<PractitionerRole xmlns="http://hl7.org/fhir">
  <id value="ReferralRecipientProviderRole Instance Example" />
  <meta>
    <profile value="http://hl7.org/fhir/us/bser/StructureDefinition/ReferralRecipientProviderRole" />
  </meta>
  <practitioner>
    <reference value="PractitionerPerson Instance Example" />
  </practitioner>
  <organization>
    <reference value="OrganizationEntity Instance Example" />
  </organization>
  <code>
    <coding>
      <system value="http://hl7.org/fhir/v2/0286" />
      <code value="RT" />
      <display value="Referred to Provider" />
    </coding>
  </code>
  <location>
    <reference value="ServiceDeliveryLocation Instance Example" />
  </location>
</PractitionerRole>