<?xml version="1.0" encoding="UTF-8"?>

<DiagnosticReport xmlns="http://hl7.org/fhir">
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    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: DiagnosticReport PGxGenomicReportEMERGE</b></p><a name="PGxGenomicReportEMERGE"> </a><a name="hcPGxGenomicReportEMERGE"> </a><a name="PGxGenomicReportEMERGE-en-US"> </a><h2><span title="Codes:{http://loinc.org 51969-4}, {http://example.org/hgsc.bcm.edu/lab-test-codes/ emerge-seq-ngs-pnl}">Genetic analysis report</span> (<span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0074 GE}">Genetics</span>) </h2><table class="grid"><tr><td>Subject</td><td>Adam B. Everyman  Male, DoB: 1951-01-20 ( Medical Record Number: m123 (use: usual, ))</td></tr><tr><td>When For</td><td>2020-01-01 00:00:00-0500</td></tr><tr><td>Reported</td><td>2020-01-01 00:00:00-0500</td></tr><tr><td>Performer</td><td> <a href="Organization-ExampleOrg.html">Organization some lab</a></td></tr></table><p><b>Report Details</b></p><table class="grid"><tr><td><b>Code</b></td><td><b>Value</b></td><td><b>Flags</b></td><td><b>Note</b></td><td><b>When For</b></td></tr><tr><td><a href="Observation-TxImp01.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-TxImp02.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-TxImp03.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-TxImp04.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-TxImp05.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-TxImp06.html"><span title="Codes:{http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs therapeutic-implication}">Therapeutic Implication</span></a></td><td/><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-geno-1001.html"><span title="Codes:{http://loinc.org 84413-4}">Genotype display name</span></a></td><td><span title="Codes:{http://www.ncbi.nlm.nih.gov/clinvar 638797}">CYP2C19*2/*2</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-geno-1003.html"><span title="Codes:{http://loinc.org 84413-4}">Genotype display name</span></a></td><td><span title="Codes:">VKORC1 rs9923231 C/T</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-geno-1002.html"><span title="Codes:{http://loinc.org 84413-4}">Genotype display name</span></a></td><td><span title="Codes:">CYP2C9*1/*1</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1011.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2020-01-01</td></tr><tr><td><a href="Observation-Pgx-var-1012.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1013.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1014.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1015.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1016.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1017.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1018.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td/><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1019.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td>This variant was confirmed with SANGER sequencing</td><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1020.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td>This variant was confirmed with SANGER sequencing</td><td>2019-04-01</td></tr><tr><td><a href="Observation-Pgx-var-1021.html"><span title="Codes:{http://loinc.org 69548-6}">Genetic variant assessment</span></a></td><td><span title="Codes:{http://loinc.org LA9633-4}">Present</span></td><td>Final</td><td>This variant was confirmed with SANGER sequencing</td><td>2019-04-01</td></tr></table><p>Based on the genotype result, this patient is predicted to have a CYP2C19 poor metabolizer phenotype. This genotype information can be used by patients and clinicians as part of the shared decision-making process for several drugs metabolized by CYP2C19 including clopidogrel, voriconazole, amitriptyline, citalopram and escitalopram.</p><p><b>Coded Conclusions:</b></p><ul><li><span title="Codes:{http://loinc.org LA6576-8}">Positive</span></li></ul></div>
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  <extension url="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action">
    <valueReference>
      <reference value="Task/PGxRecEx01"/>
      <display value="No clopidogrel"/>
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  <extension url="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action">
    <valueReference>
      <reference value="Task/PGxRecEx02"/>
      <display value="No voriconazole"/>
    </valueReference>
  </extension>
  <extension url="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action">
    <valueReference>
      <reference value="Task/PGxRecEx03"/>
      <display value="50% citalopram"/>
    </valueReference>
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  <extension url="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action">
    <valueReference>
      <reference value="Task/PGxRecEx04"/>
      <display value="50% escitalopram"/>
    </valueReference>
  </extension>
  <extension url="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action">
    <valueReference>
      <reference value="Task/PGxRecEx04"/>
      <display value="50% amitriptyline"/>
    </valueReference>
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      <text value="This test was developed and its performance determined by this laboratory. It has not been cleared or approved by U.S. Food and Drug Administration.&#xA;Since FDA Approval is not required for clinical use of this test, this laboratory has established and validated the test's accuracy and precision,&#xA;pursuant to the requirement of CLIA '88. This laboratory is licensed and/or accredited under CLIA and CAP (CAP# xxxxxxx / CLIA# xxxxxxxxxx)."/>
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    <reference value="ServiceRequest/eMERGEServiceRequest"/>
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  <status value="final"/>
  <category>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v2-0074"/>
      <code value="GE"/>
    </coding>
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  <code>
    <coding>
      <system value="http://loinc.org"/>
      <code value="51969-4"/>
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    <coding>
      <system value="http://example.org/hgsc.bcm.edu/lab-test-codes/"/>
      <code value="emerge-seq-ngs-pnl"/>
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  <effectiveDateTime value="2020-01-01T00:00:00-05:00"/>
  <issued value="2020-01-01T00:00:00-05:00"/>
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    <reference value="Organization/ExampleOrg"/>
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  <result>
    <reference value="Observation/TxImp01"/>
    <display value="clopidogrel, poor metabolizer"/>
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  <result>
    <reference value="Observation/TxImp02"/>
    <display value="voriconazole, poor metabolizer"/>
  </result>
  <result>
    <reference value="Observation/TxImp03"/>
    <display value="citalopram, poor metabolizer"/>
  </result>
  <result>
    <reference value="Observation/TxImp04"/>
    <display value="escitalopram, poor metabolizer"/>
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  <result>
    <reference value="Observation/TxImp05"/>
    <display value="amitriptyline, poor metabolizer"/>
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  <result>
    <reference value="Observation/TxImp06"/>
    <display value="medium sensitivity to warfarin"/>
  </result>
  <result>
    <reference value="Observation/Pgx-geno-1001"/>
    <display value="CYP2C19*2/*2"/>
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  <result>
    <reference value="Observation/Pgx-geno-1003"/>
    <display value="VKORC1 rs9923231 C/T"/>
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  <result>
    <reference value="Observation/Pgx-geno-1002"/>
    <display value="CYP2C9*1/*1"/>
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  <result>
    <reference value="Observation/Pgx-var-1011"/>
    <display value="NC_000010.10(CYP2C19):g.96521657C="/>
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  <result>
    <reference value="Observation/Pgx-var-1012"/>
    <display value="NC_000010.10(CYP2C19):g.96522463A="/>
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  <result>
    <reference value="Observation/Pgx-var-1013"/>
    <display value="NC_000010.10(CYP2C19):g.96535173T="/>
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  <result>
    <reference value="Observation/Pgx-var-1014"/>
    <display value="NC_000010.10(CYP2C19):g.96535210G="/>
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  <result>
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    <display value="NC_000010.10(CYP2C19):g.96540410G&gt;A"/>
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  <result>
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    <display value="NC_000010.10(CYP2C19):g.96541616G="/>
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  <result>
    <reference value="Observation/Pgx-var-1017"/>
    <display value="NC_000010.10(CYP2C19):g.96541756T="/>
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    <display value="NC_000016.9(VKORC1):g.31096368C&gt;T"/>
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  <result>
    <reference value="Observation/Pgx-var-1020"/>
    <display value="NC_000010.10(CYP2C9):g.96702047C="/>
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  <result>
    <reference value="Observation/Pgx-var-1021"/>
    <display value="NC_000010.10(CYP2C9):g.96741053A="/>
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  <conclusion value="Based on the genotype result, this patient is predicted to have a CYP2C19 poor metabolizer phenotype. This genotype information can be used by patients and clinicians as part of the shared decision-making process for several drugs metabolized by CYP2C19 including clopidogrel, voriconazole, amitriptyline, citalopram and escitalopram."/>
  <conclusionCode>
    <coding>
      <system value="http://loinc.org"/>
      <code value="LA6576-8"/>
      <display value="Positive"/>
    </coding>
  </conclusionCode>
</DiagnosticReport>