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<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3">
   <realmCode code="US"/>
   <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
   <templateId root="2.16.840.1.113883.10.20.27.1.1" extension="2017-06-01"/>
   <templateId root="2.16.840.1.113883.10.20.27.1.2" extension="2017-07-01"/>
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   <code code="55184-6"
         codeSystem="2.16.840.1.113883.6.1"
         codeSystemName="LOINC"
         displayName="Quality Reporting Document Architecture Calculated Summary Report"/>
   <title>Comprehensive Primary Care Plus (CPC+) Sample QRDA-III Report</title>
   <effectiveTime value="20170311061231"/>
   <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
   <languageCode code="en"/>
   <setId root="D5E68223-5760-11E7-1256-09173F13E4C5"/>
   <versionNumber value="1"/>
   <recordTarget>
      <patientRole>
         <id nullFlavor="NA"/>
      </patientRole>
   </recordTarget>
   <!--Device Author Example-->
	  <author>
      <time value="20170311061231"/>
      <assignedAuthor>
         <id root="D5E68225-5760-11E7-1256-09173F13E4C5"/>
         <assignedAuthoringDevice>
            <softwareName>SOME Data Aggregator Transform Tool AS00016dev</softwareName>
         </assignedAuthoringDevice>
         <representedOrganization>
            <id root="2.16.840.1.113883.19.5" extension="223344"/>
            <name>Good Health Clinic</name>
         </representedOrganization>
      </assignedAuthor>
   </author>
   <!--Person Author Example-->
	  <author>
      <time value="20180311061231"/>
      <assignedAuthor>
         <id root="2.16.840.1.113883.4.6"
             extension="2567891421"
             assigningAuthorityName="NPI"/>
         <assignedPerson>
            <name>
               <given>Trevor</given>
               <family>Phillips</family>
            </name>
         </assignedPerson>
         <representedOrganization>
            <id root="2.16.840.1.113883.19.5" extension="223344"/>
            <name>Good Health Clinic</name>
         </representedOrganization>
      </assignedAuthor>
   </author>
   <custodian>
      <assignedCustodian>
         <representedCustodianOrganization>
            <id root="2.16.840.1.113883.19.5" extension="223344"/>
            <name>Good Health Clinic</name>
         </representedCustodianOrganization>
      </assignedCustodian>
   </custodian>
   <!--Program for which data is being submitted-->
	  <informationRecipient>
      <intendedRecipient>
         <id root="2.16.840.1.113883.3.249.7" extension="CPCPLUS"/>
      </intendedRecipient>
   </informationRecipient>
   <legalAuthenticator>
      <time value="20170312153222"/>
      <signatureCode code="S"/>
      <assignedEntity>
         <id root="D5E68226-5760-11E7-1256-09173F13E4C5"/>
         <representedOrganization>
            <id root="2.16.840.1.113883.19.5" extension="223344"/>
            <name>Good Health Clinic</name>
         </representedOrganization>
      </assignedEntity>
   </legalAuthenticator>
   <participant typeCode="DEV">
      <associatedEntity classCode="RGPR">
         <id root="2.16.840.1.113883.3.2074.1"
             extension="CMS_EHR_Certification_Identification_Number_Goes_Here"/>
         <code code="129465004"
               displayName="medical record, device"
               codeSystem="2.16.840.1.113883.6.96"
               codeSystemName="SNOMED-CT"/>
      </associatedEntity>
   </participant>
   <!--Practice Site-->
	  <participant typeCode="LOC">
      <associatedEntity classCode="SDLOC">
         <id root="2.16.840.1.113883.3.249.5.1"
            extension="TestApmEntityId"
             assigningAuthorityName="CMS-CMMI"/>
         <code code="394730007"
               displayName="healthcare related organization"
               codeSystem="2.16.840.1.113883.6.96"
               codeSystemName="SNOMED-CT"/>
         <addr>
            <streetAddressLine>123 Healthcare St</streetAddressLine>
            <city>Norman</city>
            <state>OK</state>
            <postalCode>73019</postalCode>
         </addr>
      </associatedEntity>
   </participant>
   <!--Providers in Practice Site for which data is being submitted-->
	  <documentationOf typeCode="DOC">
      <serviceEvent classCode="PCPR">
         <effectiveTime>
            <low value="20170101"/>
            <high value="20171231"/>
         </effectiveTime>	
         <performer typeCode="PRF">
            <time>
               <low value="20170101"/>
               <high value="20171231"/>
            </time>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6" extension="2567891421"/>
               <representedOrganization>
                  <id root="2.16.840.1.113883.4.2" extension="990000099"/>
                  <name>Good Health Clinic</name>
               </representedOrganization>
            </assignedEntity>
         </performer>	
         <performer typeCode="PRF">
            <time>
               <low value="20170101"/>
               <high value="20171231"/>
            </time>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6" extension="2589654740"/>
               <representedOrganization>
                  <id root="2.16.840.1.113883.4.2" extension="990000099"/>
                  <name>Good Health Clinic</name>
               </representedOrganization>
            </assignedEntity>
         </performer>	
         <performer typeCode="PRF">
            <time>
               <low value="20170101"/>
               <high value="20171231"/>
            </time>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6" extension="2345872354"/>
               <representedOrganization>
                  <id root="2.16.840.1.113883.4.2" extension="990000099"/>
                  <name>Good Health Clinic</name>
               </representedOrganization>
            </assignedEntity>
         </performer>	
         <performer typeCode="PRF">
            <time>
               <low value="20170101"/>
               <high value="20171231"/>
            </time>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6" extension="2365987421"/>
               <representedOrganization>
                  <id root="2.16.840.1.113883.4.2" extension="990000099"/>
                  <name>Good Health Clinic</name>
               </representedOrganization>
            </assignedEntity>
         </performer>	
         <performer typeCode="PRF">
            <time>
               <low value="20170101"/>
               <high value="20171231"/>
            </time>
            <assignedEntity>
               <id root="2.16.840.1.113883.4.6" extension="2357943549"/>
               <representedOrganization>
                  <id root="2.16.840.1.113883.4.2" extension="990000099"/>
                  <name>Good Health Clinic</name>
               </representedOrganization>
            </assignedEntity>
         </performer>
      </serviceEvent>
   </documentationOf>
   <authorization>
      <consent>
         <id root="D5E68227-5760-11E7-1256-09173F13E4C5"/>
         <code code="425691002"
               displayName="consent given for electronic record sharing"
               codeSystem="2.16.840.1.113883.6.96"
               codeSystemName="SNOMED-CT"/>
         <statusCode code="completed"/>
      </consent>
   </authorization>
   <!--
********************************************************
CDA Body
********************************************************
-->
	  <component>
      <structuredBody>
  
      <!-- 
	         ********************************************************
	         Advancing Care Information Section
	         ********************************************************
	         -->
			<component>
				<section>
					<!-- Measure Section -->
					<templateId root="2.16.840.1.113883.10.20.24.2.2"/>
					<!-- Advancing Care Information Section V2 templateId -->
					<templateId root="2.16.840.1.113883.10.20.27.2.5" extension="2017-06-01"/>
					<code code="55186-1" codeSystem="2.16.840.1.113883.6.1"
						displayName="Measure Section"/>
					<title>Measure Section</title>
					<text>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>ACI Measure Title</th>
									<th>Measure Identifier</th>
								</tr>
							</thead>
							<tbody>
								<tr>
									<td>Security Risk Analysis</td>
									<td>ACI_PPHI_1</td>
								</tr>
							</tbody>
						</table>
						<list>
							<item>
								<content styleCode="Bold">Measure Answer (Yes/No):
								</content>Yes</item>
						</list>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>ACI Measure Title</th>
									<th>Measure Identifier</th>
								</tr>
							</thead>
							<tbody>
								<tr>
									<td>ePrescribing</td>
									<td>ACI_EP_1</td>
								</tr>
							</tbody>
						</table>
						<list>
							<item>
								<content styleCode="Bold">Denominator: </content>800</item>
							<item>
								<content styleCode="Bold">Numerator: </content>750</item>
						</list>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>ACI Measure Title</th>
									<th>Measure Identifier</th>
								</tr>
							</thead>
							<tbody>
								<tr>
									<td>Provide Patient Access</td>
									<td>ACI_PEA_1</td>
								</tr>
							</tbody>
						</table>
						<list>
							<item>
								<content styleCode="Bold">Denominator: </content>800</item>
							<item>
								<content styleCode="Bold">Numerator: </content>600</item>
						</list>
					</text>
					<!-- ACI_PPHI_1 which is an example of ACI measure with reporting metric of yes/no -->
					<entry>
						<organizer classCode="CLUSTER" moodCode="EVN">
							<!-- Implied template Measure Reference templateId -->
							<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
							<!-- ACI Numerator Measure Performed Measure Reference and Results templateId -->
							<templateId root="2.16.840.1.113883.10.20.27.3.29"
								extension="2016-09-01"/>
							<id root="ac575aef-7062-4ea2-b723-df517cfa470a"/>
							<statusCode code="completed"/>
							<reference typeCode="REFR">
								<!-- Reference to a particular ACI measure's unique identifier. -->
								<externalDocument classCode="DOC" moodCode="EVN">
									<!-- extension is the unique identifier for an ACI measure. -->
									<id root="2.16.840.1.113883.3.7031" extension="ACI_PPHI_1"/>
									<!-- ACI measure title -->
									<text>Security Risk Analysis</text>
								</externalDocument>
							</reference>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- Measure Performed templateId -->
									<templateId root="2.16.840.1.113883.10.20.27.3.27"
										extension="2016-09-01"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
										codeSystemName="ActCode" displayName="Assertion"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="Y" codeSystem="2.16.840.1.113883.12.136"
										codeSystemName="Yes/no indicator (HL7 Table 0136)" displayName="Yes"/>
								</observation>
							</component>
						</organizer>
					</entry>
					<!-- ACI_EP_1 which is an example of ACI measure with reporting metric of numerator/denominator -->
					<entry>
						<organizer classCode="CLUSTER" moodCode="EVN">
							<!-- Implied template Measure Reference templateId -->
							<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
							<!-- ACI Numerator Denominator Type Measure Reference and Results V2 templateId -->
							<templateId root="2.16.840.1.113883.10.20.27.3.28"
								extension="2017-06-01"/>
							<id root="ac575aef-7062-4ea2-b723-df517cfa470a"/>
							<statusCode code="completed"/>
							<reference typeCode="REFR">
								<!-- Reference to a particular ACI measure's unique identifier. -->
								<externalDocument classCode="DOC" moodCode="EVN">
									<!-- extension is the unique identifier for an ACI measure. -->
									<id root="2.16.840.1.113883.3.7031" extension="ACI_EP_1"/>
									<!-- ACI measure title -->
									<text>ePrescribing</text>
								</externalDocument>
							</reference>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ACI Numerator Denominator Type Measure Numerator Data templateId -->
									<templateId root="2.16.840.1.113883.10.20.27.3.31"
										extension="2016-09-01"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
										codeSystemName="ActCode" displayName="Assertion"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="NUMER"
										codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
									<!-- Numerator Count-->
									<entryRelationship typeCode="SUBJ" inversionInd="true">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.27.3.3"/>
											<code code="MSRAGG" codeSystem="2.16.840.1.113883.5.4"
												codeSystemName="ActCode"
												displayName="rate aggregation"/>
											<statusCode code="completed"/>
											<value xsi:type="INT" value="750"/>
											<methodCode code="COUNT"
												codeSystem="2.16.840.1.113883.5.84"
												codeSystemName="ObservationMethod"
												displayName="Count"/>
										</observation>
									</entryRelationship>
								</observation>
							</component>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ACI Numerator Denominator Type Measure Denominator Data templateId -->
									<templateId root="2.16.840.1.113883.10.20.27.3.32"
										extension="2016-09-01"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
										codeSystemName="ActCode" displayName="Assertion"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="DENOM"
										codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
									<!-- Denominator Count-->
									<entryRelationship typeCode="SUBJ" inversionInd="true">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.27.3.3"/>
											<code code="MSRAGG" codeSystem="2.16.840.1.113883.5.4"
												codeSystemName="ActCode"
												displayName="rate aggregation"/>
											<statusCode code="completed"/>
											<value xsi:type="INT" value="800"/>
											<methodCode code="COUNT"
												codeSystem="2.16.840.1.113883.5.84"
												codeSystemName="ObservationMethod"
												displayName="Count"/>
										</observation>
									</entryRelationship>
								</observation>
							</component>
						</organizer>
					</entry>
					<!-- ACI_PEA_1 which is an example of a numerator/denominator ACI measure -->
					<entry>
						<organizer classCode="CLUSTER" moodCode="EVN">
							<!-- Implied template Measure Reference templateId -->
							<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
							<!-- ACI Numerator Denominator Type Measure Reference and Results V2 templateId -->
							<templateId root="2.16.840.1.113883.10.20.27.3.28"
								extension="2017-06-01"/>
							<id root="ac575aef-7062-4ea2-b723-df517cfa470a"/>
							<statusCode code="completed"/>
							<reference typeCode="REFR">
								<!-- Reference to a particular ACI measure's unique identifier. -->
								<externalDocument classCode="DOC" moodCode="EVN">
									<!-- extension is the unique identifier for an ACI measure. -->
									<id root="2.16.840.1.113883.3.7031" extension="ACI_PEA_1"/>
									<!-- ACI measure title -->
									<text>Provide Patient Access</text>
								</externalDocument>
							</reference>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ACI Numerator Denominator Type Measure Numerator Data templateId -->
									<templateId root="2.16.840.1.113883.10.20.27.3.31"
										extension="2016-09-01"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
										codeSystemName="ActCode" displayName="Assertion"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="NUMER"
										codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
									<!-- Numerator Count-->
									<entryRelationship typeCode="SUBJ" inversionInd="true">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.27.3.3"/>
											<code code="MSRAGG" codeSystem="2.16.840.1.113883.5.4"
												codeSystemName="ActCode"
												displayName="rate aggregation"/>
											<statusCode code="completed"/>
											<value xsi:type="INT" value="600"/>
											<methodCode code="COUNT"
												codeSystem="2.16.840.1.113883.5.84"
												codeSystemName="ObservationMethod"
												displayName="Count"/>
										</observation>
									</entryRelationship>
								</observation>
							</component>
							<component>
								<observation classCode="OBS" moodCode="EVN">
									<!-- ACI Numerator Denominator Type Measure Denominator Data templateId -->
									<templateId root="2.16.840.1.113883.10.20.27.3.32"
										extension="2016-09-01"/>
									<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"
										codeSystemName="ActCode" displayName="Assertion"/>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="DENOM"
										codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
									<!-- Denominator Count-->
									<entryRelationship typeCode="SUBJ" inversionInd="true">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.27.3.3"/>
											<code code="MSRAGG" codeSystem="2.16.840.1.113883.5.4"
												codeSystemName="ActCode"
												displayName="rate aggregation"/>
											<statusCode code="completed"/>
											<value xsi:type="INT" value="800"/>
											<methodCode code="COUNT"
												codeSystem="2.16.840.1.113883.5.84"
												codeSystemName="ObservationMethod"
												displayName="Count"/>
										</observation>
									</entryRelationship>
								</observation>
							</component>
						</organizer>
					</entry>
					<!-- Performance Period -->
					<entry typeCode="DRIV">
						<act classCode="ACT" moodCode="EVN">
							<!-- Reporting Parameters Act -->
							<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
							<id root="95944FB8-241B-11E5-1027-09173F13E4C5"/>
							<code code="252116004" codeSystem="2.16.840.1.113883.6.96"
								displayName="Observation Parameters"/>
							<effectiveTime>
								<low value="20170101"/>
								<high value="20171231"/>
							</effectiveTime>
						</act>
					</entry>
				</section>
			</component>
			
      </structuredBody>
   </component>
</ClinicalDocument>
