<?xml version="1.0" encoding="UTF-8"?>

<DeviceRequest xmlns="http://hl7.org/fhir">
  <id value="left-lens"/>
  <identifier>
    <system value="http://www.happysight.com/prescription"/>
    <value value="15013L"/>
  </identifier>
  <!--  insert contents here  -->
  <groupIdentifier>
    <system value="http://acme.org"/>
    <value value="15013"/>
  </groupIdentifier>
  <status value="completed"/>
  <intent value="original-order"/>
  <productCodeableConcept>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/ex-visionprescriptionproduct"/>
      <code value="lens"/>
    </coding>
  </productCodeableConcept>
  <parameter>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="28842-3"/>
        <display value="Left glasses lens prescription Sphere far"/>
      </coding>
      <text value="sphere, left lens"/>
    </code>
    <valueQuantity>
      <value value="-1.00"/>
      <unit value="Diopter"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="[diop]"/>
    </valueQuantity>
  </parameter>
  <parameter>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="28843-1"/>
        <display value="Left glasses lens prescription Cylinder far"/>
      </coding>
      <text value="cylinder, left lens"/>
    </code>
    <valueQuantity>
      <value value="-0.50"/>
      <unit value="Diopter"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="[diop]"/>
    </valueQuantity>
  </parameter>
  <parameter>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="28844-9"/>
        <display value="Left glasses lens prescription Axis far"/>
      </coding>
      <text value="axis, left lens"/>
    </code>
    <valueQuantity>
      <value value="180"/>
      <unit value="Degrees"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="deg"/>
    </valueQuantity>
  </parameter>
  <subject>
    <reference value="Patient/example"/>
  </subject>
  <occurrenceDateTime value="2014-06-15"/>
  <requester>
    <reference value="Practitioner/example"/>
  </requester>
</DeviceRequest>