<entry>

<act classCode="ACT" moodCode="EVN">
  <!-- Conforms to C-CDA 2.1 Problem Concern Act (V3) -->
  <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
  <!-- Diagnosis Concern Act -->
  <templateId root="2.16.840.1.113883.10.20.24.3.137" extension="2019-12-01"/>
  <id root="1.3.6.1.4.1.115" extension="{{object_id}}"/>
  <code code="CONC" codeSystem="2.16.840.1.113883.5.6" displayName="Concern" />
  {{#prevalencePeriod}}
  {{#completed_prevalence_period}}
  <statusCode code="completed" />
  {{/completed_prevalence_period}}
  {{^completed_prevalence_period}}
  <statusCode code="active" />
  {{/completed_prevalence_period}}
  {{{prevalence_period}}}
  {{/prevalencePeriod}}
  <entryRelationship typeCode="SUBJ">
    <observation classCode="OBS" moodCode="EVN">
      <!-- Conforms to C-CDA R2.1 Problem Observation (V3) -->
      <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
      <!-- Diagnosis template -->
      <templateId root="2.16.840.1.113883.10.20.24.3.135" extension="2019-12-01" />
      <id root="1.3.6.1.4.1.115" extension="{{object_id}}"/>
      <code code="29308-4" codeSystem="2.16.840.1.113883.6.1">
        <translation code="282291009" codeSystem="2.16.840.1.113883.6.96"/>
      </code>
      <statusCode code="completed" />
      {{#prevalencePeriod}}
      {{{prevalence_period}}}
      {{/prevalencePeriod}}
      <!-- QDM Attribute: Code -->
      {{> qrda_templates/template_partials/_data_element_codes_as_values}}
      {{#anatomicalLocationSite}}
        <!-- QDM Attribute: Anatomical Location Site -->
        {{> qrda_templates/template_partials/_anatomical_location_site}}
      {{/anatomicalLocationSite}}
      {{#authorDatetime}}
        <!-- QDM Attribute: Author dateTime -->
        {{> qrda_templates/template_partials/_author}}
      {{/authorDatetime}}
      {{#recorder}}
        <!-- QDM Attribute: Recorder -->
        <participant typeCode="PRF">
          {{> qrda_templates/template_partials/_entity}}
        </participant>
      {{/recorder}}
      {{#severity}}
        <!-- QDM Attribute: Severity -->
        {{> qrda_templates/template_partials/_severity}}
      {{/severity}}
    </observation>
  </entryRelationship>
</act>

</entry>