QI-Core Implementation Guide
4.1.1 - STU 4.1.1 US

This page is part of the Quality Improvement Core Framework (v4.1.1: STU 4) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: ServiceRequest referral example - XML Representation

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="referral-example"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><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">Resource "referral-example" </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-qicore-servicerequest.html">QICoreServiceRequest</a></p></div><p><b>Reason for current status</b>: Refused by parents of subject <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#609589008)</span></p><p><b>status</b>: revoked</p><p><b>intent</b>: order</p><p><b>category</b>: Referral for procedure <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#700274009)</span></p><p><b>priority</b>: routine</p><p><b>code</b>: Myringotomy and insertion of short-term tympanic ventilation tube (procedure) <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#172676009)</span></p><p><b>subject</b>: <a href="Patient-example.html">Patient/example</a> " CHALMERS"</p><p><b>encounter</b>: <a href="Encounter-example.html">Encounter/example</a></p><p><b>occurrence</b>: 2014-02-13</p><p><b>authoredOn</b>: 2014-02-14</p><p><b>performerType</b>: Pediatric otolaryngology <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#417887005)</span></p><p><b>reasonCode</b>: Otitis media <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="https://browser.ihtsdotools.org/">SNOMED CT</a>#65363002)</span></p></div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/request-statusReason">
    <valueCodeableConcept>
      <coding>
        <system value="http://snomed.info/sct"/>
        <code value="609589008"/>
        <display value="Refused by parents of subject"/>
      </coding>
    </valueCodeableConcept>
  </extension>
<!--  NOTE: This isn't quite right, it wasn't revoked by the authorizing provider, it was refused by the patient... not clear how to represent this in the R4 resource  -->
  <status value="revoked"/>
  <intent value="order"/>
  <category>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="700274009"/>
      <display value="Referral for procedure"/>
    </coding>
  </category>
  <priority value="routine"/>
  <code>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="172676009"/>
      <display
               value="Myringotomy and insertion of short-term tympanic ventilation tube (procedure)"/>
    </coding>
  </code>
  <subject>
    <reference value="Patient/example"/>
  </subject>
  <encounter>
    <reference value="Encounter/example"/>
  </encounter>
  <occurrenceDateTime value="2014-02-13"/>
  <authoredOn value="2014-02-14"/>
<!-- <requester> -->
<!-- <agent> -->
<!-- <reference value="Practitioner/example"/> -->
<!-- </agent> -->
<!-- </requester> -->
  <performerType>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="417887005"/>
      <display value="Pediatric otolaryngology"/>
    </coding>
  </performerType>
<!-- <recipient> -->
<!-- <reference value="Practitioner/example"/> -->
<!-- </recipient> -->
  <reasonCode>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="65363002"/>
      <display value="Otitis media"/>
    </coding>
  </reasonCode>
</ServiceRequest>