{
  "resourceType" : "Consent",
  "id" : "provider-treatment-attestation-1",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Consent provider-treatment-attestation-1</b></p><a name=\"provider-treatment-attestation-1\"> </a><a name=\"hcprovider-treatment-attestation-1\"> </a><h2>Participants</h2><table class=\"grid\"><tr><td><b>Role</b></td><td><b>Details</b></td></tr><tr><td title=\"Who the consent applies to\">Patient</td><td><a href=\"Patient-1.html\">Johnny Appleseed  Male, DoB: 1986-01-01 ( Member Number)</a></td></tr><tr><td title=\"Who is agreeing to the policy and rules\">Party</td><td>Dr. Susan Smith (Identifier: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893)</td></tr><tr><td title=\"Who manages the consent through its lifecycle.\">Manager</td><td>Provider 1 (Identifier: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1982947230)</td></tr></table><p>This consent is made under the policy <a href=\"https://example.org/provider-attestation-policy\">https://example.org/provider-attestation-policy</a> .</p><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Rule\">Rule</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Period\">Time Period</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Parties\">Who</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Applicable Data\">What</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_extension.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Consent Provision\" class=\"hierarchy\"/> permit</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_extension.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Consent Provision\" class=\"hierarchy\"/> permit</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li>Period: 2024-01-15 --&gt; (ongoing)</li></ul></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ParticipationType IRCP}\">information recipient</span>: Dr. Susan Smith (Identifier: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893)</li><li><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleClass PROV}\">healthcare provider</span>: Provider 1 (Identifier: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1982947230)</li></ul></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><ul><li>Purpose: <a href=\"http://terminology.hl7.org/7.2.0/CodeSystem-v3-ActReason.html#v3-ActReason-TREAT\">ActReason: TREAT</a> (treatment)</li><li>Purpose: <a href=\"http://terminology.hl7.org/7.2.0/CodeSystem-v3-ActReason.html#v3-ActReason-HPAYMT\">ActReason: HPAYMT</a> (healthcare payment)</li><li>Purpose: <a href=\"http://terminology.hl7.org/7.2.0/CodeSystem-v3-ActReason.html#v3-ActReason-HOPERAT\">ActReason: HOPERAT</a> (healthcare operations)</li></ul></td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
  },
  "status" : "active",
  "scope" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
      "code" : "patient-privacy"
    }]
  },
  "category" : [{
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code" : "IDSCL",
      "display" : "Information Disclosure"
    }]
  },
  {
    "coding" : [{
      "system" : "http://loinc.org",
      "code" : "64292-6",
      "display" : "Release of information consent"
    }]
  }],
  "patient" : {
    "reference" : "Patient/1"
  },
  "dateTime" : "2024-11-14T10:30:00Z",
  "performer" : [{
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "1234567893"
    },
    "display" : "Dr. Susan Smith"
  }],
  "organization" : [{
    "identifier" : {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "1982947230"
    },
    "display" : "Provider 1"
  }],
  "sourceReference" : {
    "reference" : "DocumentReference/provider-attestation-doc-1",
    "display" : "Provider Attestation Form"
  },
  "policy" : [{
    "authority" : "https://example.org/health-authority",
    "uri" : "https://example.org/provider-attestation-policy"
  }],
  "verification" : [{
    "verified" : true,
    "verifiedWith" : {
      "reference" : "Patient/1",
      "display" : "Patricia Ann Person"
    },
    "verificationDate" : "2024-11-14T10:30:00Z"
  }],
  "provision" : {
    "type" : "permit",
    "period" : {
      "start" : "2024-01-15"
    },
    "actor" : [{
      "role" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
          "code" : "IRCP",
          "display" : "information recipient"
        }]
      },
      "reference" : {
        "identifier" : {
          "system" : "http://hl7.org/fhir/sid/us-npi",
          "value" : "1234567893"
        },
        "display" : "Dr. Susan Smith"
      }
    },
    {
      "role" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
          "code" : "PROV",
          "display" : "healthcare provider"
        }]
      },
      "reference" : {
        "identifier" : {
          "system" : "http://hl7.org/fhir/sid/us-npi",
          "value" : "1982947230"
        },
        "display" : "Provider 1"
      }
    }],
    "purpose" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code" : "TREAT",
      "display" : "treatment"
    },
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code" : "HPAYMT",
      "display" : "healthcare payment"
    },
    {
      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code" : "HOPERAT",
      "display" : "healthcare operations"
    }]
  }
}