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
<act xmlns="urn:hl7-org:v3" moodCode="INT" classCode="ACT">
<templateId root="2.16.840.1.113883.10.20.22.4.129" extension="2024-05-01"/>
<id root="03f5e10b-7e79-4610-9626-d2984ff10cc1"/>
<code displayName="Payment Sources" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="52556-8"/>
<statusCode code="active"/>
<entryRelationship typeCode="COMP">
<act moodCode="INT" classCode="ACT">
<!-- These act/identifiers are unique identifiers
for the policy or program providing the coverage. -->
<id root="4c9a3be1-5f09-46dd-88e7-14c8ec612e4c"/>
<code displayName="Medicare PPO"
codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" code="112"/>
<statusCode code="active"/>
</act>
</entryRelationship>
</act>