<H3>Special Instructions</H3>   <p>CRD Form Fillers and Form Managers which support the CCD option run this test.</p>   <H3>Description</H3>  <p>This test asks Form Fillers to create pre-population data for two subjects/patients and then    verifies that this data is sent back correctly by the Form Manager in the form returned to the    Form Filler.</p>   <p>Data to be used in this test follows: </p>   <table width="1005" border="3" cellspacing="0" cellpadding="0">    <tr>     <td width="99" bgcolor="#CCCCCC">      <div align="center">       <strong>Data Element </strong>      </div>     </td>     <td width="177" bgcolor="#CCCCCC">      <div align="center">       <strong>Template ID </strong>      </div>     </td>     <td width="243" bgcolor="#CCFFCC">      <div align="center">       <strong>data for subject Miguel </strong>      </div>     </td>     <td width="2" bgcolor="#CCFFCC">'</td>     <td width="35" bgcolor="#CCFFCC">      <p align="center">       <strong>Eval:<br/> Y/N</strong>      </p>     </td>     <td width="243" bgcolor="#FFFFCC">      <div align="center">       <strong>data for subject Kendra </strong>      </div>     </td>     <td width="42" bgcolor="#FFFFCC">      <div align="center">       <strong>Eval: Y/N </strong>      </div>     </td>     <td width="142" bgcolor="#CCCCCC">      <div align="center">       <strong>Evaluator's Comments</strong>      </div>     </td>    </tr>    <tr>     <td>Date of Birth </td>     <td>patientRole/patient/birthTime</td>     <td>19440404</td>     <td>'</td>     <td>'</td>     <td>19660606</td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Gender</td>     <td>      <p>patientRole/patient/<br/> administrativeGenderCode</p>     </td>     <td>M</td>     <td>'</td>     <td>'</td>     <td>F</td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Ethnicity</td>     <td>patientRole/patient/<br/> ethnicGroupCode</td>     <td>2149-3 (Mexican American)</td>     <td>'</td>     <td>'</td>     <td>(none)</td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Race</td>     <td>patientRole/patient/raceCode</td>     <td>2106-3 (White) </td>     <td>'</td>     <td>'</td>     <td>2029-7 (Asian Indian) </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Active Problems </td>     <td>      <p>component/section/entry/act/<br/> entryRelationship/observation</p>     </td>     <td>      <p>Knee strain </p>     </td>     <td>'</td>     <td>'</td>     <td>      <p>Chronic Migraine Headaches </p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Past Medical History </td>     <td>      <p>component/section/entry/act/<br/> entryRelationship/observation</p>     </td>     <td>Patient is recovering from a salomnella infection from eating raw eggs. </td>     <td>'</td>     <td>'</td>     <td>      <p>Patient suffers from asthma. </p>      <p>Patient experiences arthritis in her left foot that was broken in the past.</p>      <p>Patient was a pack-a-day tobacco smoker for 10 years. She quit smoking in 1990. </p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Procedures and Interventions </td>     <td>component/section/entry/<br/> procedure</td>     <td>      <p>MRI of left knee </p>     </td>     <td>'</td>     <td>'</td>     <td>      <p>Head CT </p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Social History </td>     <td>component/section</td>     <td>text="Miguel is a tri-athlete <br/> who runs at least 5 miles a day." </td>     <td>'</td>     <td>'</td>     <td>text="Patient is a foster mother caring for a 3-month infant." </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Current Medications </td>     <td>component/section/entry/<br/> substanceAdminstration</td>     <td>      <p>Augmentin 125 Mg Chew</p>      <p>Freq: twice/day. Start: 11-Feb-09. Status: active </p>     </td>     <td>'</td>     <td>'</td>     <td>      <p>Albuterol Sulfate 108 MCG/ACT AERS</p>      <p>Freq: 2 puffs q6hrs pm. Start: 21-Feb-09. Status: active </p>      <p>=================</p>      <p>Naproxen Sodium 550 MG TABS</p>      <p>Take one tablet by mouth every six hours as needed.</p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Vital Signs </td>     <td>component/section/entry/<br/> organizer/<br/> component/observation/</td>     <td>      <p>code/code=8380-6</p>      <p>code/displayName=<br/> INTRAVASCULAR SYSTOLIC</p>      <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>      <p>value/value=68</p>      <p>value/unit=mm[Hg]</p>      <p>===========================</p>      <p>code/code=8462-4</p>      <p>code/displayName=<br/> INTRAVASCULAR DIASTOLIC</p>      <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>      <p>value/value=108</p>      <p>value/unit=mm[Hg]</p>      <p>=========</p>      <p>Pulse: 82 / minute</p>      <p>Respiration: 29 / minute </p>     </td>     <td>'</td>     <td>'</td>     <td>      <p>code/code=8380-6</p>      <p>code/displayName=<br/> INTRAVASCULAR SYSTOLIC</p>      <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>      <p>value/value=102</p>      <p>value/unit=mm[Hg]</p>      <p>===========================</p>      <p>code/code=8462-4</p>      <p>code/displayName=<br/> INTRAVASCULAR DIASTOLIC</p>      <p>code/codeSystem=<br/> 2.16.840.1.113883.6.1</p>      <p>value/value=140</p>      <p>value/unit=mm[Hg]</p>      <p>======</p>      <p>Pulse: 86 / minute</p>      <p>Respiration: 30 / minute </p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Physical Exam</td>     <td>component/section</td>     <td>      <p>code/code=10210-3</p>      <p>code/displayName=<br/> GENERAL STATUS</p>      <p>code/codesSystem=<br/> 2.16.840.113883.6.1</p>      <p>text="This is a very healthy patient." </p>     </td>     <td>'</td>     <td>'</td>     <td>None</td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Allergies and Other Adverse Reactions </td>     <td>component/section/entry/act/<br/> entryRelationship/observation</td>     <td>      <p>Milk Products - active allergy</p>      <p>Peanuts - active allergy </p>     </td>     <td>'</td>     <td>'</td>     <td>      <p>Laytex - active allergy </p>     </td>     <td>'</td>     <td>'</td>    </tr>    <tr>     <td>Coded Results </td>     <td>'</td>     <td>'</td>     <td>'</td>     <td>'</td>     <td>'</td>     <td>'</td>     <td>'</td>    </tr>   </table> <H3>Evaluation</H3>  <Evaluation>   <p>The Connectathon Monitor will check for correct exchange of the pre-population data contained    in the test description. </p>   <p>The table in the test description contains all "R" and "R2" elements in the CCD option. The    connectathon monitor will use this table to record (Y/N) which elements were successfully    exchanged.</p>   <p>The Connectathon Monitor may ask the Form Filler to request the forms for the test patients    again in his/her presence, or to send data for an additional subject/patient and observe the    transfer real-time.</p>   <p>On the <strong>Form Filler</strong>, the Connectathon monitor will observe that a form is    returned with the data in the Test Description pre-populated on the form. The Form Filler should    be able to add additional data, or change existing fields, and then submit the completed form    back to the Form Manager.</p>    </Evaluation>