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Diagnosticreport-example-f001-bloodexam.xml

Example DiagnosticReport/f001 (XML)

Maturity Level : N/A
Responsible Owner: Orders and Observations Work Group Standards Status : Informative Compartments : Device , Encounter , Group , Patient , Practitioner

Raw XML ( canonical form + also see XML Format Specification )

Real-world patient example (id = "f001")

<?xml version="1.0" encoding="UTF-8"?>


  
  
  
    
    
      
        (Details : {SNOMED CT code '252275004' = 'Haematology test', given as 'Haematology test'};
                 {http://terminology.hl7.org/CodeSystem/v2-0074 code 'HM' = 'Hematology)(Details : {LOINC code '58410-2' = 'Complete blood count (hemogram) panel - Blood by Automated
                 count', given as 'Complete blood count (hemogram) panel - Blood by Automated count'})
          
          
          
        
        
          
        
        
        
          
            
            
            
          
          
            
            
          
        
        
          
            
            
            
          
        
        
          
          
        
        
        
          
          
        
        
          
        
        
          
        
        
          
        
        
          
        
        
          
        
        
      
    
  
  
    
    
      
        
        (Details : {LOINC code '58410-2' = 'Complete blood count (hemogram) panel - Blood by Automated
                 count', given as 'Complete blood count (hemogram) panel - Blood by Automated count'})
          
            
              
              
              
            
          
        
        
          
          
        
        
        
        
          
            
            
            
          
        
        
          
          
        
        
          
        
        
            
            
        
        
          
        
      
    
  

<Bundle xmlns="http://hl7.org/fhir">
  <id value="f001"/> 
  <type value="collection"/> 
  <entry> 
    <fullUrl value="https://example.com/base/DiagnosticReport/f001"/> 
    <resource> 
      <DiagnosticReport> 
        <!--    ISO 8601    -->
        <!--    OID: 2.16.840.1.113883.4.642.1.7    -->
        <id value="f001"/> 
        <text> 
          <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b> Generated Narrative: DiagnosticReport f001</b> </p> <a name="f001"> </a> <a name="hcf001"> </a> <h2> <span title="Codes:{http://loinc.org 58410-2}">CBC panel - Blood by Automated count</span>  (<span title="Codes:{http://snomed.info/sct 252275004}, {http://terminology.hl7.org/CodeSystem/v2-0074
               HM}">Haematology test</span> ) </h2> <table class="grid"><tr> <td> Subject</td> <td> Pieter van de Heuvel  Male, DoB: 1944-11-17 ( urn:oid:2.16.840.1.113883.2.4.6.3#?ngen-9? (use
                  : usual, ))</td> </tr> <tr> <td> Reported</td> <td> 2013-05-15T19:32:52+01:00</td> </tr> <tr> <td> Performer</td> <td>  <a href="organization-example-f001-burgers.html">Burgers University Medical Centre</a> </td> </tr> <tr> <td> Identifier</td> <td>  <code> http://www.bmc.nl/zorgportal/identifiers/reports</code> /nr1239044 (use: official, )</td> </tr> </table> <p> <b> Report Details</b> </p> <table class="grid"><tr> <td> <b> Code</b> </td> <td> <b> Value</b> </td> <td> <b> Reference Range</b> </td> <td> <b> Flags</b> </td> <td> <b> When For</b> </td> <td> <b> Reported</b> </td> </tr> <tr> <td> <a href="observation-example-f001-glucose.html"><span title="Codes:{http://loinc.org 15074-8}">Glucose [Moles/volume] in Blood</span> </a> </td> <td> 6.3 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span> </td> <td> 3.1 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span>  - 6.2 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span> </td> <td> Final, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation H}">High</span> </td> <td> 2013-04-02T09:30:10+01:00</td> <td> 2013-04-03T15:30:10+01:00</td> </tr> <tr> <td> <a href="observation-example-f002-excess.html"><span title="Codes:{http://loinc.org 11555-0}">Base excess in Blood by calculation</span> </a> </td> <td> 12.6 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span> </td> <td> 7.1 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span>  - 11.2 mmol/l<span style="background: LightGoldenRodYellow"> (Details: UCUM  codemmol/L = 'mmol/L')</span> </td> <td> Final, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation H}">High</span> </td> <td> 2013-04-02T10:30:10+01:00</td> <td> 2013-04-03T15:30:10+01:00</td> </tr> <tr> <td> <a href="observation-example-f003-co2.html"><span title="Codes:{http://loinc.org 11557-6}">Carbon dioxide [Partial pressure] in Blood</span> </a> </td> <td> 6.2 kPa<span style="background: LightGoldenRodYellow"> (Details: UCUM  codekPa = 'kPa')</span> </td> <td> 4.8 kPa<span style="background: LightGoldenRodYellow"> (Details: UCUM  codekPa = 'kPa')</span>  - 6.0 kPa<span style="background: LightGoldenRodYellow"> (Details: UCUM  codekPa = 'kPa')</span> </td> <td> Final, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation H}">High</span> </td> <td> 2013-04-02T10:30:10+01:00</td> <td> 2013-04-03T15:30:10+01:00</td> </tr> <tr> <td> <a href="observation-example-f004-erythrocyte.html"><span title="Codes:{http://loinc.org 789-8}">Erythrocytes [#/volume] in Blood by Automated count</span> </a> </td> <td> 4.12 10^12/L<span style="background: LightGoldenRodYellow"> (Details: UCUM  code10*12/L = '10*12/L')</span> </td> <td> <div> <p> 12-14 y Male: 4.4 - 5.2  x  10^12/L ; 12-14 y Female: 4.2 - 4.8  x  10^12/L ; 15-17
                       y Male: 4.6 - 5.4  x  10^12/L ; 15-17 y Female: 4.2 - 4.8  x  10^12/L ; 18-64 y
                       Male: 4.6 - 5.4  x  10^12/L ; 18-64 y Female: 4.0 - 4.8  x  10^12/L ; 65-74 y Male:
                       4.3 - 5.3  x  10^12/L ; 65-74 y Female: 4.1 - 4.9  x  10^12/L</p> 
</div> </td> <td> Final, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation L}">Low</span> </td> <td> 2013-04-02T10:30:10+01:00</td> <td> 2013-04-03T15:30:10+01:00</td> </tr> <tr> <td> <a href="observation-example-f005-hemoglobin.html"><span title="Codes:{http://loinc.org 718-7}">Hemoglobin [Mass/volume] in Blood</span> </a> </td> <td> 7.2 g/dl<span style="background: LightGoldenRodYellow"> (Details: UCUM  codeg/dL = 'g/dL')</span> </td> <td> 7.5 g/dl<span style="background: LightGoldenRodYellow"> (Details: UCUM  codeg/dL = 'g/dL')</span>  - 10 g/dl<span style="background: LightGoldenRodYellow"> (Details: UCUM  codeg/dL = 'g/dL')</span> </td> <td> Final, <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ObservationInterpretation L}">Low</span> </td> <td> 2013-04-05T10:30:10+01:00</td> <td> 2013-04-05T15:30:10+01:00</td> </tr> </table> <div> <p> Core lab</p> </div> </div>         </text>         <identifier>           <use value="official"/>           <system value="http://www.bmc.nl/zorgportal/identifiers/reports"/>           <value value="nr1239044"/>         </identifier>         <basedOn>           <reference value="ServiceRequest/req"/>         </basedOn>         <status value="final"/>         <category>           <coding>             <system value="http://snomed.info/sct"/>             <code value="252275004"/>             <display value="Haematology test"/>           </coding>           <coding>             <system value="http://terminology.hl7.org/CodeSystem/v2-0074"/>             <code value="HM"/>           </coding>         </category>         <code>           <coding>             <system value="http://loinc.org"/>             <code value="58410-2"/>             <display value="CBC panel - Blood by Automated count"/>           </coding>         </code>         <subject>           <reference value="Patient/f001"/>           <display value="P. van den Heuvel"/>         </subject>         <issued value="2013-05-15T19:32:52+01:00"/>         <performer>           <reference value="Organization/f001"/>           <display value="Burgers University Medical Centre"/>         </performer>         <result>           <reference value="Observation/f001"/>         </result>         <result>           <reference value="Observation/f002"/>         </result>         <result>           <reference value="Observation/f003"/>         </result>         <result>           <reference value="Observation/f004"/>         </result>         <result>           <reference value="Observation/f005"/>         </result>         <conclusion value="Core lab"/>       </DiagnosticReport>     </resource>   </entry>   <entry>     <fullUrl value="https://example.com/base/ServiceRequest/req"/>     <resource>       <ServiceRequest>         <id value="req"/>         <text>           <status value="extensions"/> <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b> Generated Narrative: ServiceRequest req</b> </p> <a name="req"> </a> <a name="hcreq"> </a> <p> <b> org/bodysitecode</b> : <span title="Codes:{http://snomed.info/sct 14975008}">Forearm structure</span> </p> <p> <b> identifier</b> : <code> http://www.bmc.nl/zorgportal/identifiers/labresults</code> /L2381</p> <p> <b> status</b> : Active</p> <p> <b> intent</b> : Original Order</p> <h3> Codes</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Concept</b> </td> </tr> <tr> <td style="display: none">*</td> <td> <span title="Codes:{http://loinc.org 58410-2}">CBC panel - Blood by Automated count</span> </td> </tr> </table> <p> <b> subject</b> : <a href="patient-example-f001-pieter.html">P. van den Heuvel</a> </p> <p> <b> encounter</b> : <a href="encounter-example-f001-heart.html">Encounter: identifier = http://www.amc.nl/zorgportal/identifiers/visits#v1451 (use: official,

                 ); status = completed; class = ambulatory; priority = Non-urgent cardiological
                 admission; type = Patient-initiated encounter</a> </p> <p> <b> requester</b> : <a href="practitioner-example-f001-evdb.html">E.van den Broek</a> </p> <p> <b> note</b> : </p> <blockquote> <div> <p> patient almost fainted during procedure</p> 
</div> </blockquote> </div>         </text>         <extension url="http://example.org/bodysitecode">          <valueCodeableConcept>             <coding>               <system value="http://snomed.info/sct"/>               <code value="14975008"/>               <display value="Forearm structure"/>             </coding>           </valueCodeableConcept>         </extension>         <identifier>           <system value="http://www.bmc.nl/zorgportal/identifiers/labresults"/>           <value value="L2381"/>         </identifier>         <status value="active"/>         <intent value="original-order"/>         <code>           <concept>             <coding>               <system value="http://loinc.org"/>               <code value="58410-2"/>               <display value="CBC panel - Blood by Automated count"/>             </coding>           </concept>         </code>         <subject>           <reference value="Patient/f001"/>           <display value="P. van den Heuvel"/>         </subject>         <encounter>           <reference value="Encounter/f001"/>         </encounter>         <requester>           <reference value="Practitioner/f001"/>           <display value="E.van den Broek"/>         </requester>         <note>           <text value="patient almost fainted during procedure"/>         </note>       </ServiceRequest>     </resource>   </entry> 


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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.