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

<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="example-drp-clinical-imaging"/>
  <meta>
    <extension id="{{kid}}" url="https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-key-pseudonymization">
      <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-drp-clinical-imaging</b></p><a name="example-drp-clinical-imaging"> </a><a name="hcexample-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>: 2026-03-03 --&gt; 2027-03-03</p><p><b>Request status reason</b>: <span title="Codes:">urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</span></p><p><b>BePSSInfo</b>: <a href="https://www.ehealth.fgov.be/standards/fhir/referral/1.0.0/NamingSystem-be-ns-pss-id.html" title="PSS ID naming system">BePSSId</a>/PSS-DRP-IMG-001</p><p><b>BeUrgencyJustification</b>: urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</p><p><b>status</b>: Active</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>: Urgent</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-drp-clinical-imaging/patient">Anonymous Patient (no stated gender), DoB: </a></p><p><b>authoredOn</b>: 2026-03-03 10:15:00+0100</p><p><b>requester</b>: <a href="PractitionerRole-72101230445-PHYSICIAN.html">PractitionerRole physician</a></p><p><b>reasonCode</b>: <span title="Codes:">urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</span></p><p><b>supportingInfo</b>: </p><ul><li><a href="ServiceRequest-example-prior-drp-clinical-imaging.html">ServiceRequest Computed tomography of abdomen with contrast (procedure)</a></li><li>Coded prior imaging request</li><li>Coded patient condition</li><li>Free-text patient condition</li><li><a href="#hcexample-drp-clinical-imaging/ci-attention-qr">Response to Questionnaire '-&gt;Imaging Attention Conditions Questionnaire' about 'Unspecified Subject'</a></li></ul><p><b>bodySite</b>: <span title="Codes:"></span></p><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse #ci-attention-qr</b></p><a name="example-drp-clinical-imaging/ci-attention-qr"> </a><a name="hcexample-drp-clinical-imaging/ci-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"/> ci-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_bck11.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-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> implants</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">Implants</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"><span><span><a href="http://snomed.info/id/40388003">SNOMED CT: 40388003</a> (Implant)</span></span></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_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.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"/> implants-other</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">Other implant type</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">urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</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">true</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_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"/> other</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">Other</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">urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</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_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: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> none</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">None</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><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><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Patient #patient</b></p><a name="example-drp-clinical-imaging/patient"> </a><a name="hcexample-drp-clinical-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: </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></div>
  </text>
  <contained>
    <QuestionnaireResponse>
      <id value="ci-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="2026-03-03T10:15:00+01:00"/>
      <item>
        <linkId value="implants"/>
        <text value="Implants"/>
        <answer>
          <valueCoding>
            <system value="http://snomed.info/sct"/>
            <code value="40388003"/>
          </valueCoding>
          <item>
            <linkId value="implants-other"/>
            <text value="Other implant type"/>
            <answer>
              <valueString value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
                <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="encrypted"/>
                  </extension>
                  <extension url="version">
                    <valuePositiveInt value="1"/>
                  </extension>
                </extension>
              </valueString>
            </answer>
          </item>
        </answer>
      </item>
      <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="true"/>
        </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="other"/>
        <text value="Other"/>
        <answer>
          <valueString value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
            <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="encrypted"/>
              </extension>
              <extension url="version">
                <valuePositiveInt value="1"/>
              </extension>
            </extension>
          </valueString>
        </answer>
      </item>
      <item>
        <linkId value="none"/>
        <text value="None"/>
        <answer>
          <valueBoolean value="false"/>
        </answer>
      </item>
    </QuestionnaireResponse>
  </contained>
  <contained>
    <Patient>
      <id value="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>
      <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>
  <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-validity-period">
    <valuePeriod>
      <start value="2026-03-03"/>
      <end value="2027-03-03"/>
    </valuePeriod>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/request-statusReason">
    <valueCodeableConcept>
      <text value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
        <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="encrypted"/>
          </extension>
          <extension url="version">
            <valuePositiveInt value="1"/>
          </extension>
        </extension>
      </text>
    </valueCodeableConcept>
  </extension>
  <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-pss-info">
    <valueIdentifier>
      <system value="https://www.ehealth.fgov.be/standards/fhir/pss/NamingSystem/pss-id"/>
      <value value="PSS-DRP-IMG-001"/>
    </valueIdentifier>
  </extension>
  <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-urgency-justification">
    <valueString value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
      <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="encrypted"/>
        </extension>
        <extension url="version">
          <valuePositiveInt value="1"/>
        </extension>
      </extension>
    </valueString>
  </extension>
  <status value="active"/>
  <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"/>
    </coding>
  </category>
  <priority value="urgent"/>
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="32962002"/>
      <display value="Computed tomography of abdomen with contrast (procedure)"/>
    </coding>
  </code>
  <subject>
    <reference value="#patient"/>
    <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>
  </subject>
  <authoredOn value="2026-03-03T10:15:00+01:00"/>
  <requester>
    <reference value="PractitionerRole/72101230445-PHYSICIAN"/>
  </requester>
  <reasonCode>
    <text value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
      <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="encrypted"/>
        </extension>
        <extension url="version">
          <valuePositiveInt value="1"/>
        </extension>
      </extension>
    </text>
  </reasonCode>
  <supportingInfo>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="prior-request"/>
    </extension>
    <reference value="ServiceRequest/example-prior-drp-clinical-imaging"/>
  </supportingInfo>
  <supportingInfo>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="prior-request"/>
    </extension>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-codeable-concept">
      <valueCodeableConcept>
        <coding>
          <system value="https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-imaging-modality"/>
          <code value="ct"/>
          <display value="CT"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <display value="Coded prior imaging request"/>
  </supportingInfo>
  <supportingInfo>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="patient-condition"/>
    </extension>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-codeable-concept">
      <valueCodeableConcept>
        <coding>
          <system value="https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-pss-qsi-indications"/>
          <code value="2506"/>
          <display value="AAA screening, family history of AAA"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <display value="Coded patient condition"/>
  </supportingInfo>
  <supportingInfo>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="patient-condition"/>
    </extension>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-codeable-concept">
      <valueCodeableConcept>
        <text value="urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}">
          <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="encrypted"/>
            </extension>
            <extension url="version">
              <valuePositiveInt value="1"/>
            </extension>
          </extension>
        </text>
      </valueCodeableConcept>
    </extension>
    <display value="Free-text patient condition"/>
  </supportingInfo>
  <supportingInfo>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/referral/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="safety-checklist"/>
    </extension>
    <reference value="#ci-attention-qr"/>
  </supportingInfo>
  <bodySite>
    <extension url="https://www.ehealth.fgov.be/standards/fhir/core-clinical/StructureDefinition/be-ext-laterality">
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="24028007"/>
        <display value="Right"/>
      </valueCoding>
    </extension>
  </bodySite>
</ServiceRequest>