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

<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="myringotomy"/>
  <identifier>
    <system value="http://orionhealth.com/fhir/apps/referralids"/>
    <value value="ret4421"/>
  </identifier>
  <basedOn>
    <display value="ServiceRequest for Myringotomy and insertion of short-term grommet"/>
  </basedOn>
  <replaces>
    <display value="prior ServiceRequest"/>
  </replaces>
  <requisition>
    <value value="1234"/>
  </requisition>
  <status value="active"/>
  <intent value="order"/>
  <category>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="103696004"/>
      <display value="Patient referral to specialist"/>
    </coding>
  </category>
  <priority value="routine"/>
  <code>
    <concept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="172676009"/>
        <display value="Myringotomy and insertion of short-term grommet"/>
      </coding>
      <text value="Insertion of grommets"/>
    </concept>
  </code>
  <subject>
    <reference value="https://fhir.example.org/blaze/fhir/Patient/77662"/>
    <display value="Beverly Weaver"/>
  </subject>
  <encounter>
    <display value="Beverly Waver's encounter on 2014-02-14"/>
  </encounter>
  <occurrencePeriod>
    <end value="2014-03-14"/>
  </occurrencePeriod>
  <authoredOn value="2014-02-14"/>
  <requester>
    <reference value="https://fhir.example.org/blaze/fhir/Practitioner/77272"/>
    <display value="Serena Shrink"/>
  </requester>
  <performerType>
    <coding>
      <system value="http://orionhealth.com/fhir/apps/specialties"/>
      <code value="ent"/>
      <display value="ENT"/>
    </coding>
  </performerType>
  <performer>
    <reference value="https://fhir.example.org/blaze/fhir/Practitioner/76597"/>
    <display value="Dr Dave"/>
  </performer>
  <reason>
    <concept>
      <text value="For consideration of Grommets"/>
    </concept>
  </reason>
  <note>
    <authorString value="Serena Shrink"/>
    <time value="2014-02-14"/>
    <text value="In the past 2 years Beverly has had 6 instances of rt-sided Otitis media. She is     falling behind her peers at school, and displaying some learning difficulties."/>
  </note>
</ServiceRequest>