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Example ServiceRequest/physiotherapy (XML)

Orders and Observations Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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An example of an order for home physiotherapy (id = "physiotherapy")

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

<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="physiotherapy"/> 
      <!--    demonstrating in this example the reason reference element using contained resources
   for the purpose of this example only typically this would be a separate independent
   resource   -->
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: ServiceRequest</b> <a name="physiotherapy"> </a> </p> <div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border:
       1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ServiceRequest &quot;physiotherapy&quot; </p> </div> <p> <b> identifier</b> : Placer: 20170201-0001</p> <p> <b> basedOn</b> : <span title="   example to show how a CarePlan can be referenced from a request  "><a href="careplan-example-GPVisit.html">CarePlan/gpvisit</a> </span> </p> <p> <b> status</b> : completed</p> <p> <b> intent</b> : order</p> <h3> Codes</h3> <table class="grid"><tr> <td> -</td> <td> <b> Concept</b> </td> </tr> <tr> <td> *</td> <td> Physiotherapy of chest (regime/therapy) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #34431008)</span> </td> </tr> </table> <p> <b> subject</b> : <a href="patient-example.html">Patient/example</a>  &quot;Peter CHALMERS&quot;</p> <p> <b> occurrence</b> : Duration 15days, 1-1 per 1 days</p> <p> <b> asNeeded</b> : as needed to clear mucus <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span> </p> <p> <b> authoredOn</b> : <span title="  TimeStamp when order authorized ">2017-02-01T17:23:07Z</span> </p> <p> <b> requester</b> : <a href="practitioner-example.html">Practitioner/example: Dr Adam Careful</a>  &quot;Adam CAREFUL&quot;</p> <h3> Reasons</h3> <table class="grid"><tr> <td> -</td> <td> <b> Reference</b> </td> </tr> <tr> <td> *</td> <td> <a name="cystic-fibrosis"> </a> <blockquote> <p/>  <p> <a name="cystic-fibrosis"> </a> </p> <p> <b> clinicalStatus</b> : Active <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-condition-clinical.html">Condition Clinical Status Codes</a> #active)</span> </p> <p> <b> verificationStatus</b> : Confirmed <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-condition-ver-status.html">ConditionVerificationStatus</a> #confirmed)</span> </p> <p> <b> category</b> : Problem List Item <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-condition-category.html">Condition Category Codes</a> #problem-list-item)</span> </p> <p> <b> severity</b> : Mild <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a> #255604002)</span> </p> <p> <b> code</b> : Cystic Fibrosis <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-icd10CM.html">International Classification of Diseases, 10th Revision, Clinical Modification
                     (ICD-10-CM)</a> #E84.0 &quot;Cystic fibrosis with pulmonary manifestations&quot;)</span> </p> <p> <b> subject</b> : <a href="patient-example.html">Patient/example</a>  &quot;Peter CHALMERS&quot;</p> <p> <b> onset</b> : 2012-11-12</p> </blockquote> </td> </tr> </table> <p> <b> relevantHistory</b> : <span title="  demonstrating in this example the relevant history element using a contained
         resource for the purpose of this example only typically would reference an external
         resource "><a name="signature"> </a> </span> </p> <blockquote> <p/>  <p> <a name="signature"> </a> </p> <p> <b> target</b> : <a href="servicerequest-example2.html">ServiceRequest/physiotherapy/_history/1</a> </p> <p> <b> recorded</b> : Feb 1, 2017, 5:23:07 PM</p> <h3> Agents</h3> <table class="grid"><tr> <td> -</td> <td> <b> Role</b> </td> <td> <b> Who</b> </td> </tr> <tr> <td> *</td> <td> author (originator) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/4.0.0/CodeSystem-v3-ParticipationType.html">ParticipationType</a> #AUT)</span> </td> <td> <a href="practitioner-example.html">Practitioner/example: Dr Adam Careful</a>  &quot;Adam CAREFUL&quot;</td> </tr> </table> <h3> Signatures</h3> <table class="grid"><tr> <td> -</td> <td> <b> Type</b> </td> <td> <b> When</b> </td> <td> <b> Who</b> </td> <td> <b> TargetFormat</b> </td> <td> <b> SigFormat</b> </td> <td> <b> Data</b> </td> </tr> <tr> <td> *</td> <td> Author's Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.1
               = 'Author's Signature', stated as 'Author's Signature')</td> <td> Feb 1, 2017, 5:23:07 PM</td> <td> <a href="practitioner-example.html">Practitioner/example: Dr Adam Careful</a>  &quot;Adam CAREFUL&quot;</td> <td> application/fhir+xml</td> <td> application/signature+xml</td> <td> dGhpcyBibG9iIGlzIHNuaXBwZWQ=</td> </tr> </table> </blockquote> </div> </text> <contained> 
    <Provenance> 
      <id value="signature"/> 
      <target> 
        <reference value="ServiceRequest/physiotherapy/_history/1"/> 
      </target> 
      <recorded value="2017-02-01T17:23:07Z"/> 
      <agent> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="AUT"/> 
          </coding> 
        </role> 
        <who> 
          <reference value="Practitioner/example"/> 
          <display value="Dr Adam Careful"/> 
        </who> 
      </agent> 
      <signature> 
        <type> 
          <system value="urn:iso-astm:E1762-95:2013"/> 
          <code value="1.2.840.10065.1.12.1.1"/> 
          <display value="Author's Signature"/> 
        </type> 
        <when value="2017-02-01T17:23:07Z"/> 
        <who> 
          <reference value="Practitioner/example"/> 
          <display value="Dr Adam Careful"/> 
        </who> 
        <targetFormat value="application/fhir+xml"/> 
        <sigFormat value="application/signature+xml"/> 
        <data value="dGhpcyBibG9iIGlzIHNuaXBwZWQ="/> 
      </signature> 
    </Provenance> 
  </contained> 
  <contained> 
    <Condition> 
      <id value="cystic-fibrosis"/> 
      <clinicalStatus> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/condition-clinical"/> 
          <code value="active"/> 
        </coding> 
        </clinicalStatus> 
        <verificationStatus> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/condition-ver-status"/> 
          <code value="confirmed"/> 
        </coding> 
        </verificationStatus> 
      <category> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/condition-category"/> 
          <code value="problem-list-item"/> 
          <display value="Problem List Item"/> 
        </coding> 
      </category> 
      <severity> 
        <coding> 
          <system value="http://snomed.info/sct"/> 
          <code value="255604002"/> 
          <display value="Mild"/> 
        </coding> 
      </severity> 
      <code> 
        <coding> 
          <system value="http://hl7.org/fhir/sid/icd-10-cm"/> 
          <code value="E84.0"/> 
          <display value="Cystic fibrosis with pulmonary manifestations"/> 
        </coding> 
        <text value="Cystic Fibrosis"/> 
      </code> 
      <subject> 
        <reference value="Patient/example"/> 
      </subject> 
      <onsetDateTime value="2012-11-12"/> 
    </Condition> 
  </contained> 
  <identifier> 
    <type> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/> 
        <code value="PLAC"/> 
        <display value="Placer Identifier"/> 
      </coding> 
      <text value="Placer"/> 
    </type> 
    <system value="http://goodhealth.org/placer-ids">
    </system> 
    <value value="20170201-0001"/> 
  </identifier> 
      <!--     example to show how a CarePlan can be referenced from a request    -->
  <basedOn> 
    <reference value="CarePlan/gpvisit"/> 
  </basedOn> 
  <status value="completed"/> 
  <intent value="order"/> 
      <!--    Physiotherapy or home excercises would be a common use case for as needed. E.g.
   exercises for cystic fibrosis - "Chest therapy 1-4 times per day as needed to clear
   mucus"    -->
  <code> 
    <concept> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <code value="34431008"/> 
      <display value="Physiotherapy of chest (regime/therapy)"/> 
    </coding> 
    </concept> 
  </code> 
  <subject> 
    <reference value="Patient/example"/> 
  </subject> 
  <occurrenceTiming> 
    <repeat> 
      <duration value="15"/> 
      <durationMax value="25"/> 
      <durationUnit value="min"/> 
      <frequency value="1"/> 
      <frequencyMax value="4"/> 
      <period value="1"/> 
      <periodUnit value="d"/> 
    </repeat> 
  </occurrenceTiming> 
  <asNeededCodeableConcept> 
    <text value="as needed to clear mucus"/> 
  </asNeededCodeableConcept> 
      <!--    TimeStamp when order authorized   -->
  <authoredOn value="2017-02-01T17:23:07Z"/> 
  <requester> 
      <reference value="Practitioner/example"/> 
      <display value="Dr Adam Careful"/> 
  </requester> 
      <!--    demonstrating in this example the reason reference element using a contained
   resource for the purpose of this example only typically would reference an external
   resource   -->
  <reason> 
     <reference> 
      <reference value="#cystic-fibrosis"/> 
    </reference> 
  </reason> 
      <!--    demonstrating in this example the relevant history element using a contained
   resource for the purpose of this example only typically would reference an external
   resource   -->
  <relevantHistory> 
    <reference value="#signature"/> 
    <display value="Author's Signature"/> 
  </relevantHistory> 
</ServiceRequest> 

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.