{
  "resourceType" : "ClinicalDocument",
  "realmCode" : [{
    "code" : "US"
  }],
  "typeId" : {
    "extension" : "POCD_HD000040",
    "root" : "2.16.840.1.113883.1.3"
  },
  "templateId" : [{
    "extension" : "2024-05-01",
    "root" : "2.16.840.1.113883.10.20.22.1.1"
  },
  {
    "extension" : "2024-05-01",
    "root" : "2.16.840.1.113883.10.20.29.1"
  }],
  "id" : {
    "root" : "2c1e0e12-b0ae-4456-a526-c11d5e69e77c"
  },
  "code" : {
    "code" : "68831-7",
    "codeSystem" : "2.16.840.1.113883.6.1",
    "codeSystemName" : "LOINC",
    "displayName" : "Discharge summary note"
  },
  "title" : {
    "xmlText" : "Patient Discharge Summary"
  },
  "effectiveTime" : {
    "value" : "2013-08-15T10:30:00-08:00"
  },
  "confidentialityCode" : {
    "code" : "N",
    "codeSystem" : "2.16.840.1.113883.5.25",
    "codeSystemName" : "Confidentiality",
    "displayName" : "normal"
  },
  "languageCode" : {
    "code" : "en-US"
  },
  "recordTarget" : [{
    "patientRole" : {
      "id" : [{
        "extension" : "444222222",
        "root" : "2.16.840.1.113883.4.1"
      }],
      "addr" : [{
        "use" : ["HP"],
        "item" : [{
          "streetAddressLine" : {
            "xmlText" : "2222 Home Street"
          }
        },
        {
          "city" : {
            "xmlText" : "Beaverton"
          }
        },
        {
          "state" : {
            "xmlText" : "OR"
          }
        },
        {
          "postalCode" : {
            "xmlText" : "97867"
          }
        },
        {
          "country" : {
            "xmlText" : "US"
          }
        }]
      }],
      "telecom" : [{
        "use" : ["HP"],
        "value" : "tel:+1(555)555-2003"
      }],
      "patient" : {
        "name" : [{
          "use" : ["L"],
          "item" : [{
            "given" : [{
              "xmlText" : "Adam"
            }]
          },
          {
            "family" : [{
              "xmlText" : "Everyman"
            }]
          }]
        }],
        "administrativeGenderCode" : {
          "code" : "M",
          "codeSystem" : "2.16.840.1.113883.5.1",
          "codeSystemName" : "AdministrativeGender",
          "displayName" : "Male"
        },
        "birthTime" : {
          "value" : "1975-05-01"
        },
        "religiousAffiliationCode" : {
          "code" : "1013",
          "codeSystem" : "2.16.840.1.113883.5.1076",
          "codeSystemName" : "HL7 Religious Affiliation",
          "displayName" : "Christian (non-Catholic, non-specific)"
        },
        "raceCode" : {
          "code" : "2106-3",
          "codeSystem" : "2.16.840.1.113883.6.238",
          "codeSystemName" : "Race & Ethnicity - CDC",
          "displayName" : "White"
        },
        "ethnicGroupCode" : {
          "code" : "2186-5",
          "codeSystem" : "2.16.840.1.113883.6.238",
          "codeSystemName" : "Race & Ethnicity - CDC",
          "displayName" : "Not Hispanic or Latino"
        },
        "birthplace" : {
          "place" : {
            "addr" : {
              "use" : ["H"],
              "item" : [{
                "streetAddressLine" : {
                  "xmlText" : "4444 Home Street"
                }
              },
              {
                "city" : {
                  "xmlText" : "Beaverton"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "97867"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }]
            }
          }
        },
        "languageCommunication" : [{
          "languageCode" : {
            "code" : "en"
          },
          "modeCode" : {
            "code" : "ESP",
            "codeSystem" : "2.16.840.1.113883.5.60",
            "codeSystemName" : "LanguageAbilityMode",
            "displayName" : "Expressed spoken"
          },
          "proficiencyLevelCode" : {
            "code" : "G",
            "codeSystem" : "2.16.840.1.113883.5.61",
            "codeSystemName" : "LanguageAbilityProficiency",
            "displayName" : "Good"
          },
          "preferenceInd" : {
            "value" : true
          }
        }]
      }
    }
  }],
  "author" : [{
    "time" : {
      "value" : "2013-08-15T10:30:00-08:00"
    },
    "assignedAuthor" : {
      "id" : [{
        "extension" : "5555555555",
        "root" : "2.16.840.1.113883.4.6"
      }],
      "code" : {
        "code" : "ONESELF",
        "codeSystem" : "2.16.840.1.113883.5.111",
        "codeSystemName" : "HL7 Role code",
        "displayName" : "Self"
      },
      "addr" : [{
        "use" : ["HP"],
        "item" : [{
          "streetAddressLine" : {
            "xmlText" : "2222 Home Street"
          }
        },
        {
          "city" : {
            "xmlText" : "Boston"
          }
        },
        {
          "state" : {
            "xmlText" : "MA"
          }
        },
        {
          "postalCode" : {
            "xmlText" : "02368"
          }
        },
        {
          "country" : {
            "xmlText" : "US"
          }
        }]
      }],
      "telecom" : [{
        "use" : ["WP"],
        "value" : "tel:+1(555)555-1004"
      }],
      "assignedPerson" : {
        "name" : [{
          "item" : [{
            "given" : [{
              "xmlText" : "Patient"
            }]
          },
          {
            "family" : [{
              "xmlText" : "Author"
            }]
          }]
        }]
      }
    }
  }],
  "custodian" : {
    "assignedCustodian" : {
      "representedCustodianOrganization" : {
        "id" : [{
          "extension" : "321CX",
          "root" : "2.16.840.1.113883.4.6"
        }],
        "name" : {
          "item" : [{
            "xmlText" : "Good Health HIE"
          }]
        },
        "telecom" : {
          "use" : ["WP"],
          "value" : "tel:+1(555)555-1009"
        },
        "addr" : {
          "use" : ["WP"],
          "item" : [{
            "streetAddressLine" : {
              "xmlText" : "1009 Healthcare Drive"
            }
          },
          {
            "city" : {
              "xmlText" : "Portland"
            }
          },
          {
            "state" : {
              "xmlText" : "OR"
            }
          },
          {
            "postalCode" : {
              "xmlText" : "99123"
            }
          },
          {
            "country" : {
              "xmlText" : "US"
            }
          }]
        }
      }
    }
  },
  "informationRecipient" : [{
    "intendedRecipient" : {
      "id" : [{
        "extension" : "adameveryman@direct.sampleHISP.com",
        "root" : "2.16.123.123.12345.1234"
      }],
      "informationRecipient" : {
        "name" : [{
          "item" : [{
            "given" : [{
              "xmlText" : "Adam"
            }]
          },
          {
            "family" : [{
              "xmlText" : "Everyman"
            }]
          }]
        }]
      },
      "receivedOrganization" : {
        "id" : [{
          "extension" : "999.3",
          "root" : "2.16.840.1.113883.19"
        }],
        "name" : [{
          "item" : [{
            "xmlText" : "MyPersonalHealthRecord.Com"
          }]
        }]
      }
    }
  },
  {
    "intendedRecipient" : {
      "id" : [{
        "extension" : "999.4",
        "root" : "2.16.840.1.113883.19"
      },
      {
        "extension" : "1122334455",
        "root" : "2.16.840.1.113883.4.6"
      },
      {
        "extension" : "DrP@direct.sampleHISP2.com",
        "root" : "2.16.123.123.12345.4321"
      }],
      "telecom" : [{
        "use" : ["WP"],
        "value" : "tel:(781)555-1212"
      },
      {
        "use" : ["WP"],
        "value" : "mailto:DrP@direct.sampleHISP2.com"
      }],
      "informationRecipient" : {
        "name" : [{
          "item" : [{
            "prefix" : [{
              "xmlText" : "Dr."
            }]
          },
          {
            "given" : [{
              "xmlText" : "Patricia"
            }]
          },
          {
            "family" : [{
              "xmlText" : "Primary"
            }]
          }]
        }]
      },
      "receivedOrganization" : {
        "id" : [{
          "extension" : "999.2",
          "root" : "2.16.840.1.113883.19"
        },
        {
          "extension" : "1234567890",
          "root" : "2.16.840.1.113883.4.6"
        }],
        "name" : [{
          "item" : [{
            "xmlText" : "Good Health Internal Medicine"
          }]
        }],
        "telecom" : [{
          "use" : ["WP"],
          "value" : "tel:(781)555-1212"
        }],
        "addr" : [{
          "item" : [{
            "streetAddressLine" : {
              "xmlText" : "100 Health Drive"
            }
          },
          {
            "city" : {
              "xmlText" : "Boston"
            }
          },
          {
            "state" : {
              "xmlText" : "MA"
            }
          },
          {
            "postalCode" : {
              "xmlText" : "02368"
            }
          },
          {
            "country" : {
              "xmlText" : "USA"
            }
          }]
        }]
      }
    }
  }],
  "legalAuthenticator" : {
    "time" : {
      "value" : "2013-08-01T22:36:15-08:00"
    },
    "signatureCode" : {
      "code" : "S"
    },
    "assignedEntity" : {
      "id" : [{
        "extension" : "555555555",
        "root" : "2.16.840.1.113883.4.6"
      }],
      "code" : {
        "code" : "207QA0505X",
        "codeSystem" : "2.16.840.1.113883.6.101",
        "codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
        "displayName" : "Adult Medicine Physician"
      },
      "addr" : [{
        "item" : [{
          "streetAddressLine" : {
            "xmlText" : "1004 Healthcare Drive"
          }
        },
        {
          "city" : {
            "xmlText" : "Portland"
          }
        },
        {
          "state" : {
            "xmlText" : "OR"
          }
        },
        {
          "postalCode" : {
            "xmlText" : "99123"
          }
        },
        {
          "country" : {
            "xmlText" : "US"
          }
        }]
      }],
      "telecom" : [{
        "use" : ["WP"],
        "value" : "tel:+1(555)-1004"
      }],
      "assignedPerson" : {
        "name" : [{
          "item" : [{
            "given" : [{
              "xmlText" : "Patricia"
            }]
          },
          {
            "given" : [{
              "xmlText" : "Patty",
              "qualifier" : ["CL"]
            }]
          },
          {
            "family" : [{
              "xmlText" : "Primary"
            }]
          },
          {
            "suffix" : [{
              "xmlText" : "M.D.",
              "qualifier" : ["AC"]
            }]
          }]
        }]
      }
    }
  },
  "component" : {
    "structuredBody" : {
      "component" : [{
        
      }]
    }
  }
}