<?xml-stylesheet type="text/xsl" href="cda.xsl"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:sdtc="urn:hl7-org:sdtc" xsi:schemaLocation="urn:hl7-org:v3 ../../../CDASchema/CDA.xsd">
	<!-- Vendor Report Version: EH_2026_CQM_60_1.04.0 | Vendor Software Version: 6.08 | ValueSetVersion: eCQM Update 2025-05-08 -->
	<realmCode code="US"/>
	<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
	<!-- US Realm Header (V3) -->
	<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
	<!-- QRDA Category I Framework (V4) -->
	<templateId root="2.16.840.1.113883.10.20.24.1.1" extension="2017-08-01"/>
	<!-- QDM-Based QRDA (V7) -->
	<templateId root="2.16.840.1.113883.10.20.24.1.2" extension="2021-08-01"/>
	<!-- QRDA Category I Report - CMS (V7) -->
	<templateId root="2.16.840.1.113883.10.20.24.1.3" extension="2025-03-01"/>
	<!-- This is the globally unique identifier for this QRDA-I document -->
	<id root="66594ED0-3D71-42FC-B925-9B0519ED63C0"/>
	<code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
	<title>QRDA Incidence Report</title>
	<effectiveTime value="20260619160739"/>
	<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" codeSystemName="HL7Confidentiality"/>
	<languageCode code="en"/>
	<recordTarget>
		<!-- Administrative and Demographic data of the Patient -->
		<patientRole>
			<id root="2.16.840.1.113883.3.6128.2" extension="6952b4dd61bc756ccfce6ff1"/>
			<id extension="2JA6V24WQ07" root="2.16.840.1.113883.4.927"/>
			<addr use="HP">
				<state>IN</state>
				<city>Feesttown</city>
				<postalCode>46395</postalCode>
				<streetAddressLine>443 Rusty Lights Canyon</streetAddressLine>
			</addr>
			<telecom use="HP" value="tel:tel:(276)716-1837"/>
			<patient>
				<name>
					<family>Stokes</family>
					<given> Kathy</given>
				</name>
				<administrativeGenderCode nullFlavor="UNK" codeSystem="2.16.840.1.113883.5.1"/>
				<birthTime value="194411210000"/>
				<maritalStatusCode nullFlavor="NI"/>
				<raceCode code="2054-5" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDCREC" displayName="Black or African American"/>
				<ethnicGroupCode code="2135-2" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDCREC" displayName="Hispanic or Latino"/>
				<languageCommunication>
					<languageCode nullFlavor="UNK"/>
				</languageCommunication>
			</patient>
		</patientRole>
	</recordTarget>
	<!-- Author is the creator of the clinical document, which may be a device or person -->
	<author>
		<time value="20260619160739"/>
		<assignedAuthor>
			<id nullFlavor="NA"/>
			<addr use="WP">
				<state>MA</state>
				<city>Canton</city>
				<postalCode>02021</postalCode>
				<streetAddressLine>7 Blue Hill River Road</streetAddressLine>
			</addr>
			<telecom use="WP" value="tel:781-821-3000"/>
			<assignedAuthoringDevice>
				<manufacturerModelName>MEDITECH Release 6.08</manufacturerModelName>
				<softwareName>MEDITECH</softwareName>
			</assignedAuthoringDevice>
			<representedOrganization>
				<name>MEDITECH</name>
			</representedOrganization>
		</assignedAuthor>
	</author>
	<author>
		<time value="20260619160739"/>
		<assignedAuthor>
			<id root="2.16.840.1.113883.4.6" nullFlavor="UNK"/>
			<addr use="WP">
				<state>ø</state>
				<city>ø</city>
				<postalCode>ø</postalCode>
				<streetAddressLine>ø</streetAddressLine>
			</addr>
			<telecom use="WP" value="tel:ø"/>
			<assignedPerson>
				<name>
					<given>2020 AUTHOR GIVEN</given>
					<family>2020 EH AUTHOR FAMILY</family>
				</name>
			</assignedPerson>
		</assignedAuthor>
	</author>
	<!-- Custodian represents the organization thats in charge of maintaining the clinical document -->
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<id root="2.16.840.1.113883.4.336" extension="800890"/>
				<name>ø</name>
				<telecom use="WP" value="tel:ø"/>
				<addr use="WP">
					<state>ø</state>
					<city>ø</city>
					<postalCode>ø</postalCode>
					<streetAddressLine>ø</streetAddressLine>
				</addr>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<!-- Information Recipient records the intended recipient of the information at the time the document was created -->
	<informationRecipient>
		<intendedRecipient>
			<id root="2.16.840.1.113883.3.249.7" extension="HQR_IQR"/>
		</intendedRecipient>
	</informationRecipient>
	<!-- Legal Authenticator identifies the single person legally responsible for the document -->
	<legalAuthenticator>
		<time value="20260619160746"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="2.16.840.1.113883.19.2" root="2.16.840.1.113883.19"/>
			<addr>
				<streetAddressLine>7 Blue Hill River Road</streetAddressLine>
				<city nullFlavor="NA"/>
				<state nullFlavor="NA"/>
				<postalCode>2090</postalCode>
				<country>Default Legal Auth Country</country>
			</addr>
			<telecom nullFlavor="NA"/>
			<assignedPerson>
				<name>
					<given>Default Given Name</given>
					<family nullFlavor="NA"/>
				</name>
			</assignedPerson>
		</assignedEntity>
	</legalAuthenticator>
	<!-- Participant identifies supporting entities related to the Patient -->
	<participant typeCode="DEV">
		<associatedEntity classCode="RGPR">
			<id root="2.16.840.1.113883.3.2074.1" extension="0015CWC16S4KU7N"/>
		</associatedEntity>
	</participant>
	<!-- The Documentation Service Event represents the main act being documented -->
	<documentationOf typeCode="DOC">
		<serviceEvent classCode="PCPR">
			<effectiveTime>
				<low value="20260101"/>
				<high value="20261231"/>
			</effectiveTime>
			<performer typeCode="PRF">
				<assignedEntity>
					<id root="2.16.840.1.113883.4.6" nullFlavor="UNK"/>
					<representedOrganization>
						<id nullFlavor="UNK"/>
					</representedOrganization>
				</assignedEntity>
			</performer>
		</serviceEvent>
	</documentationOf>
	<component>
		<structuredBody>
			<!-- This section contains information about the measure(s) being reported -->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.24.2.2"/>
					<templateId root="2.16.840.1.113883.10.20.24.2.3"/>
					<code code="55186-1" codeSystem="2.16.840.1.113883.6.1"/>
					<title>Measure Section</title>
					<text>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>eMeasure Title</th>
									<th>Version neutral identifier</th>
									<th>eMeasure Version Number</th>
									<th>NQF eMeasure Number</th>
									<th>eMeasure Identifier (MAT)</th>
									<th>Version specific identifier</th>
								</tr>
							</thead>
							<!-- The measure section must contain a reference to at least one externalDocument id among all measures -->
							<tbody>
								<tr>
									<td>Hospital Harm - Falls with Injury</td>
									<td>e7b2323f-934a-4e2f-abb1-3391011dc5b0</td>
									<td>2.1.000</td>
									<td>4120e</td>
									<td>1017</td>
									<td>50ea2f4e-a952-47af-ac5b-c3530f5d792c</td>
								</tr>
							</tbody>
						</table>
					</text>
					<entry>
						<organizer classCode="CLUSTER" moodCode="EVN">
							<!-- This is the templateId for Measure Reference -->
							<templateId root="2.16.840.1.113883.10.20.24.3.98"/>
							<!-- This is the templateId for eMeasure Reference QDM -->
							<templateId root="2.16.840.1.113883.10.20.24.3.97"/>
							<id root="59147977-5815-42D3-9BF5-C9E7857794EC"/>
							<statusCode code="completed"/>
							<reference typeCode="REFR">
								<externalDocument classCode="DOC" moodCode="EVN">
									<!-- SHALL: This is the version specific identifier for eMeasure: 
									QualityMeasureDocument/id - the OID in the @root indicates that 
									the @extension (which is a GUID) contains the version specific identifier for 
									eMeasure -->
									<id root="2.16.840.1.113883.4.738" extension="50ea2f4e-a952-47af-ac5b-c3530f5d792c"/>
									<!-- SHOULD: This is the NQF Number, root is an NQF OID and for 
									eMeasure Number and extension is the eMeasure NQF number -->
									<id root="2.16.840.1.113883.3.560.1" extension="4120e"/>
									<!-- SHOULD: eMeasure Measure Authoring Tool Identifier (not the real root yet-->
									<id root="2.16.840.1.113883.3.560.101.2" extension="1017"/>
									<!-- SHOULD This is the title of the eMeasure -->
									<text>Hospital Harm - Falls with Injury</text>
									<!-- SHOULD: setId is the eMeasure version neutral id  -->
									<setId root="e7b2323f-934a-4e2f-abb1-3391011dc5b0"/>
									<versionNumber value="2"/>
								</externalDocument>
							</reference>
						</organizer>
					</entry>
				</section>
			</component>
			<!-- Reporting Parameters Section (ex. Reporting Period) -->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.10.20.17.2.1"/>
					<templateId root="2.16.840.1.113883.10.20.17.2.1.1" extension="2016-03-01"/>
					<code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
					<title>Reporting Parameters</title>
					<text>
						<list>
							<item>Reporting period: 01 January 2026 - 31 December 2026</item>
						</list>
					</text>
					<entry typeCode="DRIV">
						<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.17.3.8"/>
							<templateId root="2.16.840.1.113883.10.20.17.3.8.1" extension="2016-03-01"/>
							<id nullFlavor="NI"/>
							<code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
							<effectiveTime>
								<low value="20260101"/>
								<high value="20261231"/>
							</effectiveTime>
						</act>
					</entry>
				</section>
			</component>
			<!-- Patient Data Section -->
			<component>
				<section>
					<!-- This is the templateId for Patient Data section -->
					<templateId root="2.16.840.1.113883.10.20.17.2.4"/>
					<!-- This is the templateId for Patient Data QDM section -->
					<templateId root="2.16.840.1.113883.10.20.24.2.1" extension="2021-08-01"/>
					<!-- Patient Data Section QDM (V7) - CMS-->
					<templateId root="2.16.840.1.113883.10.20.24.2.1.1" extension="2022-02-01"/>
					<code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
					<title>Patient Data</title>
					<text>
						<table border="1" width="100%">
							<thead>
								<tr>
									<th>Data Element</th>
									<th>Value</th>
									<th>Date/Time</th>
								</tr>
							</thead>
							<!-- All Data Element templates -->
							<!-- Must be at least one element -->
							<tbody>
								<tr>
									<td>Encounter, Performed: Encounter Inpatient using 2.16.840.1.113883.3.666.5.307</td>
									<td>Hospital admission (procedure) (Diagnoses: Fall (event) using 1912002) (Diagnoses: Subarachnoid hemorrhage from carotid siphon and bifurcation (disorder) using 195155004) (Encounter, Performed EOC ID) (diagnosisHx: Liver Disease (moderate to severe) (2.16.840.1.113762.1.4.1248.137))</td>
									<td>20260504080000 - 20260509081500</td>
								</tr>
								<tr>
									<td>Patient Characteristic Payer: Payer using "Payer (2.16.840.1.114222.4.11.3591)</td>
									<td>MEDICARE</td>
									<td>20091101190000 - NULL</td>
								</tr>
							</tbody>
						</table>
					</text>
					<entry>
						<encounter classCode="ENC" moodCode="EVN">
							<!-- Conforms to C-CDA R2.1 Encounter Activity (V3) -->
							<templateId root="2.16.840.1.113883.10.20.22.4.49" extension="2015-08-01"/>
							<!-- Encounter Performed (V5) template-->
							<templateId root="2.16.840.1.113883.10.20.24.3.23" extension="2021-08-01"/>
							<!-- the encounter/id/@root (or combined with @extension, if @extension is present) uniquely identifies an encounter -->
							<id root="35BFA096-29E0-445F-B2D1-1A96879C2E14" extension="6952b4dd61bc756ccfce6fe8"/>
							<!--Encounter, Performed: Encounter Inpatient using 2.16.840.1.113883.3.666.5.307-->
							<code code="32485007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT" displayName="Hospital admission (procedure)"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<!-- QDM Attribute: Relevant Period - admission datetime -->
								<low value="20260504080000"/>
								<!-- QDM Attribute: Relevant Period - discharge datetime -->
								<high value="20260509081500"/>
							</effectiveTime>
							<!-- QDM Attribute: Diagnosis -->
							<entryRelationship typeCode="REFR">
								<!--Diagnoses: Fall (event) using 1912002-->
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.24.3.168" extension="2021-08-01"/>
									<code code="29308-4" codeSystem="2.16.840.1.113883.6.1" displayName="Diagnosis" codeSystemName="LOINC"/>
									<value xsi:type="CD" code="1912002" displayName="Fall (event)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
									<!-- QDM Attribute: Present On Admission Indicator (V2) -->
									<entryRelationship typeCode="REFR">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.24.3.169" extension="2021-08-01"/>
											<code code="78026-2" displayName="Present on admission" codeSystem="2.16.840.1.113883.6.1"/>
											<value code="W" codeSystem="2.16.840.1.113883.6.301.11" codeSystemName="Unknown" xsi:type="CD"/>
										</observation>
									</entryRelationship>
								</observation>
							</entryRelationship>
							<!-- QDM Attribute: Diagnosis -->
							<entryRelationship typeCode="REFR">
								<!--Diagnoses: Subarachnoid hemorrhage from carotid siphon and bifurcation (disorder) using 195155004-->
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.24.3.168" extension="2021-08-01"/>
									<code code="29308-4" codeSystem="2.16.840.1.113883.6.1" displayName="Diagnosis" codeSystemName="LOINC"/>
									<value xsi:type="CD" code="195155004" displayName="Subarachnoid hemorrhage from carotid siphon and bifurcation (disorder)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
								</observation>
							</entryRelationship>
							<!-- QDM Attribute: Diagnosis -->
							<entryRelationship typeCode="REFR">
								<!--diagnosisHx: Liver Disease (moderate to severe) (2.16.840.1.113762.1.4.1248.137)-->
								<observation classCode="OBS" moodCode="EVN">
									<templateId root="2.16.840.1.113883.10.20.24.3.168" extension="2021-08-01"/>
									<code code="29308-4" codeSystem="2.16.840.1.113883.6.1" displayName="Diagnosis" codeSystemName="LOINC"/>
									<value xsi:type="CD" code="K72.90" displayName="Hepatic failure, unspecified without coma" codeSystem="2.16.840.1.113883.6.90" codeSystemName="ICD10CM"/>
									<!-- QDM Attribute: Rank -->



					-<entryRelationship typeCode="REFR">


						-<observation classCode="OBS" moodCode="EVN">
											<templateId extension="2019-12-01" root="2.16.840.1.113883.10.20.24.3.166"/>
											<code code="263486008" displayName="Rank" codeSystem="2.16.840.1.113883.6.96"/>
											<value value="0" xsi:type="INT"/>
										</observation>
									</entryRelationship>
									<!-- QDM Attribute: Present On Admission Indicator (V2) -->
									<entryRelationship typeCode="REFR">
										<observation classCode="OBS" moodCode="EVN">
											<templateId root="2.16.840.1.113883.10.20.24.3.169" extension="2021-08-01"/>
											<code code="78026-2" displayName="Present on admission" codeSystem="2.16.840.1.113883.6.1"/>
											<value code="Y" codeSystem="2.16.840.1.113883.6.301.11" codeSystemName="Unknown" xsi:type="CD"/>
										</observation>
									</entryRelationship>
								</observation>
							</entryRelationship>
						</encounter>
					</entry>
					<entry typeCode="DRIV">
						<observation classCode="OBS" moodCode="EVN">
							<!-- Patient Characteristic Payer -->
							<templateId root="2.16.840.1.113883.10.20.24.3.55"/>
							<id root="ED00240A-1459-4571-863F-18B22805DBE7"/>
							<code code="48768-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Payment source"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<!-- QDM Attribute: Start Datetime -->
								<low value="20091101190000"/>
								<!-- QDM Attribute: Stop Datetime -->
								<high nullFlavor="NI"/>
							</effectiveTime>
							<!--Patient Characteristic Payer: Payer using "Payer (2.16.840.1.114222.4.11.3591)-->
							<value xsi:type="CD" code="1" codeSystem="2.16.840.1.113883.3.221.5" codeSystemName="SOP" displayName="MEDICARE"/>
						</observation>
					</entry>
				</section>
			</component>
		</structuredBody>
	</component>
</ClinicalDocument>