---
type: "example"
title: "DeviceRequest Example: devicerequest-example-insulinpump"
resource: "DeviceRequest"
example: "devicerequest-example-insulinpump"
---
# DeviceRequest Example: devicerequest-example-insulinpump

## Example XML



```xml
<?xml version="1.0" encoding="UTF-8"?>
<!--Insulin pump request-->
<DeviceRequest xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../schema/device.xsd">
  <id value="insulinpump"/>
  <!--	<extension url="http://hl7.org/fhir/StructureDefinition/bodysitecode">
  <valueCodeableConcept>
    <coding>
      <system value="http://snomed.info/sct"/>
      <code value="51185008"/>
      <display value="Thoracic structure"/>
    </coding>
  </valueCodeableConcept>
</extension>	-->
<identifier>
  <value value="ip_request1.1"/>
</identifier>
<basedOn>
  <display value="Homecare - DM follow-up"/>
</basedOn>
<replaces>
  <display value="CGM ambulatory"/>
</replaces>
<groupIdentifier>
  <value value="ip_request1"/>
</groupIdentifier>
<status value="active"/>
<intent value="instance-order"/>
<priority value="routine"/>
<productCodeableConcept>
  <coding>
    <system value="http://loinc.org"/>
    <code value="43148-6"/>
  </coding>
  <text value="Insulin delivery device panel"/>
</productCodeableConcept>
<subject>
  <reference value="Patient/dicom"/>
</subject>
<encounter>
  <display value="Encounter 1"/>
</encounter>
<occurrenceDateTime value="2013-05-08T09:33:27+07:00"/>
<authoredOn value="2013-05-08T09:33:27+07:00"/>
<requester>
  <reference value="Practitioner/example"/>
  <display value="Dr. Adam Careful"/>
</requester>
<performer>
  <reference>
    <display value="Nurse Rossignol"/>
  </reference>
</performer>
<reason>
  <concept>
    <text value="gastroparesis"/>
  </concept>
</reason>
<reason>
  <reference>
    <display value="Gastroparesis"/>
  </reference>
</reason>
<supportingInfo>
  <display value="Previous results"/>
</supportingInfo>
<note>
  <text value="this is the right device brand and model"/>
</note>
<relevantHistory>
  <display value="Request for unspecified device"/>
</relevantHistory>
</DeviceRequest>
```