Resource Contract "C-2121" Version "1" Updated "2016-07-19T18:18:42.108-04:00"
status: executed
contentDerivative: Content Registration (Contract Content Derivation Codes#registration)
issued: 2013-11-01T21:18:27-04:00
applies: 2013-11-01T21:18:27-04:00 --> (ongoing)
subject: Patient/f201 "Roel"
type: Opt-in consent directive (consentdirective-type#OPTIN)
subType: Health Care Directive (Consent Category Codes#hcd)
term
Offers
- Type Decision Text * Statutory (Contract Term Type Codes#statutory) opt-in (ActCode#OPTIN) Can't refuse Assets
- Period * 2013-11-01T21:18:27-04:00 --> 2019-11-01T21:18:27-04:00 action
type: Action A (Contract Action Codes#action-a)
subject
reference: Organization/f001: VA Ann Arbor Healthcare System "Burgers University Medical Center"
role: Recipient of restricted health information (consent-actor-type#IR "Recipient")
subject
reference: Organization/2: Community Mental Health Clinic "XYZ Insurance"
role: Sender of restricted health information (consent-actor-type#IS "Sender")
intent: health program reporting (ActReason#HPRGRP)
status: Sample ()
signer
type: SELF (Details: http://mdhhs.org/fhir/consent-signer-type code SELF = 'SELF', stated as 'null')
party: Patient/f201: Alice Recruit "Roel"
Signatures
- Type When Who * Author's Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.1 = 'Author's Signature', stated as 'null') 8 Feb 2017, 8:57:34 pm Patient/f201 "Roel"
| - | Content[x] |
| * |