<ProcedureRequest xmlns="http://hl7.org/fhir">
  <meta>
    <lastUpdated value="2017-08-22T16:10:38+00:00" />
  </meta>
  <text>
    <status value="additional" />
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p>%Some xhtml content%</p>
    </div>
  </text>
  <extension url="[base-structure]/ca-on-lab-ext-note">
    <extension url="source">
      <valueCoding>
        <system value="http://hl7.org/fhir/v2/0105" />
        <code value="P" />
        <display value="Order" />
      </valueCoding>
    </extension>
    <extension url="annotation">
      <valueAnnotation>
        <authorString value="[id-system-global-base]/ca-on-lab-license:4008" />
        <text value="Example of procedure request note" />
      </valueAnnotation>
    </extension>
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-ordering-facility">
    <valueReference>
      <reference value="Organization#1" />
    </valueReference>
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-cc-list">
    <valueReference>
      <reference value="Practitioner#1" />
    </valueReference>
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-trq-placer">
    <valueReference>
      <reference value="Organization#1" />
    </valueReference>
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-dest-lab">
    <valueReference>
      <reference value="Organization#2" />
    </valueReference>
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-record-block">
    <valueBoolean value="true" />
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-poc-test-id">
    <valueString value="PORT" />
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-record-replace">
    <valueBoolean value="true" />
  </extension>
  <extension url="[base-structure]/ca-on-lab-ext-trq-sort-key">
    <valueString value="AC2345" />
  </extension>
  <identifier>
    <system value="[id-system-local-base]/lab/test-request-id-lab-license-4004" />
    <value value="1231-R1" />
    <assigner>
      <reference value="#Org1" />
    </assigner>
  </identifier>
  <requisition>
    <system value="[id-system-local-base]/lab/report-id-lab-license-4008" />
    <value value="11111121" />
    <assigner>
      <reference value="#Org1" />
    </assigner>
  </requisition>
  <status value="completed" />
  <intent value="order" />
  <priority value="routine" />
  <code>
    <coding>
      <system value="[code-system-local-base]/lab/test-request-codes" />
      <code value="TR11663-2" />
      <display value="Electrolytes" />
    </coding>
  </code>
  <subject>
    <reference value="Patient#1" />
  </subject>
  <context>
    <reference value="Encounter#1" />
  </context>
  <occurrenceDateTime value="2017-08-22T12:10:41-04:00" />
  <authoredOn value="2017-08-22T12:10:41-04:00" />
  <requester>
    <agent>
      <reference value="Practitioner#1" />
    </agent>
  </requester>
</ProcedureRequest>