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

<DeviceRequest xmlns="http://hl7.org/fhir">
  <id value="wheelchair-request"/>
  <identifier>
    <value value="wheelchair_request.1"/>
  </identifier>
  <status value="active"/>
  <intent value="order"/>
  <priority value="routine"/>
  <productCodeableConcept>
    <coding>
      <system value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
      <code value="K0001"/>
    </coding>
    <text value="Standard wheelchair"/>
  </productCodeableConcept>
  <subject>
    <reference value="Patient/bob"/>
  </subject>
  <occurrencePeriod>
    <start value="2025-05-01"/>
    <end value="2025-07-06"/>
  </occurrencePeriod>
  <authoredOn value="2025-05-01T09:33:27+07:00"/>
  <requester>
    <reference value="Practitioner/example"/>
    <display value="Dr. Adam Careful"/>
  </requester>
  <reason>
    <concept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="11865081000119107"/>
      </coding>
      <text value="Injury of left leg"/>
    </concept>
  </reason>
  <insurance>
    <reference value="Coverage/primiary-insurance"/>
    <display value="Blue Cross Blue Shield"/>
  </insurance>
  <location>
    <concept>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
        <code value="PTRES"/>
      </coding>
      <text value="Patient's Residence"/>
    </concept>
  </location>
  <supportingInfo>
    <reference value="Observation/cognitive-status-observation"/>
  </supportingInfo>
  <note>
    <text value="Patient has a broken left fibula and requires a wheelchair to move about their home while immobilizing the leg during recovery. Because the patient is a fall risk, as indicated after a cognitive assessment was completed, other mobility devices are not appropriate. A home assessment has been completed and the patient will be able to use the wheelchair without home modifications"/>
  </note>
</DeviceRequest>