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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: service4 - XML Representation

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<ServiceRequest xmlns="http://hl7.org/fhir">
  <id value="service4"/>
  <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="service4"> </a><a name="hcservice4"> </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;service4&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>: therapeutic exercises to improve balance skills <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>#97110)</span></p><p><b>quantity</b>: 1 visit<span style="background: LightGoldenRodYellow"> (Details: NCI Thesaurus  codeC25716 = 'Visit')</span>/1 week<span style="background: LightGoldenRodYellow"> (Details: UCUM  codewk = 'wk')</span></p><p><b>subject</b>: <a href="Patient-patientBSJ1.html">Patient/patientBSJ1</a> &quot; SMITH-JOHNSON&quot;</p><p><b>occurrence</b>: 2020-05-01 --&gt; 2020-08-01</p><p><b>performer</b>: <a href="Practitioner-provider4.html">Practitioner/provider4</a> &quot; TRAINER&quot;</p><p><b>reasonReference</b>: <a href="Condition-need1.html">Condition/need1</a></p><p><b>supportingInfo</b>: </p><ul><li><a href="Goal-goal1.html">Goal/goal1</a></li><li><a href="Goal-goal2.html">Goal/goal2</a></li><li><a href="Claim-claim3.html">Claim/claim3</a></li></ul></div>
  </text>
  <status value="active"/>
  <intent value="plan"/>
  <code>
    <coding>
      <system
              value="http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets"/>
      <code value="97110"/>
    </coding>
    <text value="therapeutic exercises to improve balance skills"/>
  </code>
  <quantityRatio>
    <numerator>
      <value value="1"/>
      <unit value="visit"/>
      <system value="http://ncicb.nci.nih.gov/xml/owl/EVS/Thesaurus.owl"/>
      <code value="C25716"/>
    </numerator>
    <denominator>
      <value value="1"/>
      <unit value="week"/>
      <system value="http://unitsofmeasure.org"/>
      <code value="wk"/>
    </denominator>
  </quantityRatio>
  <subject>🔗 
    <reference value="Patient/patientBSJ1"/>
  </subject>
  <occurrencePeriod>
    <start value="2020-05-01"/>
    <end value="2020-08-01"/>
  </occurrencePeriod>
  <performer>🔗 
    <reference value="Practitioner/provider4"/>
  </performer>
  <reasonReference>🔗 
    <reference value="Condition/need1"/>
  </reasonReference>
  <supportingInfo>🔗 
    <reference value="Goal/goal1"/>
  </supportingInfo>
  <supportingInfo>🔗 
    <reference value="Goal/goal2"/>
  </supportingInfo>
  <supportingInfo>🔗 
    <reference value="Claim/claim3"/>
  </supportingInfo>
</ServiceRequest>