C-CDA on FHIR Implementation Guide STU 1 (v1.0.0)

This page is part of the C-CDA on FHIR Implementation Guide (v1.0.0: STU 1) based on FHIR R3. This is the current published version. For a full list of available versions, see the Directory of published versions

Document Id 12345
Document Created: June 15, 2016, 16:14, PST
Care Provision Care Plan for Amy Shaw
Performer Ronald Boone, MD
Author Ronald Boone, MD
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Encounter Id 9937012 2.16.840.1.113883.19
Encounter Type Care Plan
Encounter Period  From June 15, 2016, 16:20 to Sept 18, 2016, 18:20
Encounter Location Ambulatory Care at Acme Laboratories
Responsible party Ronald Boone, MD
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Assigned entity Acme Laboratories
Emergency contact Michael Shaw
Contact info 49 Meadow St
Amherst MA 01003, US
Tel: (555)555-1212
Care giver Mrs. Lillian White
Contact info 49 Meadow St
Amherst MA 01003, US
Tel: (555)555-1215
Entered by Sally Jones
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Signed Ronald Boone at June 15, 2016
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Informant Henry Vincent, CPh
Contact info 1007 Pharmacy Drive
Portland, OR 99123, US
Tel: +1(555)555-1215
Information recipient: Primary Physician, MD
Contact info 1005 St. Clair Avenue
Amherst MA 01002, US
Tel: +1(555)555-1666
Legal authenticator Ronald Boone, MD signed at June 15, 2016
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Document maintained by Acme Laboratories
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003