{ "resourceType" : "ServiceRequest", "id" : "example-pss-radiology-scenario-07", "meta" : { "profile" : ["https://www.riziv-inami.be/standards/fhir/ereferral/StructureDefinition/ereferral-servicerequest-diagnosticimaging"] }, "language" : "en", "text" : { "status" : "extensions", "div" : "

Generated Narrative: ServiceRequest example-pss-radiology-scenario-07

Profile: EReferralServiceRequestDiagnosticImaging

BeValidityPeriod: 2026-09-24 --> 2027-09-24

BePSSInfo: BePSSId/PSS-RAD-007

status: Active

intent: Order

category: Diagnostic imaging (Appendix 82), Imaging, Ambulatory

priority: Routine

code: Magnetic resonance angiography of head with contrast (procedure)

subject: Anonymous Patient (no stated gender), DoB:

authoredOn: 2026-09-24 10:15:00+0200

requester: Physician Example (official) (https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#72101230445\u00a0(use:\u00a0official)): physician

reasonCode: urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}

supportingInfo:

note:

urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}

\n

Generated Narrative: Patient #pss-radiology-scenario-07-patient

Profile: BePatient version: 2.2.0

Anonymous Patient (no stated gender), DoB:

BeExtGenderAtBirthOther

Generated Narrative: QuestionnaireResponse #pss-radiology-scenario-07-checklist

Profile: EReferralImagingAttentionConditionsResponse

\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextDefinitionAnswer\"doco\"
\"\"\"\" pss-radiology-scenario-07-checklistQuestionnaire:Imaging Attention Conditions Questionnaire
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / implantsImplants
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / pregnancyPregnancyfalse
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / diabetesDiabetesfalse
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / allergy-contrast-agentAllergy to contrast agentfalse
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / metallic-debrisMetallic debrisfalse
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / renal-dysfunctionRenal dysfunctionfalse
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / otherOther
\"\"\"\"\"\" pss-radiology-scenario-07-checklist / noneNonetrue

\"doco\" Documentation for this format
" }, "contained" : [{ "resourceType" : "Patient", "id" : "pss-radiology-scenario-07-patient", "meta" : { "profile" : ["https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-patient|2.2.0"] }, "extension" : [{ "url" : "https://www.ehealth.fgov.be/standards/fhir/core/StructureDefinition/be-ext-gender-at-birth", "valueCodeableConcept" : { "extension" : [{ "extension" : [{ "url" : "encryptedValue", "valueString" : "urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}" }, { "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content" }], "coding" : [{ "system" : "http://hl7.org/fhir/administrative-gender", "code" : "other" }] } }], "_birthDate" : { "extension" : [{ "extension" : [{ "url" : "encryptedValue", "valueString" : "urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}" }, { "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymized-content" }] } }, { "resourceType" : "QuestionnaireResponse", "id" : "pss-radiology-scenario-07-checklist", "meta" : { "profile" : ["https://www.riziv-inami.be/standards/fhir/ereferral/StructureDefinition/ereferral-imaging-attention-conditions-response"] }, "questionnaire" : "https://www.ehealth.fgov.be/standards/fhir/drp/Questionnaire/be-questionnaire-imaging-attention-conditions", "status" : "completed", "authored" : "2026-09-24T10:15:00+02:00", "item" : [{ "linkId" : "implants", "text" : "Implants" }, { "linkId" : "pregnancy", "text" : "Pregnancy", "answer" : [{ "valueBoolean" : false }] }, { "linkId" : "diabetes", "text" : "Diabetes", "answer" : [{ "valueBoolean" : false }] }, { "linkId" : "allergy-contrast-agent", "text" : "Allergy to contrast agent", "answer" : [{ "valueBoolean" : false }] }, { "linkId" : "metallic-debris", "text" : "Metallic debris", "answer" : [{ "valueBoolean" : false }] }, { "linkId" : "renal-dysfunction", "text" : "Renal dysfunction", "answer" : [{ "valueBoolean" : false }] }, { "linkId" : "other", "text" : "Other" }, { "linkId" : "none", "text" : "None", "answer" : [{ "valueBoolean" : true }] }] }], "extension" : [{ "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-validity-period", "valuePeriod" : { "start" : "2026-09-24", "end" : "2027-09-24" } }, { "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-pss-info", "valueIdentifier" : { "system" : "https://www.ehealth.fgov.be/standards/fhir/pss/NamingSystem/pss-id", "value" : "PSS-RAD-007" } }], "status" : "active", "intent" : "order", "category" : [{ "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-prescription-type", "code" : "diagnostic-imaging-appendix-82" }] }, { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "363679005" }] }, { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-request-track", "code" : "ambulatory" }] }], "priority" : "routine", "code" : { "coding" : [{ "system" : "http://snomed.info/sct", "code" : "702684006", "display" : "Magnetic resonance angiography of head with contrast (procedure)" }] }, "subject" : { "reference" : "#pss-radiology-scenario-07-patient", "identifier" : { "use" : "official", "system" : "https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin", "value" : "urn:be:fgov:pseudo:v2:{{SEC1}}:{{transit-info}}", "_value" : { "extension" : [{ "extension" : [{ "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "direct" }, { "url" : "version", "valuePositiveInt" : 2 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization" }] } } }, "authoredOn" : "2026-09-24T10:15:00+02:00", "requester" : { "reference" : "PractitionerRole/72101230445-PHYSICIAN" }, "reasonCode" : [{ "text" : "urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}", "_text" : { "extension" : [{ "extension" : [{ "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization" }] } }], "supportingInfo" : [{ "extension" : [{ "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-radiology-supporting-info-role", "valueCode" : "safety-checklist" }], "reference" : "#pss-radiology-scenario-07-checklist" }, { "extension" : [{ "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-radiology-supporting-info-role", "valueCode" : "patient-condition" }, { "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-codeable-concept", "valueCodeableConcept" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-pss-qsi-indications", "code" : "5000247", "display" : "Head trauma, headache" }], "text" : "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}", "_text" : { "extension" : [{ "extension" : [{ "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization" }] } } }], "display" : "Patient condition" }, { "extension" : [{ "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-radiology-supporting-info-role", "valueCode" : "patient-condition" }, { "url" : "https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-codeable-concept", "valueCodeableConcept" : { "coding" : [{ "system" : "https://www.ehealth.fgov.be/standards/fhir/terminology/CodeSystem/be-cs-pss-qsi-indications", "code" : "193" }], "text" : "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}", "_text" : { "extension" : [{ "extension" : [{ "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization" }] } } }], "display" : "Patient condition" }], "note" : [{ "text" : "urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}", "_text" : { "extension" : [{ "extension" : [{ "url" : "marker", "valueBoolean" : true }, { "url" : "format", "valueCode" : "encrypted" }, { "url" : "version", "valuePositiveInt" : 1 }], "url" : "https://www.ehealth.fgov.be/standards/fhir/infsec/StructureDefinition/be-ext-pseudonymization" }] } }] }