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

<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="physical-therapy"/>
  <!--  insert contents here  -->
  <status value="completed"/>
  <intent value="order"/>
  <category>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="386053000"/>
      <display value="Evaluation procedure (procedure)"/>
    </coding>
    <text value="Evaluation"/>
  </category>
  <code>
    <concept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="710830005"/>
        <display value="Assessment of passive range of motion (procedure)"/>
      </coding>
      <text value="Assessment of passive range of motion"/>
    </concept>
  </code>
  <subject>
    <reference value="Patient/example"/>
  </subject>
  <occurrenceDateTime value="2016-09-27"/>
  <authoredOn value="2016-09-20"/>
  <requester>
    <display value="Ollie Ortho, MD"/>
  </requester>
  <performer>
    <display value="Paul Therapist, PT"/>
  </performer>
  <reason>
    <concept>
      <text value="assessment of mobility limitations due to osteoarthritis"/>
    </concept>
  </reason>
</ServiceRequest>