Note

From OpenIndivo Documentation Wiki

Contents 1 Overview 2 Schema 3 Detailed Schema Description 3.1 NoteType 4 XML Usage Example

Overview

In general, the Note schema models textual documents from a clinical setting: notes, reports, and letters.

Schema

• Syntax-Highlighted Schema
• Raw Schema

Detailed Schema Description

NoteType

Date

dateTime (optional)

The date this note was written.

Origin

ConciseContactInformationType (optional)

The institution which provided the data in this document.

Comments

string (optional)

Any free-text comments about this document.

Provider

ConciseContactInformationType (optional)

The provider (e.g. physician, nurse, etc.) who wrote this note. This will often indicate the same provider as in PrimaryProviderEndorsement.

EncounterId

string (optional)

An identifier which is unique across an Indivo Record, used to identify documents which originated from a discrete health encounter.

Type

CodedValueType

A code which identifies the type of document, e.g. note, report, or letter.

» Refer to coding system indivo-note-types-1.0.

Category

CodedValueType

To be described.

Setting

CodedValueType

The patient care setting under which this document was written.

» Refer to coding system indivo-settings-1.0.

Specialty

string (optional)

The medical specialty of the provider who wrote this document.

Text

string (optional)

The textual body of this document.

PrimaryProviderEndorsement

EndorsementType (optional)

A representation of the signature the primary provider made on this document.

SecondaryProviderEndorsement

EndorsementType (optional)

A representation of the signature the secondary provider made on this document.

XML Usage Example

Out of date.

<Note>
   <Date>2005-08-25T00:00:00.000-04:00</Date>
   <Type>
     <CodingSystem>
       <Format>ping-xml</Format>
       <Name>Note Types</Name>
       <Location>http://ping.chip.org/codes/note-types-1.0.xml</Location>
       <MajorVersion>1</MajorVersion>
       <MinorVersion>0</MinorVersion>
     </CodingSystem>
     <Value>note</Value>
   </Type>
   <Category>
     <CodingSystem>
       <Format>ping-xml</Format>
       <Name>Note Categories</Name>
       <Location>http://ping.chip.org/codes/note-category-1.0.xml</Location>
       <MajorVersion>1</MajorVersion>
       <MinorVersion>0</MinorVersion>
     </CodingSystem>
     <Value>unknown</Value>
   </Category>
   <Setting>
     <CodingSystem>
       <Format>ping-xml</Format>
       <Name>Note Settings</Name>
       <Location>http://ping.chip.org/codes/note-settings-1.0.xml</Location>
       <MajorVersion>1</MajorVersion>
       <MinorVersion>0</MinorVersion>
     </CodingSystem>
     <Value>ou</Value>
   </Setting>
   <Specialty>Unspecified</Specialty>
   <Text>
     Full text of note.
   </Text>
   <PrimaryProviderEndorsement>
     <FirstName>Jonas</FirstName>
     <LastName>Salk</LastName>
     <UniqueId>12345</UniqueId>
     <SignatureDate>2005-08-30T00:00:00.000-04:00</SignatureDate>
   </PrimaryProviderEndorsement>
 </Note>