<?xml version="1.0" encoding="UTF-8"?>
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.w3.org/2001/XMLSchema-instance">
    <realmCode code="FR" />
    <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3" />
    <templateId root="2.16.840.1.113883.2.8.2.1" />
    <templateId root="1.2.250.1.213.1.1.1.1" />
    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.1.18.1.2" />
    <templateId extension="2021.01" root="1.2.250.1.213.1.1.1.46" />
    <id assigningAuthorityName="DEVBOX-SANTE DMP" root="1.2.250.1.287.1.1234567.1.16680908707692" />
    <code code="87273-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Note de vaccination" />
    <title>Note de vaccination</title>
    <effectiveTime value="20221029153429+0200" />
    <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" displayName="Normal" />
    <languageCode code="fr-FR" />
    <versionNumber value="0" />
    <recordTarget>
        <patientRole>
            <id extension="155076322000225" root="1.2.250.1.213.1.4.10" />
            <id extension="2d6e0e95-31a5-44a9-bdbc-b4f0ca13b311" root="1.2.250.1.287.1.1234567.2" />
            <addr nullFlavor="NASK" />
            <telecom nullFlavor="NASK" />
            <patient>
                <name>
                    <given>JEAN</given>
                    <family qualifier="BR">BON</family>
                    <given qualifier="BR">JEAN</given>
                </name>
                <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" />
                <birthTime value="19550714" />
            </patient>
        </patientRole>
    </recordTarget>
    <author>
        <time value="20221029153429+0200" />
        <assignedAuthor>
            <id extension="3380784801/123456" root="1.2.250.1.71.4.2.1" />
            <code code="G15_10/SM26" codeSystem="1.2.250.1.213.1.1.4.5" displayName="Médecin - Qualifié en Médecine Générale (SM)" />
            <addr nullFlavor="NASK" />
            <telecom nullFlavor="NASK" />
            <assignedPerson>
                <name>
                    <given>VIRGINIE</given>
                    <family>MEDECIN RPPS0022297</family>
                </name>
            </assignedPerson>
            <representedOrganization>
                <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                <name>centre de dialyse</name>
                <telecom nullFlavor="NASK" />
                <addr nullFlavor="NASK" />
            </representedOrganization>
        </assignedAuthor>
    </author>
    <custodian>
        <assignedCustodian>
            <representedCustodianOrganization>
                <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                <name>centre de dialyse</name>
            </representedCustodianOrganization>
        </assignedCustodian>
    </custodian>
    <legalAuthenticator>
        <time value="20221029153429+0200" />
        <signatureCode code="S" />
        <assignedEntity>
            <id extension="3380784801/123456" root="1.2.250.1.71.4.2.1" />
            <code code="G15_10/SM26" codeSystem="1.2.250.1.213.1.1.4.5" displayName="Médecin - Qualifié en Médecine Générale (SM)" />
            <addr nullFlavor="NASK" />
            <telecom nullFlavor="NASK" />
            <assignedPerson>
                <name>
                    <given>VIRGINIE</given>
                    <family>MEDECIN RPPS0022297</family>
                </name>
            </assignedPerson>
            <representedOrganization>
                <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                <name>centre de dialyse</name>
                <telecom nullFlavor="NASK" />
                <addr nullFlavor="NASK" />
            </representedOrganization>
        </assignedEntity>
    </legalAuthenticator>
    <documentationOf>
        <serviceEvent>
            <code code="87273-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Note de vaccination" />
            <effectiveTime>
                <low value="20221029123429+0200" />
                <high value="20221029133429+0200" />
            </effectiveTime>
            <performer typeCode="PRF">
                <functionCode nullFlavor="UNK" />
                <time>
                    <low value="20221029123429+0200" />
                    <high value="20221029133429+0200" />
                </time>
                <assignedEntity>
                    <id extension="3380784801/123456" root="1.2.250.1.71.4.2.1" />
                    <code code="G15_10/SM26" codeSystem="1.2.250.1.213.1.1.4.5" displayName="Médecin - Qualifié en Médecine Générale (SM)" />
                    <addr nullFlavor="NASK" />
                    <telecom nullFlavor="NASK" />
                    <assignedPerson>
                        <name>
                            <given>VIRGINIE</given>
                            <family>MEDECIN RPPS0022297</family>
                        </name>
                    </assignedPerson>
                    <representedOrganization>
                        <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                        <name>centre de dialyse</name>
                        <telecom nullFlavor="NASK" />
                        <addr nullFlavor="NASK" />
                        <standardIndustryClassCode code="AMBULATOIRE" codeSystem="1.2.250.1.213.1.1.4.9" displayName="Ambulatoire" />
                    </representedOrganization>
                </assignedEntity>
            </performer>
        </serviceEvent>
    </documentationOf>
    <componentOf>
        <encompassingEncounter>
            <effectiveTime nullFlavor="UNK" />
            <location>
                <healthCareFacility>
                    <code code="SA07" codeSystem="1.2.250.1.71.4.2.4" displayName="Cabinet individuel" />
                </healthCareFacility>
            </location>
        </encompassingEncounter>
    </componentOf>
    <component>
        <structuredBody>
            <component>
                <section>
                    <templateId root="2.16.840.1.113883.10.20.1.6" />
                    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.3.23" />
                    <templateId root="1.2.250.1.213.1.1.2.147" />
                    <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Historique de vaccinations" />
                    <title>Note de vaccination</title>
                    <text>
                        <table border="1">
                            <thead align="center">
                                <tr>
                                    <th align="center">Date de l'acte</th>
                                    <th align="center">Nom du vaccin</th>
                                    <th align="center">Type d'administration</th>
                                    <th align="center">Numéro de lot</th>
                                    <th align="center">Voie d'administration</th>
                                    <th align="center">Site d'administration</th>
                                    <th align="center">Vaccinateur</th>
                                    <th align="center">Vaccin ajouté ou modifié par</th>
                                    <th align="center">Commentaire</th>
                                </tr>
                            </thead>
                            <tbody>
                                <tr ID="uuid-87dd18c7-a980-43f7-93bd-2b6620aa8c80">
                                    <td align="left">29/10/2022</td>
                                    <td ID="uuid-0f88f638-469d-400d-86e5-3424e4956b28" align="left">VACCIN TETANIQUE PASTEUR, suspension injectable en seringue préremplie vaccin tétanique adsorbé</td>
                                    <td align="left">1ère série vaccinante - 2</td>
                                    <td align="left">870343</td>
                                    <td align="left">intra musculaire</td>
                                    <td ID="uuid-d4657f99-d007-4429-a9ae-3787abb26e20" align="left">LD</td>
                                    <td align="left">Dr MEDECIN RPPS0022297 VIRGINIE - Médecin - Qualifié en Médecine Générale (SM)</td>
                                    <td align="left">Dr MEDECIN RPPS0022297 VIRGINIE - Médecin - Qualifié en Médecine Générale (SM)</td>
                                    <td ID="uuid-1f57e117-0315-4f13-9079-028126f29e84" align="left">Commentaire de la vaccination</td>
                                </tr>
                            </tbody>
                        </table>
                    </text>
                    <entry>
                        <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
                            <templateId root="2.16.840.1.113883.10.20.1.24" />
                            <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.12" />
                            <templateId root="1.2.250.1.213.1.1.3.45" />
                            <id root="0e2111cf-44fd-4ed3-a5bd-0a19de0faa2a" />
                            <code code="INITIMMUNIZ" codeSystem="2.16.840.1.113883.5.4" codeSystemName="HL7:ActCode" displayName="1ère série vaccinante" />
                            <text>
                                <reference value="#uuid-87dd18c7-a980-43f7-93bd-2b6620aa8c80" />
                            </text>
                            <statusCode code="completed" />
                            <effectiveTime value="20221029" />
                            <routeCode code="IM" codeSystem="2.16.840.1.113883.5.112" codeSystemName="routeOfAdministration" displayName="intra musculaire" />
                            <approachSiteCode code="LD" codeSystem="2.16.840.1.113883.5.1052" codeSystemName="HumanSubstanceAdministrationSite" displayName="LD">
                                <originalText>
                                    <reference value="#uuid-d4657f99-d007-4429-a9ae-3787abb26e20" />
                                </originalText>
                            </approachSiteCode>
                            <doseQuantity value="1" />
                            <consumable typeCode="CSM">
                                <manufacturedProduct>
                                    <templateId root="2.16.840.1.113883.10.20.1.53" />
                                    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.7.2" />
                                    <templateId root="1.2.250.1.213.1.1.3.43" />
                                    <manufacturedMaterial>
                                        <code code="67718545" codeSystem="1.2.250.1.213.2.3.1" codeSystemName="CIS" displayName="VACCIN TETANIQUE PASTEUR, suspension injectable en seringue préremplie vaccin tétanique adsorbé">
                                            <originalText>
                                                <reference value="#uuid-0f88f638-469d-400d-86e5-3424e4956b28" />
                                            </originalText>
                                            <translation code="J07CA06" codeSystem="2.16.840.1.113883.6.73" codeSystemName="ATC" displayName="Diphtérie - Haemophilus influenzae B - coqueluche - poliomyélite - tétanos" />
                                            <translation code="3400932857241" codeSystem="1.2.250.1.213.2.3.2" codeSystemName="Nomenclature CIP" displayName="1 seringue(s) préremplie(s) en verre de 0,5 ml" />
                                        </code>
                                        <name>vaccin tetanique pasteur</name>
                                        <lotNumberText>870343</lotNumberText>
                                    </manufacturedMaterial>
                                </manufacturedProduct>
                            </consumable>
                            <performer typeCode="PRF">
                                <time />
                                <assignedEntity>
                                    <id extension="3380784801/123456" root="1.2.250.1.71.4.2.1" />
                                    <code code="G15_10/SM26" codeSystem="1.2.250.1.213.1.1.4.5" displayName="Médecin - Qualifié en Médecine Générale (SM)" />
                                    <addr nullFlavor="NASK" />
                                    <telecom nullFlavor="NASK" />
                                    <assignedPerson>
                                        <name>
                                            <given>VIRGINIE</given>
                                            <family>MEDECIN RPPS0022297</family>
                                        </name>
                                    </assignedPerson>
                                    <representedOrganization>
                                        <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                                        <name>centre de dialyse</name>
                                        <telecom nullFlavor="NASK" />
                                        <addr nullFlavor="NASK" />
                                        <standardIndustryClassCode code="AMBULATOIRE" codeSystem="1.2.250.1.213.1.1.4.9" displayName="Ambulatoire" />
                                    </representedOrganization>
                                </assignedEntity>
                            </performer>
                            <author>
                                <time value="20221029" />
                                <assignedAuthor>
                                    <id extension="3380784801/123456" root="1.2.250.1.71.4.2.1" />
                                    <code code="G15_10/SM26" codeSystem="1.2.250.1.213.1.1.4.5" displayName="Médecin - Qualifié en Médecine Générale (SM)" />
                                    <addr nullFlavor="NASK" />
                                    <telecom nullFlavor="NASK" />
                                    <assignedPerson>
                                        <name>
                                            <given>VIRGINIE</given>
                                            <family>MEDECIN RPPS0022297</family>
                                        </name>
                                    </assignedPerson>
                                    <representedOrganization>
                                        <id extension="1380784801" root="1.2.250.1.71.4.2.2" />
                                        <name>centre de dialyse</name>
                                        <telecom nullFlavor="NASK" />
                                        <addr nullFlavor="NASK" />
                                    </representedOrganization>
                                </assignedAuthor>
                            </author>
                            <entryRelationship typeCode="SUBJ">
                                <observation classCode="OBS" moodCode="EVN">
                                    <templateId root="2.16.840.1.113883.10.20.1.46" />
                                    <templateId root="1.2.250.1.213.1.1.3.82" />
                                    <code code="30973-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Rang de la vaccination" />
                                    <statusCode code="completed" />
                                    <value value="2" xsi:type="INT" />
                                </observation>
                            </entryRelationship>
                            <entryRelationship typeCode="SUBJ">
                                <act classCode="ACT" moodCode="EVN">
                                    <templateId root="2.16.840.1.113883.10.20.1.40" />
                                    <templateId root="1.3.6.1.4.1.19376.1.5.3.1.4.2" />
                                    <code code="48767-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Commentaire" />
                                    <text>
                                        <reference value="#uuid-1f57e117-0315-4f13-9079-028126f29e84" />
                                        Commentaire de la vaccination
                                    </text>
                                    <statusCode code="completed" />
                                </act>
                            </entryRelationship>
                        </substanceAdministration>
                    </entry>
                </section>
            </component>
        </structuredBody>
    </component>
</ClinicalDocument>