{
  "resourceType" : "Provenance",
  "id" : "example-targeted-provenance",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-provenance"]
  },
  "target" : [{
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/targetElement",
      "valueUri" : "race"
    }],
    "reference" : "Patient/example-targeted-provenance"
  }],
  "recorded" : "2023-02-28T15:26:23.217+00:00",
  "agent" : [{
    "role" : [{
      "coding" : [{
        "system" : "http://dicom.nema.org/resources/ontology/DCM",
        "code" : "110150",
        "display" : "Application"
      }]
    }],
    "who" : {
      "display" : "My_Form"
    }
  },
  {
    "type" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
        "code" : "informant",
        "display" : "Informant"
      }]
    },
    "who" : {
      "reference" : "Patient/example-targeted-provenance"
    }
  }]
}