PSS radiology scenario 07 - XML Representation - eReferral Implementation Guide v3.0.0

eReferral Implementation Guide, published by Riziv-Inami Platform. This guide is not an authorized publication; it is the continuous build for version 3.0.0 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
: PSS radiology scenario 07

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="example-pss-radiology-scenario-07"/>
  <meta>
    <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-pss-radiology-scenario-07</b></p><a name="example-pss-radiology-scenario-07"> </a><a name="hcexample-pss-radiology-scenario-07"> </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>: 2026-09-24 --&gt; 2027-09-24</p><p><b>BePSSInfo</b>: <a href="https://build.fhir.org/ig/hl7-be/referral-uhmep/NamingSystem-be-ns-pss-id.html" title="PSS ID naming system">BePSSId</a>/PSS-RAD-007</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>: Routine</p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 702684006}">Magnetic resonance angiography of head with contrast (procedure)</span></p><p><b>subject</b>: <a href="#hcexample-pss-radiology-scenario-07/pss-radiology-scenario-07-patient">Anonymous Patient (no stated gender), DoB: </a></p><p><b>authoredOn</b>: 2026-09-24 10:15:00+0200</p><p><b>requester</b>: <a href="PractitionerRole-72101230445-PHYSICIAN.html">Physician Example (official) (https://www.ehealth.fgov.be/standards/fhir/core/NamingSystem/ssin#BeSSINNamingSystem#72101230445 (use: official)): physician</a></p><p><b>reasonCode</b>: <span title="Codes:">urn:be:fgov:pseudo-encrypted:v1:{{kid}}:{{jwe}}</span></p><p><b>supportingInfo</b>: </p><ul><li><a href="#hcexample-pss-radiology-scenario-07/pss-radiology-scenario-07-checklist">Response to Questionnaire '-&gt;Imaging Attention Conditions Questionnaire' about 'Unspecified Subject'</a></li><li>Patient condition</li><li>Patient condition</li></ul><p><b>note</b>: </p><blockquote><div><p>urn:be:fgov:pseudo:v1:{{kid}}:{{jwe}}</p>
</div></blockquote><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: Patient #pss-radiology-scenario-07-patient</b></p><a name="example-pss-radiology-scenario-07/pss-radiology-scenario-07-patient"> </a><a name="hcexample-pss-radiology-scenario-07/pss-radiology-scenario-07-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><hr/><blockquote><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse #pss-radiology-scenario-07-checklist</b></p><a name="example-pss-radiology-scenario-07/pss-radiology-scenario-07-checklist"> </a><a name="hcexample-pss-radiology-scenario-07/pss-radiology-scenario-07-checklist"> </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" class="xhtTableBorder1"><tr class="xhtRowBorder2"><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><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 scope="col" style="" class="hierarchy xhtCellBorder1"><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 class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck1.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> pss-radiology-scenario-07-checklist</td><td style="" class="hierarchy xhtCellBorder1"></td><td style="" class="hierarchy xhtCellBorder1"></td><td style="" class="hierarchy xhtCellBorder1">Questionnaire:<a href="https://build.fhir.org/ig/hl7-be/referral-uhmep/Questionnaire-be-questionnaire-imaging-attention-conditions.html">Imaging Attention Conditions Questionnaire</a></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>implants</td><td style="" class="hierarchy xhtCellBorder1">Implants</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>pregnancy</td><td style="" class="hierarchy xhtCellBorder1">Pregnancy</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">false</td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>diabetes</td><td style="" class="hierarchy xhtCellBorder1">Diabetes</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">false</td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>allergy-contrast-agent</td><td style="" class="hierarchy xhtCellBorder1">Allergy to contrast agent</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">false</td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>metallic-debris</td><td style="" class="hierarchy xhtCellBorder1">Metallic debris</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">false</td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>renal-dysfunction</td><td style="" class="hierarchy xhtCellBorder1">Renal dysfunction</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">false</td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck10.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>other</td><td style="" class="hierarchy xhtCellBorder1">Other</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck00.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><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"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">pss-radiology-scenario-07-checklist / </span>none</td><td style="" class="hierarchy xhtCellBorder1">None</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">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,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></blockquote></div>
  </text>
  <contained>
    <Patient>
      <id value="pss-radiology-scenario-07-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>
  <contained>
    <QuestionnaireResponse>
      <id value="pss-radiology-scenario-07-checklist"/>
      <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/drp/Questionnaire/be-questionnaire-imaging-attention-conditions"/>
      <status value="completed"/>
      <authored value="2026-09-24T10:15:00+02:00"/>
      <item>
        <linkId value="implants"/>
        <text value="Implants"/>
      </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="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="other"/>
        <text value="Other"/>
      </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/drp/StructureDefinition/be-ext-validity-period">
    <valuePeriod>
      <start value="2026-09-24"/>
      <end value="2027-09-24"/>
    </valuePeriod>
  </extension>
  <extension
             url="https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-pss-info">
    <valueIdentifier>
      <system
              value="https://www.ehealth.fgov.be/standards/fhir/pss/NamingSystem/pss-id"/>
      <value value="PSS-RAD-007"/>
    </valueIdentifier>
  </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="routine"/>
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="702684006"/>
      <display
               value="Magnetic resonance angiography of head with contrast (procedure)"/>
    </coding>
  </code>
  <subject>
    <reference value="#pss-radiology-scenario-07-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="2026-09-24T10:15:00+02:00"/>
  <requester>🔗 
    <reference value="PractitionerRole/72101230445-PHYSICIAN"/>
  </requester>
  <reasonCode>
    <text value="urn:be:fgov:pseudo-encrypted: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/drp/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="safety-checklist"/>
    </extension>
    <reference value="#pss-radiology-scenario-07-checklist"/>
  </supportingInfo>
  <supportingInfo>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="patient-condition"/>
    </extension>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/drp/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="5000247"/>
          <display value="Head trauma, headache"/>
        </coding>
        <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="Patient condition"/>
  </supportingInfo>
  <supportingInfo>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/drp/StructureDefinition/be-ext-radiology-supporting-info-role">
      <valueCode value="patient-condition"/>
    </extension>
    <extension
               url="https://www.ehealth.fgov.be/standards/fhir/drp/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="193"/>
        </coding>
        <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="Patient condition"/>
  </supportingInfo>
  <note>
    <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>
  </note>
</ServiceRequest>