<Bundle xmlns="http://hl7.org/fhir">
  <id value="AddServiceRequestBundle" />
  <type value="message" />
  <timestamp value="2020-10-09T15:21:51.2112Z" />
  <entry>
    <fullUrl value="urn:uuid:4783c82c-683e-491d-b834-3d1b8931bdd9" />
    <resource>
      <MessageHeader>
        <id value="4783c82c-683e-491d-b834-3d1b8931bdd9" />
        <eventCoding>
          <system value="http://fhir.infoway-inforoute.ca/io/CA-eReC/CodeSystem/message-event-code" />
          <code value="add-service-request" />
        </eventCoding>
        <destination>
          <name value="RMS Target" />
          <endpoint value="http://rmstarget.org/fhir/$process-message" />
        </destination>
        <author>
          <reference value="urn:uuid:86fa8373-34c8-440d-9e8f-832c1a571da8" />
          <display value="Dr. Jack Jones" />
        </author>
        <source>
          <name value="RMS Source" />
          <software value="Software" />
          <version value="1.1.0" />
          <contact>
            <system value="email" />
            <value value="tech.support@rmssource.org" />
            <rank value="1" />
          </contact>
          <endpoint value="http://rmssource.org/fhir/$process-message" />
        </source>
        <reason>
          <text value="Provide assessment for home care service provisioning" />
        </reason>
        <focus>
          <reference value="urn:uuid:05ed7277-bd41-44ee-b017-9502c3511844" />
        </focus>
      </MessageHeader>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:05ed7277-bd41-44ee-b017-9502c3511844" />
    <resource>
      <ServiceRequest>
        <id value="05ed7277-bd41-44ee-b017-9502c3511844" />
        <identifier>
          <system value="http://www.rmssource.org/identifiers/ServiceRequest" />
          <value value="request-for-assessment" />
        </identifier>
        <status value="active" />
        <intent value="proposal" />
        <category>
          <coding>
            <system value="http://snomed.info/sct" />
            <code value="424008009" />
            <display value="Nursing care surveillance" />
          </coding>
        </category>
        <priority value="routine" />
        <code>
          <coding>
            <system value="http://snomed.info/sct" />
            <code value="105385000" />
            <display value="Full-time nursing care at home by private nurse" />
          </coding>
        </code>
        <subject>
          <reference value="urn:uuid:7f7ad826-f47b-4c18-9d4a-bd3d0988ad3b" />
        </subject>
        <authoredOn value="2020-10-09" />
        <requester>
          <reference value="urn:uuid:86fa8373-34c8-440d-9e8f-832c1a571da8" />
          <display value="Dr Jack Jones" />
        </requester>
        <performer>
          <reference value="http://rmstarget.org/fhir/HealthcareService/16770" />
        </performer>
        <supportingInfo>
          <reference value="urn:uuid:9cea3cb8-d24f-4be2-acbf-dbc6c3801493" />
          <display value="Referral Form" />
        </supportingInfo>
      </ServiceRequest>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:7f7ad826-f47b-4c18-9d4a-bd3d0988ad3b" />
    <resource>
      <Patient>
        <id value="7f7ad826-f47b-4c18-9d4a-bd3d0988ad3b" />
        <identifier>
          <use value="official" />
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203" />
              <code value="JHN" />
            </coding>
            <text value="Ontario, Canada Personal Health Number" />
          </type>
          <system value="https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-patient-hcn" />
          <value value="1234567890" />
        </identifier>
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203" />
              <code value="MR" />
            </coding>
            <text value="The Hospital" />
          </type>
          <system value="http://ehealthontario.ca/fhir/NamingSystem/id-example1-uri" />
          <value value="ABC12345" />
        </identifier>
        <active value="true" />
        <name>
          <family value="Doe" />
          <given value="Jane" />
        </name>
        <telecom>
          <system value="phone" />
          <value value="1 (555) 867 5309" />
          <rank value="1" />
        </telecom>
        <telecom>
          <system value="email" />
          <value value="janedoe@example.com" />
          <rank value="2" />
        </telecom>
        <gender value="female" />
        <birthDate value="1951-02-19" />
        <address>
          <use value="home" />
          <type value="physical" />
          <line value="123 Any Street" />
          <city value="Waterloo" />
          <state value="ON" />
          <postalCode value="N2L 3G1" />
        </address>
      </Patient>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:86fa8373-34c8-440d-9e8f-832c1a571da8" />
    <resource>
      <PractitionerRole>
        <id value="86fa8373-34c8-440d-9e8f-832c1a571da8" />
        <active value="true" />
        <practitioner>
          <reference value="urn:uuid:8b9f61af-55ce-4ade-9987-f40fe54cc79e" />
          <display value="Dr Jack Jones" />
        </practitioner>
        <organization>
          <reference value="urn:uuid:334ec4c8-7932-4620-86fe-d6b33b3fc7e4" />
          <display value="Primary Care Medical Clinics" />
        </organization>
        <code>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/practitioner-role" />
            <code value="doctor" />
            <display value="Doctor" />
          </coding>
        </code>
        <specialty>
          <coding>
            <system value="https://fhir.infoway-inforoute.ca/CodeSystem/snomedctcaextension" />
            <code value="394802001" />
            <display value="General medicine" />
          </coding>
        </specialty>
        <location>
          <reference value="urn:uuid:25470f9e-0092-4997-af53-aa3ef0f50879" />
          <display value="279 Yonge St, Barrie, ON L4N 7T9" />
        </location>
        <telecom>
          <system value="phone" />
          <value value="(555) 987-1234" />
          <use value="work" />
          <rank value="1" />
        </telecom>
        <telecom>
          <system value="fax" />
          <value value="(555) 987-1234" />
          <use value="work" />
          <rank value="3" />
        </telecom>
        <telecom>
          <system value="email" />
          <value value="jack.jones@example.org" />
          <use value="work" />
          <rank value="2" />
        </telecom>
      </PractitionerRole>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:8b9f61af-55ce-4ade-9987-f40fe54cc79e" />
    <resource>
      <Practitioner>
        <id value="8b9f61af-55ce-4ade-9987-f40fe54cc79e" />
        <identifier>
          <type>
            <coding>
              <system value="http://terminology.hl7.org/CodeSystem/v2-0203" />
              <code value="LN" />
            </coding>
            <text value="Ontario Medical License Number" />
          </type>
          <system value="http://infoway-inforoute.ca/fhir/NamingSystem/ca-on-license-physician" />
          <value value="111789" />
        </identifier>
        <name>
          <use value="official" />
          <family value="Jones" />
          <given value="Jack" />
        </name>
      </Practitioner>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:334ec4c8-7932-4620-86fe-d6b33b3fc7e4" />
    <resource>
      <Organization>
        <id value="334ec4c8-7932-4620-86fe-d6b33b3fc7e4" />
        <active value="true" />
        <type>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/organization-type" />
            <code value="prov" />
            <display value="Healthcare Provider" />
          </coding>
        </type>
        <name value="Primary Care Medical Clinics" />
      </Organization>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:25470f9e-0092-4997-af53-aa3ef0f50879" />
    <resource>
      <Location>
        <id value="25470f9e-0092-4997-af53-aa3ef0f50879" />
        <name value="Yonge Street Medical Office" />
        <address>
          <type value="physical" />
          <line value="279 Yonge St" />
          <city value="Barrie" />
          <state value="ON" />
          <postalCode value="M5B 1N8" />
          <country value="CAN" />
        </address>
      </Location>
    </resource>
  </entry>
  <entry>
    <fullUrl value="urn:uuid:9cea3cb8-d24f-4be2-acbf-dbc6c3801493" />
    <resource>
      <QuestionnaireResponse>
        <id value="9cea3cb8-d24f-4be2-acbf-dbc6c3801493" />
        <basedOn>
          <reference value="urn:uuid:05ed7277-bd41-44ee-b017-9502c3511844" />
        </basedOn>
        <status value="completed" />
        <subject>
          <reference value="urn:uuid:7f7ad826-f47b-4c18-9d4a-bd3d0988ad3b" />
        </subject>
        <authored value="2020-10-09" />
        <author>
          <reference value="urn:uuid:86fa8373-34c8-440d-9e8f-832c1a571da8" />
        </author>
        <item>
          <linkId value="1" />
          <text value="Section 1 Header" />
          <item>
            <linkId value="1.1" />
            <text value="String Question in Section 1" />
            <answer>
              <valueString value="String Answer" />
            </answer>
          </item>
          <item>
            <linkId value="1.2" />
            <text value="Boolean Question in Section 1" />
            <answer>
              <valueBoolean value="true" />
            </answer>
          </item>
          <item>
            <linkId value="1.3" />
            <text value="Number Question in Section 1" />
            <answer>
              <valueInteger value="365" />
            </answer>
          </item>
          <item>
            <linkId value="1.4" />
            <text value="Decimal question in Section 1" />
            <answer>
              <valueDecimal value="364.9" />
            </answer>
          </item>
          <item>
            <linkId value="1.5" />
            <text value="DateTime Question in Section 2" />
            <answer>
              <valueDateTime value="2021-05-07T13:28:17Z" />
            </answer>
          </item>
        </item>
        <item>
          <linkId value="2" />
          <text value="Section 2 Header" />
          <item>
            <linkId value="2.1" />
            <text value="Integer Question in Section 2" />
            <answer>
              <valueInteger value="365" />
            </answer>
          </item>
          <item>
            <linkId value="2.2" />
            <text value="Multi-Select Question in Section 2" />
            <answer>
              <valueString value="tag1" />
            </answer>
            <answer>
              <valueString value="tag2" />
            </answer>
            <answer>
              <valueString value="tag3" />
            </answer>
          </item>
          <item>
            <linkId value="2.3" />
            <text value="Date Question in Section 2" />
            <answer>
              <valueDate value="2019-09-05" />
            </answer>
          </item>
          <item>
            <linkId value="2.4" />
            <text value="Time Question in Section 2" />
            <answer>
              <valueTime value="12:34:56" />
            </answer>
          </item>
        </item>
        <item>
          <linkId value="3" />
          <text value="CONDITIONAL Section 3 with Question" />
          <answer>
            <valueBoolean value="true" />
            <item>
              <linkId value="3.1" />
              <text value="Conditional Question 1:" />
              <answer>
                <valueString value="ConditionalAnswer1" />
              </answer>
            </item>
            <item>
              <linkId value="3.2" />
              <text value="Conditional Question 2:" />
              <answer>
                <valueString value="ConditionalAnswer2" />
              </answer>
            </item>
          </answer>
        </item>
      </QuestionnaireResponse>
    </resource>
  </entry>
</Bundle>