1.2.276.0.76.10.4048/static-2016-06-22T000000: Unterschied zwischen den Versionen

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<table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Id</th><td style="text-align: left;">1.2.276.0.76.10.4048</td><th style="width: 20em; text-align: left;">Gültigkeit</th><td style="text-align: left;"> gültig ab 2016‑06‑22<p></p>Es gibt Versionen von Templates mit dieser Id:<ul><li>Problemconcernacteddiagnoses vom 2016‑06‑22</li><li>Problemconcernacteddiagnoses vom 2015‑03‑03</li></ul></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Status</th><td style="text-align: left;">[[File:Kgreen.png|16px]] Aktiv</td><th style="width: 20em; text-align: left;">Versions-Label</th><td style="text-align: left;"></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Name</th><td style="text-align: left;">Problemconcernacteddiagnoses</td><th style="width: 20em; text-align: left;">Anzeigename</th><td style="text-align: left;">Problem Concern Act (Abschlussdiagnosen)</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Beschreibung</th><td style="text-align: left;" colspan="3">Sammelkontainer für Beschwerden, Symptome, Diagnose, Probleme etc., hier: Abschlussdiagnosen ggf. mit ICD10-Kodes</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Kontext</th><td style="text-align: left;" colspan="3">Elternknoten des Template-Element mit Id 1.2.276.0.76.10.4048</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Klassifikation</th><td style="text-align: left;" colspan="3">CDA Entry Level Template</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Offen/Geschlossen</th><td style="text-align: left;" colspan="3">Offen (auch andere als die definierten Elemente sind erlaubt)</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Assoziiert mit</th><td style="text-align: left;" colspan="3"><table class="treetable" id="assocsTable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;">Assoziiert mit 1 Konzept</td></tr><tr><td><div><table class="artdecor" width="100%" border="0" cellspacing="1" cellpadding="3" style="background: transparent;"><tr><th style="width: 20%; text-align: left;">Id</th><th style="width: 60%; text-align: left;">Name</th><th style="width: 20%; text-align: left;">Datensatz</th></tr><tr><td style="text-align: left; vertical-align: top; width: 1%;"><span style="color: grey;">aktin-data&#8203;element2015(1)-</span>20023</td><td style="vertical-align: top;" title="Abschlussdiagnosen / Abschlussdiagnose / ">Führende Abschlussdiagnose  / Sequenznummer</td><td style="text-align: left; vertical-align: top;">AKTIN-Datensatz</td></tr></table></div></td></tr></table></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Benutzt von / Benutzt</th><td style="text-align: left;" colspan="3"><table class="treetable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;">Benutzt von 2 Templates, Benutzt 1 Template</td></tr><tr><td><div><table class="artdecor" width="100%" border="0" cellspacing="1" cellpadding="3" style="background: transparent;"><tr><th style="width: 20%; text-align: left;">Benutzt von Template-Id</th><th style="width: 1%; text-align: left;"> als </th><th style="width: 60%; text-align: left;">Name</th><th style="width: 19%; text-align: left;">Version</th></tr><tr><td style="text-align: left;">1.2.276.0.76.10.3055</td><td style="text-align: left;">Containment</td><td style="text-align: left;">Abschlussdiagnosen</td><td style="text-align: left;">2016‑06‑22</td></tr><tr><td style="text-align: left;">1.2.276.0.76.10.1019</td><td style="text-align: left;">[[File:Link.png|16px]]</td><td style="text-align: left;">Emergency medicine Note CDA document</td><td style="text-align: left;">2016‑06‑01</td></tr><tr><th style="width: 20%; text-align: left;">Benutzt Template-Id</th><th style="width: 1%; text-align: left;"> als </th><th style="width: 60%; text-align: left;">Name</th><th style="width: 19%; text-align: left;">Version</th></tr><tr><td style="text-align: left;">1.2.276.0.76.10.4049</td><td style="text-align: left;">Containment</td><td style="text-align: left;">Problemobservationeddiagnosis</td><td style="text-align: left;">DYNAMIC</td></tr></table></div></td></tr></table></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Beziehung</th><td style="text-align: left;" colspan="3">Spezialisierung: Template 2.16.840.1.113883.10.12.301 (<i>2005‑09‑07</i>)<br />Adaptation: Template 2.16.840.1.113883.10.20.22.4.3 (<i>DYNAMIC</i>)<br />Adaptation: Template 1.2.276.0.76.10.4002 (<i>DYNAMIC</i>)</td></tr><tr class="explabel" style="vertical-align: top;"><td style="width: 20em; text-align: left;">Beispiel</td><td colspan="3"><table class="treetable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;"><span class="expcaption">Beispiel</span></td></tr><tr><td><tt><span style="display: block;" class="explrendered"><span class="ppsign">&lt;</span><span class="ppelement">act</span> <span class="ppattribute">classCode</span><span class="ppsign">="</span><span class="ppcontent">ACT</span><span class="ppsign">"</span> <span class="ppattribute">moodCode</span><span class="ppsign">="</span><span class="ppcontent">EVN</span><span class="ppsign">"</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">templateId</span> <span class="ppattribute">root</span><span class="ppsign">="</span><span class="ppcontent">1.2.276.0.76.10.4048</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">id</span> <span class="ppattribute">root</span><span class="ppsign">="</span><span class="ppcontent">1.2.276.0.76.4.17.9814184919</span><span class="ppsign">"</span> <span class="ppattribute">extension</span><span class="ppsign">="</span><span class="ppcontent">afe65ff8-ed4b-4f7e-82c3-e98e58b45dbb</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">code</span> <span class="ppattribute">code</span><span class="ppsign">="</span><span class="ppcontent">CONC</span><span class="ppsign">"</span> <span class="ppattribute">codeSystem</span><span class="ppsign">="</span><span class="ppcontent">2.16.840.1.113883.5.6</span><span class="ppsign">"</span> <span class="ppattribute">displayName</span><span class="ppsign">="</span><span class="ppcontent">Concern</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">statusCode</span> <span class="ppattribute">code</span><span class="ppsign">="</span><span class="ppcontent">active</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">effectiveTime</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">    <span class="ppsign">&lt;</span><span class="ppelement">low</span> <span class="ppattribute">value</span><span class="ppsign">="</span><span class="ppcontent">20150304</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span>  <span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">effectiveTime</span><span class="ppsign">&gt;</span></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">entryRelationship</span> <span class="ppattribute">typeCode</span><span class="ppsign">="</span><span class="ppcontent">SUBJ</span><span class="ppsign">"</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">    <span class="ppsign">&lt;</span><span class="ppelement">sequenceNumber</span> <span class="ppattribute">value</span><span class="ppsign">="</span><span class="ppcontent">1</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;">    <span style="color:green">&lt;!-- Problem observation template --&gt;<br /></span></span>  <span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">entryRelationship</span><span class="ppsign">&gt;</span></span><span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">act</span><span class="ppsign">&gt;</span></span></tt></td></tr></table></td></tr><tr style="vertical-align: top;"><td colspan="4" class="tabtab"><table class="treetable" id="transactionTable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr><th style="width: 30%; text-align: left;">Item</th><th style="width: 2em; text-align: left;">DT</th><th style="width: 2em; text-align: left;">Kard</th><th style="width: 2em; text-align: left;">Konf</th><th style="text-align: left;">Beschreibung</th><th style="width: 2em; text-align: left;">Label</th></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td><tt><strong>hl7:act<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong></strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@classCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">ACT</td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@moodCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">EVN</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:templateId<br /></strong></tt></td></tr></table></td><td><strong>II</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@root<br /></strong></tt></td></tr></table></td><td>uid</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">1.2.276.0.76.10.4048</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:id<br /></strong></tt></td></tr></table></td><td><strong>II</strong></td><td><span style="color: black;"><strong>1 … *</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:code<br /></strong></tt></td></tr></table></td><td><strong>CE</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@code<br /></strong></tt></td></tr></table></td><td></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td>F</td><td colspan="2">CONC</td></tr><tr style="vertical-align: top;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@codeSystem<br /></strong></tt></td></tr></table></td><td></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td>F</td><td colspan="2">2.16.840.1.113883.5.6 (ActClass)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:statusCode<br /></strong></tt></td></tr></table></td><td><strong>CS</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td class="conf">CONF</td><td colspan="4"><table class="artdecor" width="100%" border="0" cellspacing="2" cellpadding="2" style="background: transparent;"><tr style="vertical-align: top;"><td>Der Wert von @code muss gewählt werden aus dem Value Set 2.16.840.1.113883.1.11.15933 <i>ActStatus </i>(DYNAMIC)</td></tr></table></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:effectiveTime<br /></strong></tt></td></tr></table></td><td><strong>IVL_TS</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:low<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:high<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>0 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:entryRelationship<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>1 … *</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td>Abschlussdiagnose, als Text und/oder ICD10-kodiert<br />Beinhaltet 1.2.276.0.76.10.4049 <i>Problem Observation (Abschlussdiagnose)</i> (DYNAMIC)</td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td colspan="5" style="background-color: #FFEAEA;"> wo  <i> [not(@nullFlavor)]</i></td><td></td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@typeCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">SUBJ</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:sequenceNumber<br /></strong></tt></td></tr></table></td><td><strong>INT.POS</strong></td><td><span style="color: black;"><strong>0 … *</strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td>Sequenznummer wird weggelassen bei ungeordneten/gleichwertigen Diagnosen ohne führende Diagnose;<br />                            zur Andeutung einer führenden Diagnose wird die Sequenznummer "1" verwendet (maximal einmal), alle weiteren Diagnosen sollten dann eine Sequenznummern &gt; 1 haben oder keine Sequenznummern aufweisen.</td><td style="background-color: #FFEEEE;">(Problemconcernacteddiagnoses)</td></tr><tr style="vertical-align: top;"><td style="background-color: white;"> </td><td style="vertical-align: top; text-align: left;">[[File:Target.png|16px]]</td><td colspan="4" style="background-color: #F4FFF4;" class="tabtab">Ziel der Konzept Id(s): <table class="artdecor" width="100%" border="0" cellspacing="2" cellpadding="2" style="background: transparent;"><tr style="background-color: #F4FFF4;"><td style="width: 25%; vertical-align: top;"><span style="color: grey;">aktin-data&#8203;element2015(1)-</span>20023</td><td style="vertical-align: top;" title="Abschlussdiagnosen / Abschlussdiagnose / ">Führende Abschlussdiagnose  / Sequenznummer</td><td style="width: 35%; vertical-align: top;">AKTIN-Datensatz</td></tr></table></td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td rowspan="3" class="stron">Schematron assert</td><td style="background-color: #FFEEEE;">role</td><td colspan="2">[[File:Kred.png|16px]] error</td><td style="background-color: white;"> </td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td style="background-color: #FFEEEE;">test</td><td colspan="2">count(hl7:entryRelationship[hl7:sequenceNumber='1'])&lt;=1</td><td style="background-color: white;"> </td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td style="background-color: #FFEEEE;">Meldung</td><td colspan="2"><span class="pptext">Sequenznummer = 1 (führende Abschlussdiagnose) kann höchstens einmal vergeben werden</span></td><td style="background-color: white;"> </td></tr></table></td></tr></table>
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<table xmlns="http://www.w3.org/1999/xhtml" class="artdecor" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Id</th><td style="text-align: left;">1.2.276.0.76.10.4048</td><th style="width: 20em; text-align: left;">Gültigkeit</th><td style="text-align: left;"> gültig ab 2016‑06‑22<p></p>Es gibt Versionen von Templates mit dieser Id:<ul><li>Problemconcernacteddiagnoses vom 2016‑06‑22</li><li>Problemconcernacteddiagnoses vom 2015‑03‑03</li></ul></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Status</th><td style="text-align: left;">[[File:Kgreen.png|16px]] Aktiv</td><th style="width: 20em; text-align: left;">Versions-Label</th><td style="text-align: left;"></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Name</th><td style="text-align: left;">Problemconcernacteddiagnoses</td><th style="width: 20em; text-align: left;">Anzeigename</th><td style="text-align: left;">Problem Concern Act (Abschlussdiagnosen)</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Beschreibung</th><td style="text-align: left;" colspan="3">Sammelkontainer für Beschwerden, Symptome, Diagnose, Probleme etc., hier: Abschlussdiagnosen ggf. mit ICD10-Kodes</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Kontext</th><td style="text-align: left;" colspan="3">Elternknoten des Template-Element mit Id 1.2.276.0.76.10.4048</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Klassifikation</th><td style="text-align: left;" colspan="3">CDA Entry Level Template</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Offen/Geschlossen</th><td style="text-align: left;" colspan="3">Offen (auch andere als die definierten Elemente sind erlaubt)</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Assoziiert mit</th><td style="text-align: left;" colspan="3"><table class="treetable" id="assocsTable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;">Assoziiert mit 1 Konzept</td></tr><tr><td><div><table class="artdecor" width="100%" border="0" cellspacing="1" cellpadding="3" style="background: transparent;"><tr><th style="width: 20%; text-align: left;">Id</th><th style="width: 60%; text-align: left;">Name</th><th style="width: 20%; text-align: left;">Datensatz</th></tr><tr><td style="text-align: left; vertical-align: top; width: 1%;"><span style="color: grey;">aktin-data&#8203;element2015(1)-</span>20023</td><td style="vertical-align: top;" title="Abschlussdiagnosen / Abschlussdiagnose / ">Führende Abschlussdiagnose  / Sequenznummer</td><td style="text-align: left; vertical-align: top;">AKTIN-Datensatz</td></tr></table></div></td></tr></table></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Benutzt von / Benutzt</th><td style="text-align: left;" colspan="3"><table class="treetable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;">Benutzt von 2 Templates, Benutzt 1 Template</td></tr><tr><td><div><table class="artdecor" width="100%" border="0" cellspacing="1" cellpadding="3" style="background: transparent;"><tr><th style="width: 20%; text-align: left;">Benutzt von Template-Id</th><th style="width: 1%; text-align: left;"> als </th><th style="width: 60%; text-align: left;">Name</th><th style="width: 19%; text-align: left;">Version</th></tr><tr><td style="text-align: left;">1.2.276.0.76.10.3055</td><td style="text-align: left;">Containment</td><td style="text-align: left;">Abschlussdiagnosen</td><td style="text-align: left;">2016‑06‑22</td></tr><tr><td style="text-align: left;">1.2.276.0.76.10.1019</td><td style="text-align: left;">[[File:Link.png|16px]]</td><td style="text-align: left;">Emergency medicine Note CDA document</td><td style="text-align: left;">2016‑06‑01</td></tr><tr><th style="width: 20%; text-align: left;">Benutzt Template-Id</th><th style="width: 1%; text-align: left;"> als </th><th style="width: 60%; text-align: left;">Name</th><th style="width: 19%; text-align: left;">Version</th></tr><tr><td style="text-align: left;">1.2.276.0.76.10.4049</td><td style="text-align: left;">Containment</td><td style="text-align: left;">Problemobservationeddiagnosis</td><td style="text-align: left;">DYNAMIC</td></tr></table></div></td></tr></table></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Beziehung</th><td style="text-align: left;" colspan="3">Spezialisierung: Template 2.16.840.1.113883.10.12.301 (<i>2005‑09‑07</i>)<br />Adaptation: Template 2.16.840.1.113883.10.20.22.4.3 (<i>DYNAMIC</i>)<br />Adaptation: Template 1.2.276.0.76.10.4002 (<i>DYNAMIC</i>)</td></tr><tr class="explabel" style="vertical-align: top;"><td style="width: 20em; text-align: left;">Beispiel</td><td colspan="3"><table class="treetable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;"><span class="expcaption">Beispiel</span></td></tr><tr><td><tt><span style="display: block;" class="explrendered"><span class="ppsign">&lt;</span><span class="ppelement">act</span> <span class="ppattribute">classCode</span><span class="ppsign">="</span><span class="ppcontent">ACT</span><span class="ppsign">"</span> <span class="ppattribute">moodCode</span><span class="ppsign">="</span><span class="ppcontent">EVN</span><span class="ppsign">"</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">templateId</span> <span class="ppattribute">root</span><span class="ppsign">="</span><span class="ppcontent">1.2.276.0.76.10.4048</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">id</span> <span class="ppattribute">root</span><span class="ppsign">="</span><span class="ppcontent">1.2.276.0.76.4.17.9814184919</span><span class="ppsign">"</span> <span class="ppattribute">extension</span><span class="ppsign">="</span><span class="ppcontent">afe65ff8-ed4b-4f7e-82c3-e98e58b45dbb</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">code</span> <span class="ppattribute">code</span><span class="ppsign">="</span><span class="ppcontent">CONC</span><span class="ppsign">"</span> <span class="ppattribute">codeSystem</span><span class="ppsign">="</span><span class="ppcontent">2.16.840.1.113883.5.6</span><span class="ppsign">"</span> <span class="ppattribute">displayName</span><span class="ppsign">="</span><span class="ppcontent">Concern</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">statusCode</span> <span class="ppattribute">code</span><span class="ppsign">="</span><span class="ppcontent">active</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">effectiveTime</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">    <span class="ppsign">&lt;</span><span class="ppelement">low</span> <span class="ppattribute">value</span><span class="ppsign">="</span><span class="ppcontent">20150304</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span>  <span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">effectiveTime</span><span class="ppsign">&gt;</span></span><span style="display: block;" class="explrendered">  <span class="ppsign">&lt;</span><span class="ppelement">entryRelationship</span> <span class="ppattribute">typeCode</span><span class="ppsign">="</span><span class="ppcontent">SUBJ</span><span class="ppsign">"</span><span class="ppsign">&gt;</span><br /><span style="display: block;" class="explrendered">    <span class="ppsign">&lt;</span><span class="ppelement">sequenceNumber</span> <span class="ppattribute">value</span><span class="ppsign">="</span><span class="ppcontent">1</span><span class="ppsign">"</span><span class="ppsign">/</span><span class="ppsign">&gt;</span><br /></span><span style="display: block;">    <span style="color:green">&lt;!-- Problem observation template --&gt;<br /></span></span>  <span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">entryRelationship</span><span class="ppsign">&gt;</span></span><span class="ppsign">&lt;/</span><span class="ppnamespace"></span><span class="ppelement">act</span><span class="ppsign">&gt;</span></span></tt></td></tr></table></td></tr><tr style="vertical-align: top;"><td colspan="4" class="tabtab"><table class="treetable" id="transactionTable" width="100%" border="0" cellspacing="3" cellpadding="2" style="background: transparent;"><tr><th style="width: 30%; text-align: left;">Item</th><th style="width: 2em; text-align: left;">DT</th><th style="width: 2em; text-align: left;">Kard</th><th style="width: 2em; text-align: left;">Konf</th><th style="text-align: left;">Beschreibung</th><th style="width: 2em; text-align: left;">Label</th></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td><tt><strong>hl7:act<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong></strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@classCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">ACT</td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@moodCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">EVN</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:templateId<br /></strong></tt></td></tr></table></td><td><strong>II</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@root<br /></strong></tt></td></tr></table></td><td>uid</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">1.2.276.0.76.10.4048</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:id<br /></strong></tt></td></tr></table></td><td><strong>II</strong></td><td><span style="color: black;"><strong>1 … *</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:code<br /></strong></tt></td></tr></table></td><td><strong>CE</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@code<br /></strong></tt></td></tr></table></td><td></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td>F</td><td colspan="2">CONC</td></tr><tr style="vertical-align: top;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@codeSystem<br /></strong></tt></td></tr></table></td><td></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td>F</td><td colspan="2">2.16.840.1.113883.5.6 (ActClass)</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:statusCode<br /></strong></tt></td></tr></table></td><td><strong>CS</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td class="conf">CONF</td><td colspan="4"><table class="artdecor" width="100%" border="0" cellspacing="2" cellpadding="2" style="background: transparent;"><tr style="vertical-align: top;"><td>Der Wert von @code muss gewählt werden aus dem Value Set 2.16.840.1.113883.1.11.15933 <i>ActStatus </i>(DYNAMIC)</td></tr></table></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:effectiveTime<br /></strong></tt></td></tr></table></td><td><strong>IVL_TS</strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:low<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>1 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:high<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>0 … 1</strong></span></td><td><span style="color: color: black;;"><strong>R</strong></span></td><td></td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:entryRelationship<br /></strong></tt></td></tr></table></td><td><strong></strong></td><td><span style="color: black;"><strong>1 … *</strong></span></td><td><span style="color: color: black;;"><strong>M</strong></span></td><td>Abschlussdiagnose, als Text und/oder ICD10-kodiert<br />Beinhaltet 1.2.276.0.76.10.4049 <i>Problem Observation (Abschlussdiagnose)</i> (DYNAMIC)</td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td colspan="5" style="background-color: #FFEAEA;"> wo  <i> [not(@nullFlavor)]</i></td><td></td></tr><tr><td style="vertical-align: top;"><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>@typeCode<br /></strong></tt></td></tr></table></td><td>cs</td><td><span><strong>1 … 1</strong></span></td><td>F</td><td style="vertical-align: top;" colspan="2">SUBJ</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td><table class="artdecor" cellpadding="1" style="background: transparent;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td><tt><strong>hl7:sequenceNumber<br /></strong></tt></td></tr></table></td><td><strong>INT.POS</strong></td><td><span style="color: black;"><strong>0 … *</strong></span></td><td><span style="color: color: black;;"><strong></strong></span></td><td>Sequenznummer wird weggelassen bei ungeordneten/gleichwertigen Diagnosen ohne führende Diagnose;<br />                            zur Andeutung einer führenden Diagnose wird die Sequenznummer "1" verwendet (maximal einmal), alle weiteren Diagnosen sollten dann eine Sequenznummern &gt; 1 haben oder keine Sequenznummern aufweisen.</td><td style="background-color: #FFEEEE;"><span title="">(Problemconcernacteddiagnoses)</span></td></tr><tr style="vertical-align: top;"><td style="background-color: white;"> </td><td style="vertical-align: top; text-align: left;">[[File:Target.png|16px]]</td><td colspan="4" style="background-color: #F4FFF4;" class="tabtab">Ziel der Konzept Id(s): <table class="artdecor" width="100%" border="0" cellspacing="2" cellpadding="2" style="background: transparent;"><tr style="background-color: #F4FFF4;"><td style="width: 25%; vertical-align: top;"><span style="color: grey;">aktin-data&#8203;element2015(1)-</span>20023</td><td style="vertical-align: top;" title="Abschlussdiagnosen / Abschlussdiagnose / ">Führende Abschlussdiagnose  / Sequenznummer</td><td style="width: 35%; vertical-align: top;">AKTIN-Datensatz</td></tr></table></td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td rowspan="3" class="stron">Schematron assert</td><td style="background-color: #FFEEEE;">role</td><td colspan="2">[[File:Kred.png|16px]] error</td><td style="background-color: white;"> </td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td style="background-color: #FFEEEE;">test</td><td colspan="2">count(hl7:entryRelationship[hl7:sequenceNumber='1'])&lt;=1</td><td style="background-color: white;"> </td></tr><tr style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td style="background-color: #FFEEEE;">Meldung</td><td colspan="2"><span class="pptext">Sequenznummer = 1 (führende Abschlussdiagnose) kann höchstens einmal vergeben werden</span></td><td style="background-color: white;"> </td></tr></table></td></tr></table>

Version vom 2. Oktober 2016, 02:10 Uhr

Id1.2.276.0.76.10.4048Gültigkeit gültig ab 2016‑06‑22

Es gibt Versionen von Templates mit dieser Id:
  • Problemconcernacteddiagnoses vom 2016‑06‑22
  • Problemconcernacteddiagnoses vom 2015‑03‑03
StatusKgreen.png AktivVersions-Label
NameProblemconcernacteddiagnosesAnzeigenameProblem Concern Act (Abschlussdiagnosen)
BeschreibungSammelkontainer für Beschwerden, Symptome, Diagnose, Probleme etc., hier: Abschlussdiagnosen ggf. mit ICD10-Kodes
KontextElternknoten des Template-Element mit Id 1.2.276.0.76.10.4048
KlassifikationCDA Entry Level Template
Offen/GeschlossenOffen (auch andere als die definierten Elemente sind erlaubt)
Assoziiert mit
Assoziiert mit 1 Konzept
IdNameDatensatz
aktin-data​element2015(1)-20023Führende Abschlussdiagnose / SequenznummerAKTIN-Datensatz
Benutzt von / Benutzt
Benutzt von 2 Templates, Benutzt 1 Template
Benutzt von Template-Id als NameVersion
1.2.276.0.76.10.3055ContainmentAbschlussdiagnosen2016‑06‑22
1.2.276.0.76.10.1019Link.pngEmergency medicine Note CDA document2016‑06‑01
Benutzt Template-Id als NameVersion
1.2.276.0.76.10.4049ContainmentProblemobservationeddiagnosisDYNAMIC
BeziehungSpezialisierung: Template 2.16.840.1.113883.10.12.301 (2005‑09‑07)
Adaptation: Template 2.16.840.1.113883.10.20.22.4.3 (DYNAMIC)
Adaptation: Template 1.2.276.0.76.10.4002 (DYNAMIC)
Beispiel
Beispiel
<act classCode="ACT" moodCode="EVN">
  <templateId root="1.2.276.0.76.10.4048"/>
  <id root="1.2.276.0.76.4.17.9814184919" extension="afe65ff8-ed4b-4f7e-82c3-e98e58b45dbb"/>
  <code code="CONC" codeSystem="2.16.840.1.113883.5.6" displayName="Concern"/>
  <statusCode code="active"/>
  <effectiveTime>
    <low value="20150304"/>
  </effectiveTime>  <entryRelationship typeCode="SUBJ">
    <sequenceNumber value="1"/>
    <!-- Problem observation template -->
  </entryRelationship></act>
ItemDTKardKonfBeschreibungLabel
hl7:act
(Problemconcernacteddiagnoses)
Treetree.png@classCode
cs1 … 1FACT
Treetree.png@moodCode
cs1 … 1FEVN
Treetree.pnghl7:templateId
II1 … 1(Problemconcernacteddiagnoses)
Treeblank.pngTreetree.png@root
uid1 … 1F1.2.276.0.76.10.4048
Treetree.pnghl7:id
II1 … *M(Problemconcernacteddiagnoses)
Treetree.pnghl7:code
CE1 … 1M(Problemconcernacteddiagnoses)
Treeblank.pngTreetree.png@code
1 … 1FCONC
Treeblank.pngTreetree.png@codeSystem
1 … 1F2.16.840.1.113883.5.6 (ActClass)
Treetree.pnghl7:statusCode
CS1 … 1M(Problemconcernacteddiagnoses)
 CONF
Der Wert von @code muss gewählt werden aus dem Value Set 2.16.840.1.113883.1.11.15933 ActStatus (DYNAMIC)
Treetree.pnghl7:effectiveTime
IVL_TS1 … 1R(Problemconcernacteddiagnoses)
Treeblank.pngTreetree.pnghl7:low
1 … 1R(Problemconcernacteddiagnoses)
Treeblank.pngTreetree.pnghl7:high
0 … 1R(Problemconcernacteddiagnoses)
Treetree.pnghl7:entryRelationship
1 … *MAbschlussdiagnose, als Text und/oder ICD10-kodiert
Beinhaltet 1.2.276.0.76.10.4049 Problem Observation (Abschlussdiagnose) (DYNAMIC)		(Problemconcernacteddiagnoses)
wo [not(@nullFlavor)]
Treeblank.pngTreetree.png@typeCode
cs1 … 1FSUBJ
Treeblank.pngTreetree.pnghl7:sequenceNumber
INT.POS0 … *Sequenznummer wird weggelassen bei ungeordneten/gleichwertigen Diagnosen ohne führende Diagnose;
zur Andeutung einer führenden Diagnose wird die Sequenznummer "1" verwendet (maximal einmal), alle weiteren Diagnosen sollten dann eine Sequenznummern > 1 haben oder keine Sequenznummern aufweisen.		(Problemconcernacteddiagnoses)
 Target.pngZiel der Konzept Id(s):
aktin-data​element2015(1)-20023Führende Abschlussdiagnose / SequenznummerAKTIN-Datensatz
 Schematron assertroleKred.png error 
 testcount(hl7:entryRelationship[hl7:sequenceNumber='1'])<=1 
 MeldungSequenznummer = 1 (führende Abschlussdiagnose) kann höchstens einmal vergeben werden 
Abgerufen von „https://wiki.hl7.de/index.php?title=1.2.276.0.76.10.4048/static-2016-06-22T000000&oldid=31526“