Example: Prior diagnostic imaging referral - XML Representation

eReferral Implementation Guide
2.0.0 - Belgium flag
eReferral Implementation Guide, published by Riziv-Inami Platform. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-be/referral-uhmep/ and changes regularly. See the Directory of published versions
: Example: Prior diagnostic imaging referral

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="example-prior-drp-clinical-imaging"/>
  <meta>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-key-pseudonymization" id="{{kid}}">
      <extension url="key">
        <valueString value="urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}}">
          <extension
                     url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization">
            <extension url="marker">
              <valueBoolean value="true"/>
            </extension>
            <extension url="format">
              <valueCode value="direct"/>
            </extension>
            <extension url="version">
              <valuePositiveInt value="2"/>
            </extension>
          </extension>
        </valueString>
      </extension>
    </extension>
    <profile
             value="https://www.riziv-inami.be/standards/fhir/ereferral/StructureDefinition/ereferral-servicerequest-diagnosticimaging"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ServiceRequest example-prior-drp-clinical-imaging</b></p><a name="example-prior-drp-clinical-imaging"> </a><a name="hcexample-prior-drp-clinical-imaging"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ereferral-servicerequest-diagnosticimaging.html">EReferralServiceRequestDiagnosticImaging</a></p></div><p><b>BeValidityPeriod</b>: 2025-11-18 --&gt; 2026-11-18</p><p><b>status</b>: Completed</p><p><b>intent</b>: Order</p><p><b>category</b>: <span title="Codes:{https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-prescription-type diagnostic-imaging-appendix-82}">Diagnostic imaging (Appendix 82)</span>, <span title="Codes:{http://snomed.info/sct 363679005}">Imaging</span>, <span title="Codes:{https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-request-track ambulatory}">Ambulatory</span></p><p><b>priority</b>: Routine</p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 32962002}">Computed tomography of abdomen with contrast (procedure)</span></p><p><b>subject</b>: <a href="#hcexample-prior-drp-clinical-imaging/prior-imaging-patient">Anonymous Patient (no stated gender), DoB:  ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}} (use: official, ))</a></p><p><b>authoredOn</b>: 2025-11-18 09:30:00+0100</p><p><b>requester</b>: <a href="PractitionerRole-72101230445-PHYSICIAN.html">PractitionerRole physician</a></p><p><b>supportingInfo</b>: <a href="#hcexample-prior-drp-clinical-imaging/prior-imaging-attention-qr">Response to Questionnaire '-&gt;Imaging Attention Conditions Questionnaire' about 'Unspecified Subject'</a></p><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Patient #prior-imaging-patient</b></p><a name="example-prior-drp-clinical-imaging/prior-imaging-patient"> </a><a name="hcexample-prior-drp-clinical-imaging/prior-imaging-patient"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="https://www.ehealth.fgov.be/standards/fhir/core/2.2.0/StructureDefinition-be-patient.html">BePatient</a> version: 2.2.0</p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Anonymous Patient (no stated gender), DoB:  ( https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}} (use: official, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Gender at the time of birth. The gender at birth has lasting consequences on clinical and medical level."><a href="https://www.ehealth.fgov.be/standards/fhir/core/2.2.0/StructureDefinition-be-ext-gender-at-birth.html">BeExtGenderAtBirth</a></td><td colspan="3"><span title="Codes:{http://hl7.org/fhir/administrative-gender other}">Other</span></td></tr></table></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse #prior-imaging-attention-qr</b></p><a name="example-prior-drp-clinical-imaging/prior-imaging-attention-qr"> </a><a name="hcexample-prior-drp-clinical-imaging/prior-imaging-attention-qr"> </a><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"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ereferral-imaging-attention-conditions-response.html">EReferralImagingAttentionConditionsResponse</a></p></div><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> prior-imaging-attention-qr</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire:<a href="https://www.ehealth.fgov.be/standards/fhir/referral/1.0.0/Questionnaire-be-questionnaire-imaging-attention-conditions.html">Imaging Attention Conditions Questionnaire</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> pregnancy</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Pregnancy</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> diabetes</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Diabetes</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> allergy-contrast-agent</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Allergy to contrast agent</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> metallic-debris</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Metallic debris</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> renal-dysfunction</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Renal dysfunction</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> none</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">None</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></blockquote></div>
  </text>
  <contained>
    <Patient>
      <id value="prior-imaging-patient"/>
      <meta>
        <profile
                 value="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient|2.2.0"/>
      </meta>
      <extension
                 url="https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-ext-gender-at-birth">
        <valueCodeableConcept>
          <extension
                     url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content">
            <extension url="encryptedValue">
              <valueString
                           value="urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}"/>
            </extension>
            <extension url="marker">
              <valueBoolean value="true"/>
            </extension>
            <extension url="format">
              <valueCode value="encrypted"/>
            </extension>
            <extension url="version">
              <valuePositiveInt value="1"/>
            </extension>
          </extension>
          <coding>
            <system value="http://hl7.org/fhir/administrative-gender"/>
            <code value="other"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <identifier>
        <use value="official"/>
        <system
                value="https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin"/>
        <value value="urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}}">
          <extension
                     url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization">
            <extension url="marker">
              <valueBoolean value="true"/>
            </extension>
            <extension url="format">
              <valueCode value="direct"/>
            </extension>
            <extension url="version">
              <valuePositiveInt value="2"/>
            </extension>
          </extension>
        </value>
      </identifier>
      <birthDate>
        <extension
                   url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content">
          <extension url="encryptedValue">
            <valueString
                         value="urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}"/>
          </extension>
          <extension url="marker">
            <valueBoolean value="true"/>
          </extension>
          <extension url="format">
            <valueCode value="encrypted"/>
          </extension>
          <extension url="version">
            <valuePositiveInt value="1"/>
          </extension>
        </extension>
      </birthDate>
    </Patient>
  </contained>
  <contained>
    <QuestionnaireResponse>
      <id value="prior-imaging-attention-qr"/>
      <meta>
        <profile
                 value="https://www.riziv-inami.be/standards/fhir/ereferral/StructureDefinition/ereferral-imaging-attention-conditions-response"/>
      </meta>
      <questionnaire
                     value="https://www.ehealth.fgov.be/standards/fhir/referral/Questionnaire/be-questionnaire-imaging-attention-conditions"/>
      <status value="completed"/>
      <authored value="2025-11-18T09:30:00+01:00"/>
      <item>
        <linkId value="pregnancy"/>
        <text value="Pregnancy"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
      <item>
        <linkId value="diabetes"/>
        <text value="Diabetes"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
      <item>
        <linkId value="allergy-contrast-agent"/>
        <text value="Allergy to contrast agent"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
      <item>
        <linkId value="metallic-debris"/>
        <text value="Metallic debris"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
      <item>
        <linkId value="renal-dysfunction"/>
        <text value="Renal dysfunction"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
      <item>
        <linkId value="none"/>
        <text value="None"/>
        <answer>
          <valueBoolean value="true"/>
        </answer>
      </item>
    </QuestionnaireResponse>
  </contained>
  <extension
             url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-validity-period">
    <valuePeriod>
      <start value="2025-11-18"/>
      <end value="2026-11-18"/>
    </valuePeriod>
  </extension>
  <status value="completed"/>
  <intent value="order"/>
  <category>
    <coding>
      <system
              value="https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-prescription-type"/>
      <code value="diagnostic-imaging-appendix-82"/>
    </coding>
  </category>
  <category>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="363679005"/>
    </coding>
  </category>
  <category>
    <coding>
      <system
              value="https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-request-track"/>
      <code value="ambulatory"/>
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  </category>
  <priority value="routine"/>
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="32962002"/>
      <display
               value="Computed tomography of abdomen with contrast (procedure)"/>
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  </code>
  <subject>
    <reference value="#prior-imaging-patient"/>
  </subject>
  <authoredOn value="2025-11-18T09:30:00+01:00"/>
  <requester>🔗 
    <reference value="PractitionerRole/72101230445-PHYSICIAN"/>
  </requester>
  <supportingInfo>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="safety-checklist"/>
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    <reference value="#prior-imaging-attention-qr"/>
  </supportingInfo>
</ServiceRequest>
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