1.3.6.1.4.1.19376.1.3.10.9.42/static-2016-10-10T113336

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Id1.3.6.1.4.1.19376.1.3.10.9.42Effective Date2016‑10‑10 11:33:36
StatusKyellow.png DraftVersion Label2.0
NameAssessmentScoringSystemAPSR2.0Display NameAssessment Scoring System APSR 2.0
DescriptionSupportive Observation entry for describing a scoring system
ContextParent nodes of template element with id 1.3.6.1.4.1.19376.1.3.10.9.42
LabelPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Uses
Uses 4 templates
Uses as NameVersion
1.3.6.1.4.1.19376.1.3.10.9.1IncludeKyellow.png X Specimen Identified (2.0)2014‑12‑22 15:54:30
1.3.6.1.4.1.19376.1.3.10.9.43ContainmentKyellow.png Assessment Scoring Item APSR 2.0 (2.0)2016‑10‑11 10:26:17
2.16.840.1.113883.10.12.324ContainmentKgreen.png CDA Reference2005‑09‑07
2.16.840.1.113883.10.12.329ContainmentKgreen.png CDA Precondition2005‑09‑07
RelationshipSpecialization: template 1.3.6.1.4.1.19376.1.8.1.4.9 AP Observation Entry (2014‑05‑14 17:09:54)
Example
generated example for use case #1, ER-Allred Score
<observation negationInd="false" classCode="OBS" moodCode="EVN">
  <templateId root="1.3.6.1.4.1.19376.1.3.10.9.42"/>  <id root="1.3.6.1.4.1.19376.1.8.9.1" extension="A7102400008_AllredScoreSystem"/>  <code code="278061009 | Scores (qualifier value) |" codeSystem="2.16.840.1.113883.6.96" displayName="Score"/>  <derivationExpr text="sum"/>  <statusCode code="completed"/>  <effectiveTime>
    <low value="201001041405-0500"/>  </effectiveTime>
  <value code="445104009" codeSystem="2.16.840.1.113883.6.96" displayName="Sum of proportion of positive staining neoplastic cells score and average intensity of staining score for hormone receptors using immunohistochemistry (observable entity)"/>  <methodCode code="0107" displayName="Microscopy" codeSystem="2.16.840.1.113883.5.84"/>  <specimen typeCode="SPC">
    <specimenRole classCode="SPEC">
      <id root="1.3.6.1.4.1.19376.1.8.9" extension="A7102400008_slide_A1_ER"/>    </specimenRole>
  </specimen>
  <entryRelationship>
    <sequenceNumber value="1"/>    <!-- template 1.3.6.1.4.1.19376.1.3.10.9.43 'Assessment Scoring Item APSR 2.0' (2016-10-11T10:26:17) -->
  </entryRelationship>
  <reference>
    <!-- template 2.16.840.1.113883.10.12.324 'CDA Reference' (2005-09-07T00:00:00) -->
  </reference>
  <precondition>
    <!-- template 2.16.840.1.113883.10.12.329 'CDA Precondition' (2005-09-07T00:00:00) -->
  </precondition>
</observation>
ItemDTCardConfDescriptionLabel
hl7:observation
0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.png@classCode
cs1 … 1FOBS
Treetree.png@moodCode
cs1 … 1FEVN
Treetree.png@negationInd
bl0 … 1 
Treetree.pnghl7:templateId
II1 … 1MPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreetree.png@root
uid1 … 1F1.3.6.1.4.1.19376.1.3.10.9.42
Treetree.pnghl7:id
II0 … *RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:code
CV (extensible)1 … 1MPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreetree.png@code
CONF1 … 1 @code shall be out of choice:
  • 246262008
  • Score (attribute)
Treeblank.pngTreetree.png@codeSystem
1 … 1F2.16.840.1.113883.6.96 (Snomed-CT)
Treeblank.pngTreetree.png@codeSystemName
1 … 1FSCT
Treeblank.pngTreetree.png@displayName
1 … 1FScore
Treetree.pnghl7:derivationExpr
ST0 … 1RThis optional field can be used to specify how the total score is calculated. In most cases the total score will be the sum of its components. But complex mathematical functions and/or logical operations are possible as well.PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:text
ED0 … 1RScoring system usedPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:statusCode
CS (required)1 … 1MThe observation statusCode is “ completed ” if the observation was actually performed and has produced a result in the  value  element. In other cases the status of the intended observation is “ aborted ” and the result will never come. PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
 Constraint
@code shall be "completed"
or
@code shall be "aborted"

 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.15933 ActStatus (2014‑03‑26)
Treetree.pnghl7:effectiveTime
IVL_TS0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:value
CE (extensible)1 … *RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
 CONF
@code shall be "any codes from 395531003 | Tumor observable (observable entity) |"
@codeSystem shall be "2.16.840.1.113883.6.96"
@codeSystemName shall be "SCT"
@displayName shall be "any score systems from Tumor observables"
or
@code shall be "any codes from 273249006 | Assessment scales"
@codeSystem shall be "2.16.840.1.113883.6.96"
@codeSystemName shall be "SCT"
@displayName shall be "any score systems from Assessment scales"
Treetree.pnghl7:methodCode
CE0 … *RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.14079 ObservationMethod (2014‑03‑26)
Included1 … *R from 1.3.6.1.4.1.19376.1.3.10.9.1 X Specimen Identified (2014‑12‑22 15:54:30)
Treetree.pnghl7:specimen
1 … *RRequired in XD-LAB when more than one specimen is documented at this level. Always required in APSR.PaLM Suppl. APSR 2.1‑3: 6.3.5.7 X Specimen identified
 
Target.png
psr-data​element-17Kyellow.png Specimen identification Kyellow.png APSR 2.0
Treeblank.pngTreetree.png@typeCode
cs0 … 1FSPC
Treeblank.pngTreetree.pnghl7:specimenRole
1 … 1MPaLM Suppl. APSR 2.1‑3: 6.3.5.7 X Specimen identified
Treeblank.pngTreeblank.pngTreetree.png@classCode
cs0 … 1FSPEC
Treeblank.pngTreeblank.pngTreetree.pnghl7:id
II1 … 1RSpecimen ID, coming from the LISPaLM Suppl. APSR 2.1‑3: 6.3.5.7 X Specimen identified
 
Target.png
psr-data​element-95Kyellow.png Parent ID Kyellow.png APSR 2.0
psr-data​element-67Kyellow.png Block ID Kyellow.png APSR 2.0
psr-data​element-66Kyellow.png Part ID Kyellow.png APSR 2.0
psr-data​element-98Kyellow.png Specimen ID Kyellow.png APSR 2.0
psr-data​element-68Kyellow.png Tissue section ID Kyellow.png APSR 2.0
Treetree.pnghl7:entryRelationship
0 … *RContains 1.3.6.1.4.1.19376.1.3.10.9.43 Assessment Scoring Item APSR 2.0 (2016‑10‑11 10:26:17)PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreetree.png@typeCode
cs1 … 1FCOMP
Treeblank.pngTreetree.png@context​Conduction​Ind
bl0 … 1Ftrue
Treeblank.pngTreetree.pnghl7:sequenceNumber
INT0 … 1PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:reference
0 … *RContains 2.16.840.1.113883.10.12.324 CDA Reference (2005‑09‑07)PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:precondition
0 … *RContains 2.16.840.1.113883.10.12.329 CDA Precondition (2005‑09‑07)PaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treetree.pnghl7:referenceRange
0 … *RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreetree.png@typeCode
cs1 … 1FREFV
Treeblank.pngTreetree.pnghl7:observationRange
1 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreeblank.pngTreetree.png@classCode
cs0 … 1FOBS
Treeblank.pngTreeblank.pngTreetree.png@moodCode
cs0 … 1FEVN.CRT
Treeblank.pngTreeblank.pngTreetree.pnghl7:code
CD0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreeblank.pngTreeblank.pngTreetree.png@codeSystem
CONF0 … 1F2.16.840.1.113883.5.4 (Act Code)
Treeblank.pngTreeblank.pngTreetree.pnghl7:text
ED0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreeblank.pngTreetree.pnghl7:value
ANY0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
Treeblank.pngTreeblank.pngTreetree.pnghl7:interpretationCode
CE0 … 1RPaLM Suppl. APSR 2.1‑3: 6.3.5.10 Assessment scales
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.78 ObservationInterpretation (2014‑03‑26)