<?xml version="1.0" encoding="utf-8"?>
<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">

<!-- QRDA Header -->
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- US Realm Header Template Id -->
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
<!-- QRDA templateId -->
<templateId root="2.16.840.1.113883.10.20.24.1.1" extension="2017-08-01"/>
<!-- QDM-based QRDA templateId -->
<templateId root="2.16.840.1.113883.10.20.24.1.2" extension="2021-08-01"/>
<!-- CMS QRDA templateId -->
<!-- QRDA Category I Report - CMS (V9) -->
<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 document -->
<id root="c86173e0-3df0-013e-08a5-000c2966933d"/>
<!-- QRDA document type code -->
<code code="55182-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Quality Measure Report"/>
<title>QRDA Incidence Report</title>
<!-- This is the document creation time -->
<effectiveTime value="20250708061451"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en"/>
<!-- reported patient -->
<recordTarget>
  <patientRole>
    <id extension="686cb755c36836a2136c9932" root="1.3.6.1.4.1.115" />
      <addr use="HP">
          <streetAddressLine>7447 Blanda Plain Ridge</streetAddressLine>
        <city>Danialborough</city>
        <state>NY</state>
        <postalCode>12228</postalCode>
        <country>US</country>
      </addr>
      <telecom use="HP" value="tel:610-901-1948"/>
      <telecom use="HP" value="mailto:ariley2268@example.com"/>
    <patient>
        <name>
          <given>Agnes</given>
          <family>Riley</family>
        </name>
            <administrativeGenderCode nullFlavor="OTH">
              <translation code="248152002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
            </administrativeGenderCode>
        <birthTime value='20081027094041'/>
          <raceCode code="2076-8" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDCREC"/>
          <ethnicGroupCode code="2135-2" codeSystem="2.16.840.1.113883.6.238" codeSystemName="CDCREC"/>
      <languageCommunication>
        <templateId root="2.16.840.1.113883.3.88.11.83.2" assigningAuthorityName="HITSP/C83"/>
        <templateId root="1.3.6.1.4.1.19376.1.5.3.1.2.1" assigningAuthorityName="IHE/PCC"/>
        <languageCode code="eng"/>
      </languageCommunication>
    </patient>
  </patientRole>
</recordTarget>
<author>
  <time value="20250708061451"/>
  <assignedAuthor>
    <!-- NPI -->
      <id extension="1053092775" root="2.16.840.1.113883.4.6"/>
    <addr>
      <streetAddressLine>202 Burlington Rd.</streetAddressLine>
      <city>Bedford</city>
      <state>MA</state>
      <postalCode>01730</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:(781)271-3000"/>
    <assignedAuthoringDevice>
      <manufacturerModelName>TestSystem</manufacturerModelName>
      <softwareName>TestSystem</softwareName>
    </assignedAuthoringDevice>
  </assignedAuthor>
</author><custodian>
  <assignedCustodian>
    <representedCustodianOrganization>
        <id extension="573279" root="2.16.840.1.113883.4.336"/>
      <name>TestSystem Test Deck</name>
      <telecom use="WP" value="tel:(781)271-3000"/>
      <addr use="HP">
        <streetAddressLine>61118 Predovic Ford Well</streetAddressLine>
        <city>Sipesborough</city>
        <state>AK</state>
        <postalCode>99576</postalCode>
        <country>US</country>
      </addr>
    </representedCustodianOrganization>
  </assignedCustodian>
</custodian>
<informationRecipient>
  <intendedRecipient>
    <id extension="HQR_IQR" root="2.16.840.1.113883.3.249.7"/>
  </intendedRecipient>
</informationRecipient>
<legalAuthenticator>
  <time value="20250708061451"/>
  <signatureCode code="S"/>
  <assignedEntity>
    <id root="bc01a5d1-3a34-4286-82cc-43eb04c972a7"/>
    <addr>
      <streetAddressLine>202 Burlington Rd.</streetAddressLine>
      <city>Bedford</city>
      <state>MA</state>
      <postalCode>01730</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:(781)271-3000"/>
    <assignedPerson>
      <name>
        <given>Henry</given>
        <family>Seven</family>
      </name>
    </assignedPerson>
    <representedOrganization>
      <id root="2.16.840.1.113883.19.5"/>
      <name>TestSystem</name>
    </representedOrganization>
  </assignedEntity>
</legalAuthenticator><participant typeCode="DEV">
  <associatedEntity classCode="RGPR">
    <!-- CMS EHR Certification Number (formerly known as Office of the 
        National Coordinator Certification Number). Note, this is a test
        file, and the provided ID is not for a certified product set. -->
    <id extension="0015CPV4ZTB4WBU" root="2.16.840.1.113883.3.2074.1"/>
  </associatedEntity>
</participant><documentationOf typeCode="DOC">
  <serviceEvent classCode="PCPR">
    <!-- care provision -->
    <effectiveTime>
      <low nullFlavor="UNK"/>
      <high nullFlavor="UNK"/>
    </effectiveTime>
    <!-- You can include multiple performers, each with an NPI, TIN, CCN. -->
    <performer typeCode="PRF">
      <time>
        <low nullFlavor="UNK"/>
        <high nullFlavor="UNK"/>
      </time>
      <assignedEntity>
          <id extension="1053092775" root="2.16.840.1.113883.4.6"/>
          <id extension="573279" root="2.16.840.1.113883.4.336"/>
        <code code="282N00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>
        <addr use="HP">
          <streetAddressLine>61118 Predovic Ford Well</streetAddressLine>
          <city>Sipesborough</city>
          <state>AK</state>
          <postalCode>99576</postalCode>
          <country>US</country>
        </addr>
        <assignedPerson>
          <name>
            <given>Aaron</given>
            <family>Richardson</family>
          </name>
        </assignedPerson>
        <representedOrganization>
          <id extension="631185567" root="2.16.840.1.113883.4.2"/>
          <addr use="HP">
            <streetAddressLine>61118 Predovic Ford Well</streetAddressLine>
            <city>Sipesborough</city>
            <state>AK</state>
            <postalCode>99576</postalCode>
            <country>US</country>
          </addr>
        </representedOrganization>
      </assignedEntity>
    </performer>
  </serviceEvent>
</documentationOf>
<component>
  <structuredBody>
    <component>
      <section>
        <!-- 
          *****************************************************************
          Measure Section
          *****************************************************************
        -->
        <!-- This is the templateId for Measure Section -->
        <templateId root="2.16.840.1.113883.10.20.24.2.2"/>
        <!-- This is the templateId for Measure Section QDM -->
        <templateId root="2.16.840.1.113883.10.20.24.2.3"/>
        <!-- This is the LOINC code for "Measure document". This stays the same for all measure section required by QRDA standard -->
        <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 specific identifier</th>
              </tr>
            </thead>
            <tbody>
              <tr>
                <td>This ratio measure assesses the number of inpatient hospitalizations where at least one fall with a major or moderate injury occurs among the total qualifying inpatient hospital days for patients age 18 years and older</td>
                <td>50EA2F4E-A952-47AF-AC5B-C3530F5D792C</td>
                <td/>
              </tr>
            </tbody>
          </table>
        </text>
        <!-- 1..* Organizers, each containing a reference to an eMeasure -->
        <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 extension="c86a2030-3df0-013e-08a5-000c2966933d" root="1.3.6.1.4.1.115"/>
            <statusCode code="completed"/>
            <!-- Containing isBranch external references -->
            <reference typeCode="REFR">
              <externalDocument classCode="DOC" moodCode="EVN">
                <!-- SHALL: This is the version specific identifier for eMeasure: QualityMeasureDocument/id it is a GUID-->
                <id extension="50EA2F4E-A952-47AF-AC5B-C3530F5D792C" root="2.16.840.1.113883.4.738"/>
                <!-- SHOULD This is the title of the eMeasure -->
                <text>This ratio measure assesses the number of inpatient hospitalizations where at least one fall with a major or moderate injury occurs among the total qualifying inpatient hospital days for patients age 18 years and older</text>
                <!-- SHOULD: setId is the eMeasure version neutral id  -->
                <setId root="E7B2323F-934A-4E2F-ABB1-3391011DC5B0"/>
              </externalDocument>
            </reference>
          </organizer>
        </entry>
      </section>
    </component>    <component>
      <section>
        <!-- This is the templateId for Reporting Parameters section -->
        <templateId root="2.16.840.1.113883.10.20.17.2.1"/>
        <templateId extension="2016-03-01" root="2.16.840.1.113883.10.20.17.2.1.1"/>
        <code code="55187-9" codeSystem="2.16.840.1.113883.6.1"/>
        <title>Reporting Parameters</title>
        <text></text>
        <entry typeCode="DRIV">
          <act classCode="ACT" moodCode="EVN">
            <!-- This is the templateId for Reporting Parameteres Act -->
            <templateId root="2.16.840.1.113883.10.20.17.3.8"/>
            <templateId extension="2016-03-01" root="2.16.840.1.113883.10.20.17.3.8.1"/>
            <id extension="c8701cb0-3df0-013e-08a5-000c2966933d" root="1.3.6.1.4.1.115"/>
            <code code="252116004" codeSystem="2.16.840.1.113883.6.96" displayName="Observation Parameters"/>
            <effectiveTime>
              <low value="20240101000000"/>
              <high value="20241231235959"/>
            </effectiveTime>
          </act>
        </entry>
      </section>
    </component>    <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 extension="2021-08-01" root="2.16.840.1.113883.10.20.24.2.1"/>
          <!-- Patient Data Section QDM (V8) CMS -->
          <templateId extension="2022-02-01" root="2.16.840.1.113883.10.20.24.2.1.1"/>
          <code code="55188-7" codeSystem="2.16.840.1.113883.6.1"/>
          <title>Patient Data</title>
          <text/>














            <entry>
              <encounter classCode="ENC" moodCode="EVN">
                <!--  Encounter activities template -->
                <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/>
                <!-- Encounter performed template -->
                <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.3.23"/>
                <id extension="686cb755c36836a2136c992a" root="1.3.6.1.4.1.115"/>
                <!-- QDM Attribute: Code -->
                  <code code="4525004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
                <text>Emergency Department Visit</text>
                <statusCode code="completed"/>
                  <!-- QDM Attribute: Relevant Period -->
                  <effectiveTime><low value='20240622134041'/><high value='20240622145541'/></effectiveTime>
                  <!-- QDM Attribute: Facility Locations -->
                  <participant typeCode="LOC">
                    <!-- Facility Location template -->
                    <templateId extension="2017-08-01" root="2.16.840.1.113883.10.20.24.3.100"/>
                    <!-- QDM Attribute: Location Period -->
                    <time>
                      <low value='20240622134041'/><high value='20240622145541'/>
                    </time>
                    <participantRole classCode="SDLOC">
                      <code code="4525004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
                      <addr>
                        <streetAddressLine>202 Burlington Rd.</streetAddressLine>
                        <city>Bedford</city>
                        <state>MA</state>
                        <postalCode>01730</postalCode>
                        <country>US</country>
                      </addr>
                      <telecom use="WP" value="tel:(781)271-3000"/>
                      <playingEntity classCode="PLC">
                        <name>TestSystem Test Deck</name>
                      </playingEntity>
                    </participantRole>
                  </participant>              </encounter>
            </entry>            <entry>
              <encounter classCode="ENC" moodCode="EVN">
                <!--  Encounter activities template -->
                <templateId extension="2015-08-01" root="2.16.840.1.113883.10.20.22.4.49"/>
                <!-- Encounter performed template -->
                <templateId extension="2021-08-01" root="2.16.840.1.113883.10.20.24.3.23"/>
                <id extension="686cb755c36836a2136c992b" root="1.3.6.1.4.1.115"/>
                <!-- QDM Attribute: Code -->
                  <code code="32485007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
                <text>Encounter Inpatient</text>
                <statusCode code="completed"/>
                  <!-- QDM Attribute: Relevant Period -->
                  <effectiveTime><low value='20240622152541'/><high value='20240624074041'/></effectiveTime>
                  <!-- QDM Attribute: Facility Locations -->
                  <participant typeCode="LOC">
                    <!-- Facility Location template -->
                    <templateId extension="2017-08-01" root="2.16.840.1.113883.10.20.24.3.100"/>
                    <!-- QDM Attribute: Location Period -->
                    <time>
                      <low value='20240622152541'/><high value='20240624074041'/>
                    </time>
                    <participantRole classCode="SDLOC">
                      <code code="183452005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMEDCT"/>
                      <addr>
                        <streetAddressLine>202 Burlington Rd.</streetAddressLine>
                        <city>Bedford</city>
                        <state>MA</state>
                        <postalCode>01730</postalCode>
                        <country>US</country>
                      </addr>
                      <telecom use="WP" value="tel:(781)271-3000"/>
                      <playingEntity classCode="PLC">
                        <name>TestSystem Test Deck</name>
                      </playingEntity>
                    </participantRole>
                  </participant>              </encounter>
            </entry>































            <entry>
              <!-- Patient Characteristic Payer -->
              <observation classCode="OBS" moodCode="EVN">
                <templateId root="2.16.840.1.113883.10.20.24.3.55"/>
                <id root="c8806380-3df0-013e-08a5-000c2966933d"/> 
                <code code="48768-6" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" displayName="Payment source"/> 
                <statusCode code="completed"/>
                  <!-- QDM Attribute: Relevant Period -->
                  <effectiveTime><low value='20231218000000'/><high nullFlavor='UNK'/></effectiveTime>
                  <value xsi:type="CD" code="9" codeSystem="2.16.840.1.113883.3.221.5" codeSystemName="Source of Payment Typology"/>
              </observation>            
            </entry>
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>