Connectathon 11 Snapshot

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Diagnosticreport-micro1.xml

Raw XML (canonical form)

An example of a complex Micro Isolate and Sensitivities (id = "micro")

<DiagnosticReport xmlns="http://hl7.org/fhir">
  <id value="micro"/>
  <text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: micro</p><p><b>contained</b>: , , , , , , , , , , , , , , , , , , , , , , , , , </p><p><b>identifier</b>: 290741144</p><p><b>status</b>: final</p><p><b>category</b>: Microbiology <span>(Details : {http://hl7.org/fhir/v2/0074 code 'MB' = 'Microbiology)</span></p><p><b>code</b>: Culture, MRSA <span>(Details : {LOINC code '632-0' = 'Bacteria identified in Wound by Aerobe culture)</span></p><p><b>subject</b>: <a>Patient/example</a></p><p><b>effective</b>: 07/08/2009 7:00:00 PM</p><p><b>issued</b>: 10/08/2009 8:25:44 AM</p><p><b>performer</b>: Todd Ashby</p><p><b>request</b>: id: req; Patient/example; 255337816</p><p><b>result</b>: id: org1; status: final; Staphylococcus aureus Panel <span>(Details : {http://acme.org/lab/codes/organisms code 'Staaur' = '??)</span>; Patient/example</p></div></text><contained>
  <!--     

This diagnostic report shows how to do a microbiology isolate and sensitivity. This is
     a particular complex case, with two different susceptibilities.

The basic structure of the report is

DiagnosticReport - metadata
  group  - base group, code that says, ICS
    group - organism = Staphylococcus aureus. You'd repeat at this level if you had more
     than one organism
      group - automated broth dilution
        results = sensitivities
      group - Disk diffusion
        results = sensitivities

Note, then, that the organism appears in the group code, not a result code.

This diagnostic report was developed from this example HL7 v2 message:

OBR|1|255337816|290741144^HNAM_ORDERID-MRSACULT-^HNAM_ORDERID|MRSACULT^Culture, MRSA^^632-0^Culture,
     MRSA|||20090807190000|||101022^Unit|||Y|2009080800|Wound^^Right hand wound^Hand R|00013442^ASHBY^TOD
    D^R^^^PA||||000002009219104402^HNA_ACCN~21619128^HNA_ACCNID||20090810082544||MB|F||1^^^20090808040954
    ^^R~^^^^^R|||||||||20090807195000||||||||||||||||
OBX|4|CE|ORGANISM|1|Staaur^Staphylococcus aureus^Staaur|||||A~S|F|||||^10304|
OBX|5|CE|CULTPOSNEG||POS|||POS|||F||||||
OBR|2|xxxxx|xxxxxxx|60790^Susceptibility - Automated broth dilution (Billed)|||20120911072700||20025
    57|xxx||||2012091100||xxxxx||||000002012255101033^xxxxx||20120914165737||MB|F|^1^Staaur&Staphylococcu
    s aureus&310783|1^^^20120911142558^^R~^^^^^R||60108|||||||||||||||||||||||
OBX|1|ST|60504^Ampicillin&AST Interp|1|Resistant|||RESIST||A~S|F||N|||^9315|
OBX|2|ST|60512^Cefazolin&AST Dilutn|1|<=2|||SUSCEPT||A~S|F||N|||^9315|
OBX|3|ST|60512^Cefazolin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315|
OBX|4|ST|60516^Cefoxitin&AST Dilutn|1|<=4|||SUSCEPT||A~S|F||N|||^9315|
OBX|5|ST|60516^Cefoxitin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315|
OBX|6|ST|60527^Clindamycin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|7|ST|60527^Clindamycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|8|ST|61203^Daptomycin&AST Dilutn|1|<=1|||SUSCEPT||A~S|F||Y|||^9315|
OBX|9|ST|61203^Daptomycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|10|ST|60532^Doxycycline&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||N|||^9315|
OBX|11|ST|60532^Doxycycline&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315|
OBX|12|ST|60533^Erythromycin&AST Dilutn|1|>=8|||RESIST||A~S|F||Y|||^9315|
OBX|13|ST|60533^Erythromycin&AST Interp|1|Resistant|||RESIST||A~S|F||Y|||^9315|
OBX|14|ST|60536^Gentamicin&AST Dilutn|1|<=2|||SUSCEPT||A~S|F||Y|||^9315|
OBX|15|ST|60536^Gentamicin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|16|ST|61007^Levofloxacin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|17|ST|61007^Levofloxacin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|18|NM|60699^Linezolid&AST Dilutn|1|4|||SUSCEPT||A~S|F||Y|||^9315|
OBX|19|ST|60699^Linezolid&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|20|ST|61204^Moxifloxacin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||N|||^9315|
OBX|21|ST|61204^Moxifloxacin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||N|||^9315|
OBX|22|NM|60551^Oxacillin&AST Dilutn|1|0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|23|ST|60551^Oxacillin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|24|ST|60552^Penicillin&AST Dilutn|1|>=2|||RESIST||A~S|F||Y|||^9315|
OBX|25|ST|60552^Penicillin&AST Interp|1|Resistant|||RESIST||A~S|F||Y|||^9315|
OBX|26|ST|60697^Quinupristin/Dalfopristin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|27|ST|60697^Quinupristin/Dalfopristin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|28|ST|60555^Rifampin&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|29|ST|60555^Rifampin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|30|ST|60558^Tetracycline&AST Dilutn|1|<=0.5|||SUSCEPT||A~S|F||Y|||^9315|
OBX|31|ST|60558^Tetracycline&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|32|ST|60561^Trimethoprim/Sulfamethoxazole&AST Dilutn|1|<=1/19|||SUSCEPT||A~S|F||Y|||^9315|
OBX|33|ST|60561^Trimethoprim/Sulfamethoxazole&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|34|NM|60563^Vancomycin&AST Dilutn|1|1|||SUSCEPT||A~S|F||Y|||^9315|
OBX|35|ST|60563^Vancomycin&AST Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|
OBX|36|ST|60500^Susceptibilities Performed&AST Dilutn|1|Performed|||||A~S|F||N|||^9315|
OBX|37|ST|60500^Susceptibilities Performed&AST Interp|1|Completed|||||A~S|F||N|||^9315|
OBX|38|ST|2099930^D-Test&AST Interp|1|See Note|||||A~S|F||Y|||^9315|
OBX|39|ST|2099935^Interpretative Information&AST Interp|1|See Note|||||A~S|F||Y|||^9315|
NTE|1|L|D-Test:  Negative - This isolate does not demonstrate|
NTE|2|L|inducible clindamycin resistance in vitro.|
OBR|3|xxxx|xxxxxxx|60418^Susceptibility - Disk diffusion (Billed)|||20120911072700|||xxxxx||||201209
    1100||xxxxx||||000002012255101033^xxxxxx||20120914165737||MB|F|^1^Staaur&Staphylococcus
     aureus&310783|1^^^20120911142558^^R~^^^^^R||60108|||||||||||||||||||||||
OBX|1|ST|60036^Oxacillin Screen&KB Zone|1|60416|||SUSCEPT||A~S|F||N|||^9315|
OBX|2|ST|60036^Oxacillin Screen&KB Interp|1|Susceptible|||SUSCEPT||A~S|F||Y|||^9315|

     -->
  <!--      first, a series of atomic results matching the atomice result OBXs      -->
    <Observation>
      <id value="obx1-4"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="ORGANISM"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueCodeableConcept>
      <!--      CE      -->
        <coding>
          <system value="http://acme.org/lab/codes/organisms"/>
          <code value="Staaur"/>
        </coding>
        <text value="Staphylococcus aureus"/>
      </valueCodeableConcept>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx1-5"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="CULTPOSNEG"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueCodeableConcept>
        <coding>
          <system value="http://acme.org/lab/codes/flags"/>
          <code value="POS"/>
        </coding>
      </valueCodeableConcept>
    </Observation>
  </contained>
  <contained>
  <!--      this is an interpretation without a value, as in the source message. Quite Strange
          -->
    <Observation>
      <id value="obx2-1"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60504"/>
          <display value="Ampicillin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="R"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-2"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60512"/>
          <display value="Cefazolin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="2"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-4"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60516"/>
          <display value="Cefoxitin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="4"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-6"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60527"/>
          <display value="Clindamycin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&gt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-8"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="61203"/>
          <display value="Daptomycin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="1"/>
        <comparator value="&gt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-10"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60532"/>
          <display value="Doxycycline"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-12"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60533"/>
          <display value="Erythromycin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="8"/>
        <comparator value="&gt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="R"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-14"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60536"/>
          <display value="Gentamicin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="2"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-16"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="61007"/>
          <display value="Levofloxacin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-18"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60699"/>
          <display value="Linezolid"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="4"/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-20"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="61204"/>
          <display value="Moxifloxacin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-22"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60551"/>
          <display value="Oxacillin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-24"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60552"/>
          <display value="Penicillin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="2"/>
        <comparator value="&gt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="R"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-26"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60697"/>
          <display value="Quinupristin/Dalfopristin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-28"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60555"/>
          <display value="Rifampin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-30"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60558"/>
          <display value="Tetracycline"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.5"/>
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-32"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60561"/>
          <display value="Trimethoprim/Sulfamethoxazole"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="0.0526"/>
      <!--      not sure what to do with <=1/19      -->
        <comparator value="&lt;="/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx2-34"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60563"/>
          <display value="Vancomycin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueQuantity>
        <value value="1"/>
      </valueQuantity>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="nte-1"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="2099930"/>
          <display value="D-Test"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <valueString value="D-Test:  Negative - This isolate does not demonstrate inducible clindamycin resistance
       in vitro."/>
    </Observation>
  </contained>
  <contained>
    <Observation>
      <id value="obx3-1"/>
      <status value="final"/>
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/tests"/>
          <code value="60036"/>
          <display value="Oxacillin"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
      <interpretation>
        <coding>
          <system value="http://hl7.org/fhir/v2/0078"/>
          <code value="S"/>
        </coding>
      </interpretation>
    </Observation>
  </contained>
  <contained>
  <!--     
    now, nested observations for the groups/panels

    we're working bottom to top, so first we encounter an
    inner group: susceptibility measured by broth dilution

    Note that we don't have to work bottom to top - the contained
    resources can appear in any order, but since the root does have
    to appear last, we weill work up to it
       -->
    <Observation>
      <id value="obr-2"/>
      <status value="final"/>
    <!--      OBR 2      -->
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/panels"/>
          <code value="60790"/>
          <display value="Susceptibility - Automated broth dilution (Billed)"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <performer>
        <display value="Todd Ashby"/>
      <!--      of course, in practive, this would be a real reference      -->
      </performer>
    <!--      now, references to the OBXs. for reader convenience, we take keep the OBX identification,
       though this is not required in practice. Note that many of the oBX segments are pairs
       that get collapsed      -->
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-1"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-2"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-4"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-6"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-8"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-10"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-12"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-14"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-16"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-18"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-20"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-22"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-24"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-26"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-28"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-30"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-32"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx2-34"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#nte-1"/>
        </target>
      </related>
    </Observation>
  </contained>
  <contained>
  <!--      now we encounter another inner group: susceptibility measured by disk diffusion 
         -->
    <Observation>
      <id value="obr-3"/>
      <status value="final"/>
    <!--      OBR 3      -->
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/panels"/>
          <code value="60418"/>
          <display value="Susceptibility - Disk diffusion (Billed)"/>
        </coding>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx3-1"/>
        </target>
      </related>
    </Observation>
  </contained>
  <contained>
  <!--      organism group: Staphylococcus aureus. You'd repeat at this level if you had more
     than one organism      -->
    <Observation>
      <id value="org1"/>
      <status value="final"/>
    <!--      OBR 1      -->
      <code>
        <coding>
          <system value="http://acme.org/lab/codes/organisms"/>
          <code value="Staaur"/>
        </coding>
        <text value="Staphylococcus aureus Panel"/>
      </code>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx1-4"/>
        </target>
      </related>
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obx1-5"/>
        </target>
      </related>
    <!--      group - automated broth dilution. This is unusual - usually, there's just one level
       of group, and this group would be skipped      -->
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obr-2"/>
        </target>
      </related>
    <!--      group - Disk diffusion      -->
      <related>
        <type value="has-member"/>
        <target>
          <reference value="#obr-3"/>
        </target>
      </related>
    </Observation>
  </contained>
  <contained>
  <!--      ORC information      -->
    <DiagnosticOrder>
      <id value="req"/>
      <subject>
        <reference value="Patient/example"/>
      <!--      patient chosen at random      -->
      </subject>
      <identifier>
        <value value="255337816"/>
      </identifier>
    </DiagnosticOrder>
  </contained>
  <identifier>
    <system value="http://hnam.org/identifiers/orders"/>
  <!--      seems like a likely choice      -->
    <value value="290741144"/>
  </identifier>
  <status value="final"/>
  <category>
    <coding>
      <system value="http://hl7.org/fhir/v2/0074"/>
      <code value="MB"/>
    </coding>
  </category>
<!--      start of the main resource      -->
  <code>
    <coding>
      <system value="http://loinc.org"/>
      <code value="632-0"/>
    </coding>
    <text value="Culture, MRSA"/>
  </code>
  <subject>
    <reference value="Patient/example"/>
  <!--      patient chosen at random      -->
  </subject>
  <effectiveDateTime value="2009-08-07T19:00:00+10:00"/>
  <issued value="2009-08-10T08:25:44+10:00"/>
  <performer>
    <display value="Todd Ashby"/>
  <!--      of course, in practive, this would be a real reference      -->
  </performer>
  <request>
    <reference value="#req"/>
  </request>
  <result>
    <reference value="#org1"/>
  </result>
</DiagnosticReport>

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.