<Composition xmlns="http://hl7.org/fhir">
  <id value="ReferralFeedback Instance Example" />
  <meta>
    <profile value="http://hl7.org/fhir/us/bser/StructureDefinition/PatientRole" />
  </meta>
  <identifier>
    <system value="urn:oid:1.3.6.1.4.1.26580.190.12457709" />
    <value value="1234561" />
  </identifier>
  <status value="final" />
  <type>
    <coding>
      <system value="http://hl7.org/fhir/v3/NullFlavor" />
      <code value="UNC" />
      <display value="Referral Feedback" />
    </coding>
  </type>
  <subject>
    <reference value="PatientRole Instance Example" />
  </subject>
  <date value="2018-09-28" />
  <author>
    <reference value="PatientRole Instance Example" />
  </author>
  <title value="Referral Feedback Report" />
  <section>
    <title value="Common Feedback Supporting Information" />
    <code>
      <coding>
        <system value="http://hl7.org/fhir/v3/NullFlavor" />
        <code value="UNC" />
        <display value="CommonFeedbackSupportingInformation" />
      </coding>
    </code>
    <entry>
      <reference value="FeedbackReferralStatusObservation Intance Example" />
    </entry>
  </section>
  <section>
    <title value="Referral Feedback Supporting Bundle" />
    <code>
      <coding>
        <system value="http://hl7.org/fhir/v3/NullFlavor" />
        <code value="UNC" />
        <display value="ReferralFeedbackSupportingBundle" />
      </coding>
    </code>
    <entry>
      <reference value="ReferralFeedbackSupportingBundle Instance Example" />
    </entry>
  </section>
</Composition>