# entry[].resource.text.div
HLA-A,-B,-C genotyping report for Mary Chalmers (MRN:12345)

  LOCUS   ALLELE 1            ALLELE 2
  HLA-A   HLA-A:01:01G        HLA-A*01:02
  HLA-B   HLA-B*15:01:01G     HLA-B*57:01:01G
  HLA-C   HLA-C*01:02:01G     HLA-C*03:04:01G

Allele assignments based on IMGT/HLA 3.23

Effective date: 2015-12-15

Method: Sequencing of exons 2 and 3 of HLA Class I genes

Lab: aTypingLab Inc

Note: Please refer the implementation guide for more explanation on this carefully organized bundle example.

  Bob Milius - NMDP - 2016-12-01

  Transaction bundle that creates and links:
  + DiagnosticReport summarizing genotyping for HLA-A,-B,-C typing of patient(donor)
  + Obervations for each genotype
  + Observations for each allele
  + Sequences for exons 2 and 3 for HLA-A,-B, -C

  The endpoints of the following resources are hardcoded into this transaction bundle
  because these are presumed to already exist when developing the DiagnosticRequest
  which was to generate this report bundle:

  Patient/119 (potential donor)
  Specimen/120 (buccal swab)
  Organization/68  (typing lab)
  ServiceRequest/123  (report is based on this request)

# entry[].resource.extension[].valueCodeableConcept.text
Next Generation Sequencing of exons 2 and 3 of HLA Class I genes

# entry[].resource.text.div
CBC Report for Wile. E. COYOTE (MRN: 23453) issued 3-Mar 2011 11:45

Test                  Units       Value       Reference Range
Haemoglobin           g/L         176         135 - 180
Red Cell Count        x10*12/L    5.9         4.2 - 6.0
Haematocrit                       0.55+       0.38 - 0.52
Mean Cell Volume      fL          99+         80 - 98
Mean Cell Haemoglobin pg          36+         27 - 35
Platelet Count        x10*9/L     444         150 - 450
White Cell Count      x10*9/L     4.6         4.0 - 11.0
Neutrophils           %           20
Neutrophils           x10*9/L     0.9---      2.0 - 7.5
Lymphocytes           %           20
Lymphocytes           x10*9/L     0.9-        1.1 - 4.0
Monocytes             %           20
Monocytes             x10*9/L     0.9         0.2 - 1.0
Eosinophils           %           20
Eosinophils           x10*9/L     0.92++      0.04 - 0.40
Basophils             %           20
Basophils             x10*9/L     0.92+++     <0.21

Acme Laboratory, Inc signed: Dr Pete Pathologist

# entry[].resource.code.coding[].display
Complete blood count (hemogram) panel - Blood by Automated count

# entry[].resource.text.div
DXA BONE DENSITOMETRY

NAME | XXXXXXX
DOB | 10/02/1974
REFERRING DR | Smith, Jane
INDICATIONS | Early menopause on estrogen levels. No period for 18 months
PROCEDURE | Dual energy x-ray absorptiometry (DEXA)

Bone Mineral Density

Scan Type | Region | Measured | Age | BMD | T-Score | Z-Score | ?BMD(g/cm2) | ?BMD(%)
AP Spine | L1-L4 | 17/06/2008 | 34.4 | 1.148 g/cm² | -0.4 | -0.5 | - | -
Left Femur | Neck | 17/06/2008 | 34.4 | 0.891 g/cm² | -1.0 | -0.9 | - | -
Left Femur | Total | 17/06/2008 | 34.4 | 0.887 g/cm² | -1.2 | -1.3 | - | -
Right Femur | Neck | 17/06/2008 | 34.4 | 0.885 g/cm² | -1.0 | -1.0 | - | -
Right Femur | Total | 17/06/2008 | 34.4 | 0.867 g/cm² | -1.4 | -1.4 | - | -

Assessment:

The Spine L1-L4 BMD is normal.

The Left Femur Neck BMD is in the osteopenic range. Relative fracture risk is about 2.

The Left Femur Total BMD is in the osteopenic range. Relative fracture risk is about 2.

The Right Femur Neck BMD is in the osteopenic range. Relative fracture risk is about 2.

The Right Femur Total BMD is in the osteopenic range. Relative fracture risk is about 2.

COMMENT

Osteopenia on measured BMD. The estimated 10-year probability of fracture based on present age, gender and measured BMD is less than 10%. This absolute fracture risk remains low. A follow-up assessment may be considered in 2 to 3 years to monitor the trend in BMD.

Thank you for your referral. Dr Henry Seven 17/06/2008

Note:
WHO classification of osteoporosis (WHO Technical Report Series 1994: 843)
- Normal: T-score equal to -1.0 s.d. or higher
- Osteopenia: T-score  between -1.0 and -2.5 s.d.
- Osteoporosis: T-score equal to -2.5 s.d. or lower
- Severe/Established osteoporosis: Osteoporosis with one or more fragility fracture.
T-score: The number of s.d. from the mean BMD for a gender-matched young adult population.
Z-score: The number of s.d. from the mean BMD for an age-, weight- and gender-matched population.
Reference for 10-year probability of fracture risk: Kanis JA, Johnell O, Oden A, Dawson A,  De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos.Int. 2001;12(12):989-995.
GE LUNAR PRODIGY DENSITOMETER

# entry[].resource.text.div
Genetic test Report for Marry Chalmers (MRN: 12345)

              Gene                DNAVariation       Status        Interpretation
              BRCA1                                 Negative
              BRCA2                 185delAG        Positive         Pathogenic

Method: BRACAnalysis CDx Offered by Myriad Genetic Laboratories, Inc

Issued: 2015-05-26T15:30:10+01:00

FamilyMemeberHistory: Mother

              Gene                 DNAVariation      Status
              BRCA2                 185delAG        Positive

Method: BRACAnalysis CDx Offered by Myriad Genetic Laboratories, Inc

# entry[].resource.text.div
Generated Narrative with Details

id: example-pgx

basedOn: ServiceRequest/example-pgx

status: final

code: Pharmacogenetics Report (Details : {https://system/PGxReport code 'PGxReport' = 'PGxReport', given as 'Pharmacogenetics Report'})

subject: Bob Smith

effective: 15/10/2016 12:34:56 PM

issued: 20/10/2016 2:00:05 PM

performer: Organization/4829

result: Observation/example-phenotype

presentedForm:

# entry[].resource.text.div
Generated Narrative with Details

id: f001

identifier: nr1239044 (OFFICIAL)

basedOn: ServiceRequest/req

status: final

category: Haematology test (Details : {SNOMED CT code '252275004' = 'Haematology test', given as 'Haematology test'}; {http://terminology.hl7.org/CodeSystem/v2-0074 code 'HM' = 'Hematology)

code: Complete blood count (hemogram) panel - Blood by Automated count (Details : {LOINC code '58410-2' = 'Complete blood count (hemogram) panel - Blood by Automated count', given as 'Complete blood count (hemogram) panel - Blood by Automated count'})

subject: P. van den Heuvel

issued: 15/05/2013 7:32:52 PM

performer: Burgers University Medical Centre

result:

Observation/f001

Observation/f002

Observation/f003

Observation/f004

Observation/f005

conclusion: Core lab

# entry[].resource.code.coding[].display
Complete blood count (hemogram) panel - Blood by Automated count

# entry[].resource.text.div
Generated Narrative with Details

id: f201

status: final

category: Radiology (Details : {SNOMED CT code '394914008' = 'Radiology - speciality', given as 'Radiology'}; {http://terminology.hl7.org/CodeSystem/v2-0074 code 'RAD' = 'Radiology)

code: CT of head-neck (Details : {SNOMED CT code '429858000' = 'Computed tomography (CT) of head and neck', given as 'Computed tomography (CT) of head and neck'})

subject: Roel

effective: 01/12/2012 12:00:00 PM

issued: 01/12/2012 12:00:00 PM

performer: Blijdorp MC

imagingStudy: HEAD and NECK CT DICOM imaging study

conclusion: CT brains: large tumor sphenoid/clivus.

conclusionCode: Malignant tumor of craniopharyngeal duct (Details : {SNOMED CT code '188340000' = 'Malignant tumor of craniopharyngeal duct', given as 'Malignant tumor of craniopharyngeal duct'})

# entry[].resource.code.coding[].display
Computed tomography (CT) of head and neck

# entry[].resource.conclusionCode[].coding[].display
Malignant tumor of craniopharyngeal duct

# entry[].resource.text.div
Generated Narrative with Details

id: f202

basedOn: ServiceRequest/req

status: final

category: Laboratory test (Details : {SNOMED CT code '15220000' = 'Laboratory test', given as 'Laboratory test'}; {http://terminology.hl7.org/CodeSystem/v2-0074 code 'LAB' = 'Laboratory)

code: Blood culture for bacteria, including anaerobic screen (Details : {SNOMED CT code '104177005' = 'Blood culture for bacteria, including anaerobic screen', given as 'Blood culture for bacteria, including anaerobic screen'})

subject: Roel

issued: 11/03/2013 10:28:00 AM

performer: AUMC

result: Results for staphylococcus analysis on Roel's blood culture

conclusion: Blood culture tested positive on staphylococcus aureus

conclusionCode: Bacteremia due to staphylococcus (Details : {SNOMED CT code '428763004' = 'Bacteremia due to Staphylococcus aureus', given as 'Bacteremia due to staphylococcus'})

# entry[].resource.code.coding[].display
Blood culture for bacteria, including anaerobic screen

# entry[].resource.result[].display
Results for staphylococcus analysis on Roel's blood culture

# entry[].resource.conclusion
Blood culture tested positive on staphylococcus aureus

# entry[].resource.text.div
Generated Narrative with Details

id: ghp

meta:

identifier: ghp-example

status: final

code: General Health Profile (Details : {http://acme.com/labs/reports code 'GHP' = 'GHP', given as 'General Health Profile'})

subject: Patient/pat2

effective: 16/08/2015 6:40:17 AM

issued: 17/08/2015 6:40:17 AM

performer: Acme Laboratory, Inc

specimen:

Red Top Tube

Lavender Top Tube

Urine Sample

result:

Chemistry Panel

CBC

Urinalysis

# entry[].resource.text.div
Generated Narrative with Details

id: gingival-mass

identifier: P73456090

status: final

category: Pathology (Details : {http://terminology.hl7.org/CodeSystem/v2-0074 code 'PAT' = 'Pathology (gross & histopath, not surgical)', given as 'Pathology (gross & histopath, not surgical)'})

code: Biopsy without Microscopic Description (1 Site/Lesion)-Standard (Details : {https://www.acmeonline.com code '4503' = '4503', given as 'Biopsy without Microscopic Description (1 Site/Lesion)-Standard'})

subject: Max Jones

effective: 02/03/2017

issued: 15/03/2017 8:13:08 AM

performer: Acme Animal Labs

resultsInterpreter: Sean Stover, BS, DVM, DABVP (Canine/Feline), DACVP

presentedForm:

# entry[].resource.category[].coding[].display
Pathology (gross & histopath, not surgical)

# entry[].resource.resultsInterpreter[].display
Sean Stover, BS, DVM, DABVP (Canine/Feline), DACVP

# entry[].resource.presentedForm[].title
LAB ID: P73456090 MAX JONES Biopsy without Microscopic Description (1 Site/Lesion)-Standard

# entry[].resource.text.div
Lipid Report for Wile. E. COYOTE (MRN: 23453) issued 3-Mar 2009 14:26

Test                  Units       Value       Reference Range
Cholesterol           mmol/L      6.3         <4.5
Triglyceride          mmol/L      1.3         <2.0
HDL Cholesterol       mmol/L      1.3         >1.5
LDL Chol. (calc)      mmol/L      4.2         <3.0

Acme Laboratory, Inc signed: Dr Pete Pathologist

# entry[].resource.text.div
Generated Narrative with Details

id: lri-example

identifier: Placer Identifier = RP723234, Filler Identifier = 250401, Group = RFP 123456

basedOn: ServiceRequest/example

status: final

category: Laboratory (Details : {http://terminology.hl7.org/CodeSystem/v2-0074 code 'LAB' = 'Laboratory', given as 'Laboratory'}; {http://terminology.hl7.org/CodeSystem/v2-0074 code 'MB' = 'Microbiology', given as 'microbiology'})

code: Aerobic Respiratory Culture, Sputum (Details : {LOINC code '624-7' = 'Bacteria identified in Sputum by Respiratory culture', given as 'Bacteria Spt Resp Cul'})

subject: Patient/example

effective: 15/08/2016

issued: 18/08/2016 6:14:35 PM

performer: Organization/example

specimen: Specimen/example

result:

Normal Flora

Klebsiella pneumoniae

Staphlyococcuc aureus

Many WBCs

Moderate Gram Positive Rods

Moderate Gram Positive Cocci in Chains

Many Gram Negative Rods

# entry[].resource.text.div
Generated Narrative with Details

id: micro

identifier: 290741144

basedOn: ServiceRequest/req

status: final

category: Microbiology (Details : {http://terminology.hl7.org/CodeSystem/v2-0074 code 'MB' = 'Microbiology)

code: Culture, MRSA (Details : {LOINC code '632-0' = 'Bacteria identified in Wound by Aerobe culture)

subject: Patient/example

issued: 10/08/2009 8:25:44 AM

performer: Todd Ashby

result: Observation/org1

# entry[].resource.text.div
Acme Anatomic Pathology Services
2216 Santa Monica Blvd, Suite 114
Santa Monica, CA 90404
===============================================================
GYN CYTOLOGY (PAP SMEAR) REPORT
===============================================================

Patient: Everywoman, Eve Report Date: 2/14/2013
DOB: 05/31/1973 Age: 30 Sex: F MRN: PATID14567
Patient Address: 2222 Home Street
Huntington Park
CA 90255
Order: ORD40
Physician: Careful, Adam 5742200012 (NPI)
SpecimenID: GHSID40
Collected Date: 2/11/2013
Received Date: 2/12/2013
LMP: 1/28/2013
Specimen Source: Cervical Cytology (ThinPrep)
Previously abnormal Pap? Unknown

Specimen Adequacy: Satisfactory
Diagnostic Interpretation: Epithelial cell abnormality: Atypical squamous cells
of undetermined significance
Hormonal Evaluations: not possible, due to presence of atypical cells
Recommendations: Appropriate Follow-up. Suggest repeat as clinically indicated
Comments: Abnormal report reviewed by pathologist for confirmation

# entry[].resource.text.div
Generated Narrative with Details

id: report

status: final

code: comprehensive bone marrow report (Details )

subject: Everywoman, Eve A, MRN: 123456789

effective: 02/01/2015 1:20:10 PM

issued: 06/01/2015 1:20:10 PM

performer: Molecular Diagnostic Laboratory

specimen: Bone marrow ID: MLD45-Z4-1234

result:

Observation/o1

Observation/o2

Observation/o3

Observation/o4

Observation/o5

Observation/o6

Observation/o7

Observation/o8

Observation/o9

Observation/o10

Observation/o11

Observation/o12

Observation/o13

# entry[].resource.text.div
Generated Narrative with Details

id: ultrasound

status: final

category: Radiology (Details : {SNOMED CT code '394914008' = 'Radiology - speciality', given as 'Radiology'}; {http://terminology.hl7.org/CodeSystem/v2-0074 code 'RAD' = 'Radiology)

code: Abdominal Ultrasound (Details : {SNOMED CT code '45036003' = 'Ultrasonography of abdomen', given as 'Ultrasonography of abdomen'})

subject: Patient/example

effective: 01/12/2012 12:00:00 PM

issued: 01/12/2012 12:00:00 PM

performer: Practitioner/example

Media

- | Comment | Link
* | A comment about the image | WADO example image

conclusion: Unremarkable study