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<?xml version="1.0" encoding="UTF-8"?>
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<ClinicalDocument xmlns:mif="urn:hl7-org:v3/mif"
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xmlns:cnsaSDO="urn:cnsaSDO"
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xmlns:sch="http://www.ascc.net/xml/schematron"
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xmlns="urn:hl7-org:v3"
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xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
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<realmCode code="FR"/>
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<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
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<templateId root="1.2.250.1.213.1.1.1.4.8"/>
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<templateId root="2.16.840.1.113883.10.12.1"/>
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<id root="1.2.250.1.213.1.1.1.4.8" extension="idDecision"/>
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<code code="18825-0" codeSystem="2.16.840.1.113883.4.642.3.240" displayName="Medical social services attachment"/>
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<title>Exemple ESMS Décision</title>
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<effectiveTime value="20230110"/>
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<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" displayName="Normal"/>
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<languageCode code="fr-FR" />
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<recordTarget>
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<patientRole>
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<id extension="idDossierIndividu" root="1.2.250.1.213.7.14"/>
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<id extension="276059205062865" root="1.2.250.1.213.1.4.8"/>
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<addr use="PHYS">
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<streetAddressLine>17 AV de Bruxelles</streetAddressLine>
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<postalCode>35830</postalCode>
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<city>Betton</city>
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</addr>
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<telecom value="tel:0686970800" use="MC"/>
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<telecom value="mailto:lafayette.marie@gmail.com" />
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<cnsaSDO:nomOrganismeAM>CPAM</cnsaSDO:nomOrganismeAM>
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<cnsaSDO:numSecuriteSocialeOuvrantDroit>276059205062865</cnsaSDO:numSecuriteSocialeOuvrantDroit>
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<cnsaSDO:dateTransfertDossier value="20230201"/>
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<cnsaSDO:idMDPHResponsable extension="06-ALPES MARITIMES" root="1.2.250.1.213.7.6"></cnsaSDO:idMDPHResponsable>
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<cnsaSDO:idMDPHAccueil extension="22-COTES D ARMOR" root="1.2.250.1.213.7.24"></cnsaSDO:idMDPHAccueil>
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<patient>
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<name>
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<family qualifier="BR">Lafayette</family>
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<family qualifier="CL">Lafayette</family>
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<given>Marie</given>
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<given qualifier="BR">Marie</given>
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<given qualifier="CL">Marie</given>
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</name>
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<administrativeGenderCode code="F" displayName="Féminin" codeSystem="1.2.250.1.213.2.53"/>
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<birthTime value="19960531"/>
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<guardian>
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<code code="1" displayName="Tutelle" codeSystem="1.2.250.1.213.3.3.208"/>
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<addr use="PHYS">
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<postalCode>35000</postalCode>
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<city>Rennes</city>
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</addr>
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<telecom value="tel:0186940900"/>
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<guardianPerson>
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<name>
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<family>Lafayette</family>
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<given>Flore</given>
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</name>
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</guardianPerson>
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</guardian>
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<birthplace>
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<place>
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<addr use="PHYS">
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<county>35238</county>
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<city>RENNES</city>
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</addr>
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</place>
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</birthplace>
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</patient>
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</patientRole>
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</recordTarget>
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<author contextControlCode="OP" typeCode="AUT">
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<time value="20230110172308+0100"/>
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<assignedAuthor classCode="ASSIGNED">
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<id root="1.2.250.1.213.8.1" extension="ViaTrajectoire"/>
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</assignedAuthor>
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</author>
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<informant>
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<relatedEntity classCode="PRS">
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<code code="MTH" displayName="Mère" codeSystem="2.16.840.1.113883.5.111">
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<originalText>mère du patient</originalText>
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</code>
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<addr use="PHYS">
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<streetAddressLine>5 AV de Paris</streetAddressLine>
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<postalCode>75007</postalCode>
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<city>PARIS</city>
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</addr>
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<telecom value="tel:0186940910"/>
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<cnsaSDO:autoriteParentale value="true"></cnsaSDO:autoriteParentale>
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<relatedPerson>
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<name>
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<prefix>Madame</prefix>
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<family>Lafayette</family>
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<given>Elise</given>
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</name>
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</relatedPerson>
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</relatedEntity>
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</informant>
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<custodian>
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<assignedCustodian>
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<representedCustodianOrganization>
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<id root="1.2.250.1.213.8.1" extension="ViaTrajectoire"/>
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</representedCustodianOrganization>
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</assignedCustodian>
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</custodian>
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<component>
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<structuredBody>
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<component>
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<section>
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<templateId root="1.2.250.1.213.1.1.2.228"></templateId>
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<templateId root="2.16.840.1.113883.10.12.201"></templateId>
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<entry>
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<observation classCode="OBS" moodCode="EVN">
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<templateId root="1.2.250.1.213.1.1.3.176"></templateId>
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<templateId root="2.16.840.1.113883.10.12.303"></templateId>
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<code> <originalText>StatutDeces</originalText> </code>
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<effectiveTime value="20221201"/>
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<value xsi:type="CE" code="1" codeSystem="1.2.250.1.213.3.3.100" displayName="Certifié"></value>
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</observation>
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</entry>
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</section>
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</component>
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<component>
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<section>
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<templateId root="1.2.250.1.213.1.1.2.235"></templateId>
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<cnsaSDO:decision>
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<cnsaSDO:identifiantDecision root="1.2.250.1.213.1.1.1.4.8" extension="idDossierDecision"/>
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<cnsaSDO:typeDeDecision code="1" displayName="Attribution" codeSystem="1.2.250.1.213.3.3.202"/>
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<cnsaSDO:dateDeDecision value="20220101"/>
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<cnsaSDO:motivation code="364" displayName="Attrib PCH3 à 0€ adulte surcoût pris en charge ESMS" codeSystem="1.2.250.1.213.3.3.148"/>
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<cnsaSDO:droitPrestation>
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<cnsaSDO:typeDroitOuPrestation code="13.2" displayName="Orientation vers un Etablissement d'accueil médicalisé en tout ou partie" codeSystem="1.2.250.1.213.3.3.204"/>
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<cnsaSDO:natureDroit code="1" displayName="Nouveau droit" codeSystem="1.2.250.1.213.3.3.151"/>
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<cnsaSDO:dateOuvertureDuDroit value="20220104"></cnsaSDO:dateOuvertureDuDroit>
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<cnsaSDO:dateEcheanceDuDroit value="20230104"></cnsaSDO:dateEcheanceDuDroit>
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<cnsaSDO:qualification code="1" displayName="cible" codeSystem="1.2.250.1.213.3.3.171"/>
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<cnsaSDO:amendementCreton value="true"/>
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<cnsaSDO:existencePAG value="true"/>
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<cnsaSDO:caracterisation>
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<cnsaSDO:niveau code="4" displayName="Priorité 4" codeSystem="1.2.250.1.213.3.3.98" />
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<cnsaSDO:motif code="9" displayName="Maintien à domicile inadapté" codeSystem="1.2.250.1.213.3.3.141"/>
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<cnsaSDO:dateMiseAJour value="20230404"/>
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</cnsaSDO:caracterisation>
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<cnsaSDO:detailTypeDroitPrestation>
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<cnsaSDO:temporaliteAccueil code="02" displayName="Permanent" codeSystem="1.2.250.1.213.3.3.31"/>
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<cnsaSDO:accueilSequentiel value="false"/>
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<cnsaSDO:categorieEtablissement code="101" displayName="Centre Hospitalier Régional (C.H.R.)" codeSystem="1.2.250.1.213.1.6.1.8"/>
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<cnsaSDO:categorieOrganisation code="09" displayName="Centre Expert" codeSystem="1.2.250.1.213.3.3.39"/>
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<cnsaSDO:nbJourDerogationAccueilTemporaire value="16"/>
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<cnsaSDO:priseEnCharge>
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<cnsaSDO:modePriseEnCharge code="46" displayName="Hébergement (accueil jour et nuit)" codeSystem="1.2.250.1.213.3.3.13"/>
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<cnsaSDO:quantification>
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<cnsaSDO:nombre value="15"></cnsaSDO:nombre>
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<cnsaSDO:unite code="2" displayName="Journée" codeSystem="1.2.250.1.213.3.3.211"/>
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<cnsaSDO:periodicite code="3" displayName="Mensuelle" codeSystem="1.2.250.1.213.3.3.163"/>
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</cnsaSDO:quantification>
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</cnsaSDO:priseEnCharge>
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</cnsaSDO:detailTypeDroitPrestation>
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</cnsaSDO:droitPrestation>
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</cnsaSDO:decision>
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</section>
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</component>
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</structuredBody>
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</component>
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</ClinicalDocument>
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