This page is part of the electronic Long-Term Services and Supports Implementation Guide (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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: service2 - XML Representation

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="service2"/>
  <meta>
    <versionId value="1"/>
    <lastUpdated value="2020-09-03T10:16:03.512-04:00"/>
    <source value="#KZ0jzPjXDrhCiMif"/>
    <profile
             value="http://hl7.org/fhir/us/eltss/StructureDefinition/ServiceRequest-eltss"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ServiceRequest </b><a name="service2"> </a><a name="hcservice2"> </a></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">ResourceServiceRequest &quot;service2&quot; Version&quot;1&quot; Updated&quot;2020-09-03 10:16:03-0400&quot; </p><p style="margin-bottom: 0px">Information Source: #KZ0jzPjXDrhCiMif!</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ServiceRequest-eltss.html">ServiceRequest_eltss</a></p></div><p><b>status</b>: active</p><p><b>intent</b>: plan</p><p><b>code</b>: Non-emergency transportation; encounter/trip <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-hcpcs-Level-II.html">Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes</a>#T2003)</span></p><p><b>quantity</b>: 2 trips<span style="background: LightGoldenRodYellow"> (Details: NCI Thesaurus  codeC141286 = 'Transportation')</span>/1 month<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemo = 'mo')</span></p><p><b>subject</b>: <a href="Patient-patientBSJ1.html">Patient/patientBSJ1</a> &quot; SMITH-JOHNSON&quot;</p><p><b>occurrence</b>: 2020-07-01 --&gt; 2020-12-31</p><p><b>performer</b>: <a href="Organization-provider2a.html">Organization/provider2a</a> &quot;The Transporter, Inc.&quot;</p><p><b>reasonReference</b>: <a href="Condition-need1.html">Condition/need1</a></p><p><b>insurance</b>: <a href="Coverage-coverage1.html">Coverage/coverage1</a></p><p><b>supportingInfo</b>: <a href="Claim-claim1.html">Claim/claim1</a></p><p><b>note</b>: Service provider will provide a reminder the business day before the trip, and will call when on the way.</p></div>
  </text>
  <status value="active"/>
  <intent value="plan"/>
  <code>
    <coding>
      <system
              value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
      <code value="T2003"/>
    </coding>
    <text value="Non-emergency transportation; encounter/trip"/>
  </code>
  <quantityRatio>
    <numerator>
      <value value="2"/>
      <unit value="trips"/>
      <system value="http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl"/>
      <code value="C141286"/>
    </numerator>
    <denominator>
      <value value="1"/>
      <unit value="month"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="mo"/>
    </denominator>
  </quantityRatio>
  <subject>🔗 
    <reference value="Patient/patientBSJ1"/>
  </subject>
  <occurrencePeriod>
    <start value="2020-07-01"/>
    <end value="2020-12-31"/>
  </occurrencePeriod>
  <performer>🔗 
    <reference value="Organization/provider2a"/>
  </performer>
  <reasonReference>🔗 
    <reference value="Condition/need1"/>
  </reasonReference>
  <insurance>🔗 
    <reference value="Coverage/coverage1"/>
  </insurance>
  <supportingInfo>🔗 
    <reference value="Claim/claim1"/>
  </supportingInfo>
  <note>
    <text
          value="Service provider will provide a reminder the business day before the trip, and will call when on the way."/>
  </note>
</ServiceRequest>