R4 Ballot #2 (Mixed Normative/Trial use)
This page is part of the FHIR Specification (v3.5.0: R4 Ballot #2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3
Consent-example-pkb.xml

Community Based Collaborative Care Work Group
Maturity Level: N/A
Ballot Status: Informative
Compartments: Patient
Raw XML (canonical form + also see XML Format Specification)
Jump past Narrative
Example of Patients Know Best Usage (id = "consent-example-pkb")
<?xml version="1.0" encoding="UTF-8"?>

<Consent xmlns="http://hl7.org/fhir">
  <id value="consent-example-pkb"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p> 
        This example demonstrates how to encode this screen shot in a consent resource:
      </p> 
      <p> 
        <img alt="Screenshot from Patient Knows Best" src="pkb.png"/> 
      </p> 
      <p> 
        Thanks to <a href="https://www.patientsknowbest.com/">Patients Know Best</a>  for contributing this example
      </p> 
    </div> 
  </text> 
  <status value="in-progress"/> 
  <scope> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/consentscope"/> 
      <code value="patient-privacy"/> 
    </coding> 
  </scope> 
  <category> 
    <coding> 
      <system value="http://loinc.org"/> 
      <code value="59284-0"/> 
    </coding> 
  </category> 
  <patient> 
    <reference value="Patient/example"/> 
    <display value="...example patient..."/> 
  </patient> 
  <dateTime value="2016-06-16"/> 
  <organization> 
    <reference value="Organization/f001"/> 
  </organization> 
  <!--   nothing is approved unless the patient says it is   -->
  <policyRule> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
      <code value="OPTOUT"/> 
    </coding> 
  </policyRule> 
  <provision> 
    <!--   we permit   -->
    <actor> 
      <!--   as a receiver of data   -->
      <role> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
          <code value="PRCP"/> 
        </coding> 
      </role> 
      <!--   the non-migrated team   -->
      <reference> 
        <reference value="Organization/f001"/> 
      </reference> 
    </actor> 
    <!--   to read   -->
    <action> 
      <coding> 
        <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
        <code value="access"/> 
      </coding> 
    </action> 
    <!--   any data with confidentiality N   -->
    <securityLabel> 
      <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/> 
      <code value="N"/> 
    </securityLabel> 
    <provision> 
      <!--   we permit   -->
      <actor> 
        <!--   as a receiver of data   -->
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <!--   the non-migrated team   -->
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <!--   to read   -->
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <!--   any data with tag PSY (see security labels)   -->
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="PSY"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <!--   we permit   -->
      <actor> 
        <!--   as a receiver of data   -->
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <!--   the non-migrated team   -->
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <!--   to read   -->
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <!--   any data with and tag SPI (see security labels). SPI is nearest?   -->
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="SPI"/> 
      </securityLabel> 
    </provision> 
    <!--   other teams follow the same pattern   -->
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/> 
        <code value="N"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="PSY"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="SPI"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="SEX"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/> 
        <code value="N"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="PSY"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="SPI"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
        <code value="SEX"/> 
      </securityLabel> 
    </provision> 
    <provision> 
      <actor> 
        <role> 
          <coding> 
            <system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/> 
            <code value="PRCP"/> 
          </coding> 
        </role> 
        <reference> 
          <reference value="Organization/f001"/> 
        </reference> 
      </actor> 
      <action> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/consentaction"/> 
          <code value="access"/> 
        </coding> 
      </action> 
      <securityLabel> 
        <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/> 
        <code value="N"/> 
      </securityLabel> 
    </provision> 
  </provision> 
</Consent>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.