L2p:v2.0.0 FHIR lab2patient: verschil tussen versies

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(→‎Patient retrieves laboratory results in their PGO: Chaining parameters uitleg)
 
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circle 241 216 211 [https://www.medmij.nl/afsprakenstelsel Afsprakenstelsel]     
 
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circle 1013 224 212 [[L2p:v2.0.0_ontwerp_lab2patient|Functional]]
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<big>For an overview of all current documentation [[Lab:V3.0.0_Ontwerp_Laboverdacht| see information standard lab exchange main page]]</big>
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<big>For an overview of all current documentation [[Landingspagina_Labuitwisseling| see information standard lab exchange main page]]</big>
  
 
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==== Search parameters ====
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==== FHIR Search parameters ====
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{| style="text-align: left;" cellpadding=5px;  
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The search interaction is performed by an HTTP GET in agreement with the [http://hl7.org/fhir/R4/search.html FHIR specification]. The table below lists search parameters for DiagnosticReport resource that SHALL be supported for processing by servers and clients.
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{| style="text-align: left; width: 100%" cellpadding=5px;  
 
|- style="color: white; background-color: #e7844b;"
 
|- style="color: white; background-color: #e7844b;"
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! FHIR Search Parameter || Description || FHIR Resource || Example
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! Variation type || Variation || Permitted values (if limited) || Data type || Description
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
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! colspan="4"  | Retrieve laboratory results (Observation search)
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! colspan="5"  | result.category
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
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| category || Restrict search to laboratory observations || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory</pre>
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| || || {{fhir|<nowiki>https://terminology.hl7.org/CodeSystem/observation-category|laboratory</nowiki>}} || {{fhir|token}} || Search DiagnosticReports that reference laboratory Observations.
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|- style="color: white; background-color: #eda778;"
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! colspan="5"  | result.code
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
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| code || Filter by laboratory test code (LOINC/NHG) || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7</pre>
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| code system || LOINC || {{fhir|<nowiki>http://loinc.org|[test code]</nowiki>}} || {{fhir|token}} || Search on the LOINC test code
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
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| date || Filter results based on observation date || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&date=gt2022-03-12&date=lt2022-06-07</pre>
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| code system || NHG || {{fhir|<nowiki>https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code]</nowiki>}} || {{fhir|token}} || Search on the NHG test code
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
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! colspan="4" | Retrieve latest laboratory results ($lastn operation)
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! colspan="5" | result.date
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|- style="background-color: #fcf0e9;"
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| prefix || {{fhir|gt}} || || {{fhir|date}} || Search on observation date later than the value
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
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| $lastn || Retrieve most recent lab results using the $lastn operation || Observation || <pre>GET [base]/Observation/$lastn?max=5&category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&code=http://loinc.org|14683-7</pre>
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| prefix || {{fhir|lt}} || || {{fhir|date}} || Search on observation date earlier than the value
  
 
|- style="color: white; background-color: #eda778;"
 
|- style="color: white; background-color: #eda778;"
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! colspan="4" | Retrieve related resources
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! colspan="5" | _include
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|- style="background-color: #fcf0e9;"
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| modifier || {{fhir|iterate}} || || {{fhir|reference}} || Include linked resources iteratively
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|- style="background-color: #fcf0e9;"
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| resource || {{fhir|Patient}} || {{fhir|DiagnosticReport:subject}} || {{fhir|reference}} || Include linked Patient resources in the response bundle.
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|- style="background-color: #fcf0e9;"
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| resource || {{fhir|Organization}} || {{fhir|DiagnosticReport:performer}} || {{fhir|reference}} || Include linked Organization resources in the response bundle, when the performer reference points to an Organization.
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|- style="background-color: #fcf0e9;"
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| resource || {{fhir|Specimen}} || {{fhir|DiagnosticReport:specimen}} || {{fhir|reference}} || Include linked Specimen resources in the response bundle.
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|- style="background-color: #fcf0e9;"
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| resource || {{fhir|Observation}} || {{fhir|DiagnosticReport:result}} || {{fhir|reference}} || Include linked Observation resources in the response bundle.
  
 
|- style="background-color: #fcf0e9;"
 
|- style="background-color: #fcf0e9;"
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| _include || Include linked resources (Specimen, Patient, Organization) in the response bundle || Observation || <pre>GET [base]/Observation?category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&_include=Observation:specimen&_include=Observation:patient&_include=Observation:performer</pre>
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| resource || {{fhir|ServiceRequest}} || {{fhir|DiagnosticReport:basedOn}} || {{fhir|reference}} || Include linked ServiceRequest resources in the response bundle.
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|+ style="align: bottom; caption-side: bottom; text-align: left;" |
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|}
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For the DiagnosticReport search, the parameters {{fhir|result.category}} SHALL be included within every search request. The parameters {{fhir|result.code}}, {{fhir|_include}}, and {{fhir|_include:iterate}} can be repeated; {{fhir|result.code}} supports combination with AND or OR, while {{fhir|_include}} and {{fhir|_include:iterate}} support combination with AND only. In FHIR search, OR logic is used when multiple values are supplied for the same search parameter (comma-separated), meaning a resource matches if any of the values apply. AND logic is used when a search parameter is to be repeated, meaning the resource must satisfy all of the specified conditions.
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==== Chaining parameters ====
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Chained search parameters are used to apply criteria to resources referenced by {{fhir|DiagnosticReport}}. In this use case, Observation criteria are applied through {{fhir|DiagnosticReport.result}}, for example by using {{fhir|result.code}}, {{fhir|result.category}}, and {{fhir|result.date}} to search for reports that reference matching Observations. For more information on chaining, consult [https://build.fhir.org/search.html#chaining FHIR specification].
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==== Most recent functionality ====
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To retrieve the most recent reports, clients SHALL use the regular FHIR search interaction on {{fhir|DiagnosticReport}} in combination with sorting and paging parameters. The parameter {{fhir|_sort}} with value {{fhir|-date}} is used to sort reports by date in descending order. The parameter {{fhir|_count}} can be used to limit the number of {{fhir|DiagnosticReport}} resources returned.
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==== FHIR Search examples ====
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{| style="text-align: left; width: 100%;" cellpadding=5px;
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|- style="color: white; background-color: #e7844b;"
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! Examples
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|- style="color: white; background-color: #eda778;"
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! Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
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|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_include=DiagnosticReport:result</pre>
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|- style="color: white; background-color: #eda778;"
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! Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) from 12 March 2022
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|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&_include=DiagnosticReport:result</pre>
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|- style="color: white; background-color: #eda778;"
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! Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) between 12 March 2022 and 7 June 2022
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|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&result.date=lt2022-06-07&_include=DiagnosticReport:result</pre>
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|- style="color: white; background-color: #eda778;"
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! Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) or 3583 (NHG)
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|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7,https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|3583&_include=DiagnosticReport:result</pre>
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|- style="color: white; background-color: #eda778;"
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! Show the most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
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 +
|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=1&_include=DiagnosticReport:result</pre>
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|- style="color: white; background-color: #eda778;"
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! Show the five most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC)
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|- class="mw-collapsible mw-collapsed" style="background-color: #fcf0e9;"
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| <pre>GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=5&_include=DiagnosticReport:result</pre>
  
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|+ style="align: bottom; caption-side: bottom; text-align: left;" | ''All queries are executed in the authenticated patient context as per MedMij Afsprakenstelsel; no patient search parameters are used.''
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|+ style="align: bottom; caption-side: bottom; text-align: left;" |  
 
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Huidige versie van 4 jun 2026 om 14:47


The Information Standard Lab Exchange consists of four different components: Lab2Zorg, Lab2Lab, Lab2PublicHealth, and Lab2Patient. These four components were developed independently of each other and are subject to continuous development. This is reflected in the Semantic Versioning (SemVer). Each component undergoes its own development process with its own corresponding numerical publications.

Issue icon.png 

The FHIR resource used for the use case described in this technical design is DiagnosticReport. DiagnosticReport is not the preferred FHIR resource for the information standard Laboratory exchange. However, this resource has been chosen as it contains information about the order data. Optimally, order data could be linked directly to the preferred FHIR resource Observation via basedOn element. This will be updated in a future version.
AfsprakenstelselFunctionalTechnicalAfspraken-Functioneel-Technisch

For an overview of all current documentation see information standard lab exchange main page


1 Introduction

Go to functional design

This is the technical design (TO) for the information standard (IS) Lab2patient. This TO must be used together with the IS functional design, see functional design Lab2patient 1.0.0-beta.2. The data exchange format used in this version is: FHIR R4.

1.1 Support

For questions, feedback, or change requests, please contact our support team at Nictiz Servicemanagement.

1.2 Boundaries

This information standard may overlap with other standards related to identification, roles, and geographic classifications, requiring careful alignment to ensure consistency and avoid duplication. For more information, see functional design Lab2patient 1.0.0-beta.2.

1.3 Prerequisite knowledge

The following background information is required for understanding this TO:

2 Relationships

The diagram below shows the relationships between different FHIR profiles. The arrows indicate an “is referenced in” relationship.

For example, Patient → Laboratory Test means that the Patient is referenced within the Laboratory Test resource.

FHIR-model-overview-L2P.png

3 Components

HL7 FHIR is used to accommodate the Dutch Clinical Information Models (zibs) used in the IS.

3.1 HL7 FHIR R4

Em.png

Nictiz uses the FHIR Packaging mechanism. This conveniently bundles all profiles, terminology, example material and other conformance resources you need into a single archive, which can be downloaded or installed using the appropriate FHIR tooling. This version of the information standard uses the following packages:

Note: packages use Semantic Versioning. Other versions can be used at will as long as they have the same major.minor number or a minor number higher than the stated version.

3.1.1 Artifacts

The artifacts of the information standard are presented in the following table:

zib FHIR resource FHIR profile
HealthcareProvider Organization nl-core-HealthcareProvider-Organization
HealthProfessional Practitioner nl-core-HealthProfessional-Practitioner
PractitionerRole nl-core-HealthProfessional-PractitionerRole
LaboratoryTestResult Device nl-core-LaboratoryTestResult.Specimen.Source
Observation nl-core-LaboratoryTestResult
Specimen nl-core-LaboratoryTestResult.Specimen
Patient Patient nl-core-Patient
DiagnosticReport lu-LaboratoryTestResult-DiagnosticReport
ServiceRequest lu-OrderData

3.1.2 Examples of FHIR instances

You can find examples of FHIR-instances (filled-in FHIR profiles) in the Nictiz GitHub repository: Lab exchange HL7-mappings repository.

4 Transactions

4.1 Patient retrieves laboratory results in their PGO

4.1.1 Involved actors

Transaction group Transaction Actor System role code
Retrieve laboratory results (PULL) Retrieve laboratory results request Client LAB-LRR-PGO
Retrieve laboratory results response Server LAB-LRB-PGO
Abbreviations: LAB = Laboratorium, LRR = Laboratoriumresultaat raadplegend (systeem), LRB = Laboratoriumresultaat beschikbaarstellend (systeem), PGO = Persoonlijke gezondheidsomgeving.

4.1.2 FHIR Search parameters

The search interaction is performed by an HTTP GET in agreement with the FHIR specification. The table below lists search parameters for DiagnosticReport resource that SHALL be supported for processing by servers and clients.

Variation type Variation Permitted values (if limited) Data type Description
result.category
https://terminology.hl7.org/CodeSystem/observation-category|laboratory token Search DiagnosticReports that reference laboratory Observations.
result.code
code system LOINC http://loinc.org|[test code] token Search on the LOINC test code
code system NHG https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|[test code] token Search on the NHG test code
result.date
prefix gt date Search on observation date later than the value
prefix lt date Search on observation date earlier than the value
_include
modifier iterate reference Include linked resources iteratively
resource Patient DiagnosticReport:subject reference Include linked Patient resources in the response bundle.
resource Organization DiagnosticReport:performer reference Include linked Organization resources in the response bundle, when the performer reference points to an Organization.
resource Specimen DiagnosticReport:specimen reference Include linked Specimen resources in the response bundle.
resource Observation DiagnosticReport:result reference Include linked Observation resources in the response bundle.
resource ServiceRequest DiagnosticReport:basedOn reference Include linked ServiceRequest resources in the response bundle.

For the DiagnosticReport search, the parameters result.category SHALL be included within every search request. The parameters result.code, _include, and _include:iterate can be repeated; result.code supports combination with AND or OR, while _include and _include:iterate support combination with AND only. In FHIR search, OR logic is used when multiple values are supplied for the same search parameter (comma-separated), meaning a resource matches if any of the values apply. AND logic is used when a search parameter is to be repeated, meaning the resource must satisfy all of the specified conditions.

4.1.3 Chaining parameters

Chained search parameters are used to apply criteria to resources referenced by DiagnosticReport. In this use case, Observation criteria are applied through DiagnosticReport.result, for example by using result.code, result.category, and result.date to search for reports that reference matching Observations. For more information on chaining, consult FHIR specification.

4.1.4 Most recent functionality

To retrieve the most recent reports, clients SHALL use the regular FHIR search interaction on DiagnosticReport in combination with sorting and paging parameters. The parameter _sort with value -date is used to sort reports by date in descending order. The parameter _count can be used to limit the number of DiagnosticReport resources returned.

4.1.5 FHIR Search examples

Examples
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) from 12 March 2022 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) between 12 March 2022 and 7 June 2022 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&result.date=gt2022-03-12&result.date=lt2022-06-07&_include=DiagnosticReport:result
Show all DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) or 3583 (NHG) 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7,https://referentiemodel.nhg.org/tabellen/nhg-tabel-45-diagnostische-bepalingen|3583&_include=DiagnosticReport:result
Show the most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=1&_include=DiagnosticReport:result
Show the five most recent DiagnosticReports with laboratory Observations with test code 14683-7 (LOINC) 
GET [base]/DiagnosticReport?result.category=http://terminology.hl7.org/CodeSystem/observation-category|laboratory&result.code=http://loinc.org|14683-7&_sort=-date&_count=5&_include=DiagnosticReport:result
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