<?xml version="1.0" encoding="utf-8"?>
<Submission>
  <PartID>12345</PartID>
  <PartName>HealthLevel Participating Hospital</PartName>
  <PartNPI>1234567800</PartNPI>
  <Timeframe>2013Q3</Timeframe>
  <Xmsnld>1</Xmsnld>
  <VendorId>HealthLevel</VendorId>
  <VendorVer>1.0</VendorVer>
  <RegistryId>ACC-NCDR-CathPCI</RegistryId>
  <RegistryVer>4.4</RegistryVer>
  <Patients>
    <Patient NCDRPatientID="104317131">
      <LastName>Smith</LastName>
      <FirstName>John</FirstName>
      <MidName>Test</MidName>
      <SSNNA>0</SSNNA>
      <OtherID>TESTP9990705</OtherID>
      <DOB>1990-05-01</DOB>
      <RaceWhite>0</RaceWhite>
      <RaceBlack>0</RaceBlack>
      <RaceAsian>0</RaceAsian>
      <RaceAmIndian>0</RaceAmIndian>
      <RaceNatHaw>0</RaceNatHaw>
      <Episodes>
        <Episode ArrivalDate="2013-05-01">
          <ZipCode>12345</ZipCode>
          <ZipCodeNA>0</ZipCodeNA>
          <AdmtSource>1</AdmtSource>
          <InsPrivate>0</InsPrivate>
          <InsMedicare>0</InsMedicare>
          <InsMedicaid>0</InsMedicaid>
          <InsMilitary>1</InsMilitary>
          <InsState>0</InsState>
          <InsIHS>0</InsIHS>
          <InsNonUS>0</InsNonUS>
          <InsNone>0</InsNone>
          <HistoryandRiskFactors>
            <Smoker>1</Smoker>
            <Hypertension>1</Hypertension>
            <Dyslipidemia>1</Dyslipidemia>
            <FamilyHxCAD>0</FamilyHxCAD>
            <PriorMI>0</PriorMI>
            <PriorCABG>1</PriorCABG>
          </HistoryandRiskFactors>
          <CathLabVisits>
            <CathLabVisit ProcedureDate="2013-05-01" ProcedureTime="12:00:00">
              <ClinicalEvaluation />
              <ProcedureInformation>
                <PCI>0</PCI>
                <DiagnosticCath>1</DiagnosticCath>
                <ClosureMethodNA>0</ClosureMethodNA>
              </ProcedureInformation>
              <DiagnosticCatheterization>
                <DCathLName>Quinn</DCathLName>
                <DCathFName>Michaela</DCathFName>
                <DCathMName>M</DCathMName>
                <DCathNPI>0123456789</DCathNPI>
                <DiagCorAngio>1</DiagCorAngio>
                <LeftHeartCath>0</LeftHeartCath>
              </DiagnosticCatheterization>
              <CoronaryAnatomy>
                <NativeArtery>
                  <LMNA>0</LMNA>
                  <ProxLADNA>0</ProxLADNA>
                  <MidDistalLADNA>0</MidDistalLADNA>
                  <CIRCNA>0</CIRCNA>
                  <RCANA>0</RCANA>
                  <RamusNA>0</RamusNA>
                </NativeArtery>
                <Grafts>
                  <ProxLADGNA>0</ProxLADGNA>
                  <MidDistalLADGNA>0</MidDistalLADGNA>
                  <CIRCGNA>0</CIRCGNA>
                  <RCAGNA>0</RCAGNA>
                  <RamusGNA>0</RamusGNA>
                </Grafts>
              </CoronaryAnatomy>
              <PostProcedureEvents />
            </CathLabVisit>
          </CathLabVisits>
          <Discharge>
            <DCLVEFNA>0</DCLVEFNA>
            <DCDate>2013-07-01</DCDate>
            <DCStatus>1</DCStatus>
            <DCLocation>1</DCLocation>
            <DischargeMedication>
              <Medication MedID="10" MedAdmin="1" />
              <Medication MedID="11" MedAdmin="1" />
              <Medication MedID="12" MedAdmin="1" />
              <Medication MedID="13" />
              <Medication MedID="14" />
              <Medication MedID="15" />
              <Medication MedID="16" />
              <Medication MedID="17" />
              <Medication MedID="19" />
              <Medication MedID="21" />
            </DischargeMedication>
          </Discharge>
        </Episode>
      </Episodes>
    </Patient>
  </Patients>
</Submission>