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				<city>Dzierżoniów</city>
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					<prefix>tech. farm.</prefix>
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					<title>Wydanie leku</title>
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						<paragraph ID="SPLY_1">
							<caption>Wydano lek gotowy</caption>Nazwa: Enarenal<br/>Postać: tabletki<br/>Dawka: 5mg<br/>Opakowanie: 60 tabl.<br/>Ilość: 1<br/>Nr serii: 123/890<br/>Data ważności: 1 stycznia 2018 r.<br/>Identyfikator produktu: 5909990014958 (GS1/EAN)</paragraph>
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							<caption>Taksacja</caption>Wartość wydanego leku: 12,00<br/>Limit urzędowy: 8,40<br/>Poziom odpłatności leku refundowanego: 30%<br/>Kwota refundacji: 8,40 <br/>Zapłacono: 3,60</paragraph>
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										<name>Enarenal 5mg tabletki</name>
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												<pharm:name>Enarenal 5mg (60 tabl.)</pharm:name>
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								<act classCode="ACT" moodCode="EVN">
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										<reference value="#ACT_1"/>
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									<statusCode code="completed"/>
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										<observation classCode="OBS" moodCode="DEF">
											<code code="WWL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Wartość wydanego leku"/>
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											<value xsi:type="REAL" value="12.00"/>
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										<observation classCode="OBS" moodCode="DEF">
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											<statusCode code="completed"/>
											<value xsi:type="REAL" value="8.40"/>
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										<observation classCode="OBS" moodCode="DEF">
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											<statusCode code="completed"/>
											<value xsi:type="CV" code="30%" codeSystem="2.16.840.1.113883.3.4424.11.1.1"/>
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										<observation classCode="OBS" moodCode="INT">
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											<statusCode code="completed"/>
											<value xsi:type="REAL" value="8.40"/>
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										<observation classCode="OBS" moodCode="EVN">
											<code code="ZAPL" codeSystem="2.16.840.1.113883.3.4424.13.5.1" displayName="Zapłacono"/>
											<statusCode code="completed"/>
											<value xsi:type="REAL" value="3.60"/>
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					<title>Dane o ubezpieczeniu i uprawnieniach</title>
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						<paragraph ID="ACT_2">Oddział NFZ: 07 <br/>Uprawnienia dodatkowe: ZK (Nr leg.: 238/2015)</paragraph>
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									<!-- Uprawnienie dodatkowe -->
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									<performer typeCode="PRF">
										<!-- Dane ubezpieczyciela/płatnika -->
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											<!-- Informacja o dokumencie potwierdzającym uprawnienie dodatkowe -->
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											<text>Nr leg.: 238/2015</text>
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							<caption>Adnotacja farmaceuty</caption>Wydano zamiennik</paragraph>
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