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<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:sdtc="urn:hl7-org:sdtc">
  <realmCode code="US"/>
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <!--  US Realm Header Template  -->
  <templateId extension="2024-05-01" root="2.16.840.1.113883.10.20.22.1.1"/>
  <!--  Globally unique identifier for the document   -->
  <id extension="TT988" root="2.16.840.1.113883.19.5.99999.1"/>
  <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Summarization of Episode Note"/>
  <!--  Title of the document  -->
  <title>Patient Chart Summary</title>
  <effectiveTime value="20120915103000-0800"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" displayName="normal"/>
  <languageCode code="en-US"/>
  <setId extension="sTT988" root="2.16.840.1.113883.19.5.99999.19"/>
  <!--  Version of the document  -->
  <versionNumber value="1"/>
  <recordTarget>
    <patientRole>
      <id extension="444222222" root="2.16.840.1.113883.4.1"/>
      <!--  Example Social Security Number using the actual SSN OID.  -->
      <!--  US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1  -->
      <addr use="HP">
        <!--  HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119  -->
        <streetAddressLine>2222 Home Street</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97867</postalCode>
        <country>US</country>
      </addr>
      <telecom use="HP" value="tel:+1(555)555-2003"/>
      <!--  HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119  -->
      <patient>
        <name use="L">
          <given>Eve</given>
          <!--  The "SP" is "Spouse" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43  -->
          <family qualifier="SP">Betterhalf</family>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" displayName="Female"/>
        <!--  Date of birth need only be precise to the day  -->
        <birthTime value="19750501"/>
        <!--  <sdtc:multipleBirthOrderNumber value="2" />  -->
        <maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" displayName="Married"/>
        <religiousAffiliationCode code="1013" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation" displayName="Christian (non-Catholic, non-specific)"/>
        <!--  CDC Race and Ethnicity code set contains the five minimum race and ethnicity 
					categories defined by OMB Standards  -->
        <raceCode code="2106-3" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" displayName="White"/>
        <!--  The raceCode extension is only used if raceCode is valued  -->
        <sdtc:raceCode code="2076-8" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" displayName="Native Hawaiian or Other Pacific Islander"/>
        <ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" displayName="Not Hispanic or Latino"/>
        <guardian>
          <code code="POWATT" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode" displayName="Power of Attorney"/>
          <addr use="HP">
            <streetAddressLine>2222 Home Street</streetAddressLine>
            <city>Beaverton</city>
            <state>OR</state>
            <postalCode>97867</postalCode>
            <country>US</country>
          </addr>
          <telecom use="MC" value="tel:+1(555)555-2008"/>
          <guardianPerson>
            <name>
              <given>Boris</given>
              <given qualifier="CL">Bo</given>
              <family>Betterhalf</family>
            </name>
          </guardianPerson>
        </guardian>
        <birthplace>
          <place>
            <addr>
              <streetAddressLine>4444 Home Street</streetAddressLine>
              <city>Beaverton</city>
              <state>OR</state>
              <postalCode>97867</postalCode>
              <country>US</country>
            </addr>
          </place>
        </birthplace>
        <languageCommunication>
          <languageCode code="en"/>
          <!--  "en" is ISO 639-1 alpha-2 code for "English"  -->
          <modeCode code="ESP" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode" displayName="Expressed spoken"/>
          <proficiencyLevelCode code="G" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency" displayName="Good"/>
          <!--  Patient's preferred language  -->
          <preferenceInd value="true"/>
        </languageCommunication>
      </patient>
    </patientRole>
  </recordTarget>
  <!--  The author represents the person who provides the content in the document  -->
  <author>
    <time value="20130815103000-0800"/>
    <assignedAuthor>
      <id extension="5555555555" root="2.16.840.1.113883.4.6"/>
      <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" displayName="Adult Medicine Physician"/>
      <addr use="WP">
        <streetAddressLine>1004 Healthcare Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)555-1004"/>
      <assignedPerson>
        <name>
          <given>Patricia</given>
          <given qualifier="CL">Patty</given>
          <family>Primary</family>
          <suffix qualifier="AC">M.D.</suffix>
        </name>
      </assignedPerson>
    </assignedAuthor>
  </author>
  <!--  The custodian represents the organization charged with maintaining the original source document  -->
  <custodian>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id extension="321CX" root="2.16.840.1.113883.4.6"/>
        <name>Good Health HIE</name>
        <telecom use="WP" value="tel:+1(555)555-1009"/>
        <addr use="WP">
          <streetAddressLine>1009 Healthcare Drive</streetAddressLine>
          <city>Portland</city>
          <state>OR</state>
          <postalCode>99123</postalCode>
          <country>US</country>
        </addr>
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <informationRecipient>
    <intendedRecipient classCode="ASSIGNED">
      <addr>
        <streetAddressLine>1004 Healthcare Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
    </intendedRecipient>
  </informationRecipient>
  <component>
    <structuredBody>
      <component>
        <section/>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>