-ballot: CCDA 5.0 Ballot) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This version is a pre-release. The current official version is 4.0.0. For a full list of available versions, see the Directory of published versions
<supply xmlns="urn:hl7-org:v3" moodCode="INT" classCode="SPLY">
<templateId root="2.16.840.1.113883.10.20.22.4.17" extension="2014-06-09"/>
<id root="aba2fc75-1a43-435f-8309-d24e4be5f1cd"/>
<statusCode code="completed"/>
<effectiveTime xsi:type="IVL_TS">
<low value="20070103"/>
<high nullFlavor="UNK"/>
</effectiveTime>
<repeatNumber value="1"/>
<quantity value="75"/>
<product>
<manufacturedProduct classCode="MANU">
<!-- ** Medication information ** -->
<templateId root="2.16.840.1.113883.10.20.22.4.23"
extension="2014-06-09"/>
<id root="2a620155-9d11-439e-92b3-5d9815ff4ee8"/>
<manufacturedMaterial>
<code
displayName="200 ACTUAT albuterol 0.09 MG/ACTUAT Dry Powder Inhaler" codeSystemName="RxNorm" codeSystem="2.16.840.1.113883.6.88"
code="1649560"/>
</manufacturedMaterial>
<manufacturerOrganization>
<name>Medication Factory Inc.</name>
</manufacturerOrganization>
</manufacturedProduct>
</product>
<entryRelationship typeCode="SUBJ" inversionInd="true">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.515"
extension="2025-05-01"/>
<code xsi:type="CD" displayName="Instructions Provided"
codeSystem="2.16.840.1.113883.6.1" code="89187-7"/>
<text xsi:type="ED">Possible flu-like symptoms for three days.</text>
<statusCode code="completed"/>
<value xsi:type="CD" displayName="immunization education"
codeSystem="2.16.840.1.113883.6.96" code="171044003"/>
</observation>
</entryRelationship>
</supply>