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Example ServiceRequest/myringotomy (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)

An example of a Myringotomy referral request (id = "myringotomy")

<?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> 

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.