Additional Resources Included in Document

Entry 2 - fullUrl = http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1

Resource Organization:

Profile: US Core Organization Profile

identifier: United States National Provider Identifier/1234567893

active: true

name: example.org

Contacts

-	Telecom	Address
*	+1(202)776-7700	740 E. Campbell Rd. Suite 825 Richardson TX 75081 US

Entry 3 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1

Resource Patient:

Last updated: 2021-03-29 14:25:34-0500; Language: en-US

Profile: US Core Patient Profile

Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)

---

Active:	true	Marital Status:	unknown
Other Id:	Medical Record Number/1032702 (use: usual, )
Contact Detail	BetsySJ@example.com 111 Maple Court San Antonio TX 78212 US (home)
Language:	English (preferred)
son:	Charles Johnson 111 Maple Ct, Grand Rapids, MI 49503 ph: (210) 222-3333
daughter:	Debra Johnson 333 W. Camden St., Baltimore, MD 21201 ph: (410) 444-5555
US Core Race Extension:	ombCategory: CDC Race and Ethnicity 2106-3: White text: White

Entry 4 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-Notary2

Resource RelatedPerson:

Notary

Charles Xavier

Entry 5 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent3

Resource RelatedPerson:

Primary Healthcare Agent

The person I choose as my Primary Healthcare Agent is:

Charles Johnson

(Son)

CharlesSJ@example.com

[SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT]

[ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]

Entry 6 - fullUrl = http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent2

Resource Consent:

status: active

scope: Powers granted to healthcare agent - Reported

category: Advance Directive

patient: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15

dateTime: 2020-08-03

Policies

-	Authority	Uri
*	https://www.michigan.gov/	http://www.legislature.mi.gov/(S(tpnclc1ofteerx2x2dppcmdz))/mileg.aspx?page=GetObject&objectname=mcl-386-1998-V-5

provision

type: permit

actor

role: Primary healthcare agent - Reported

reference: natural son; Charles Johnson ; CharlesSJ@example.com

actor

role: First alternate healthcare agent - Reported

reference: First alternate healthcare agent - Reported, natural daughter; Debra Johnson ; DebraSJ@example.com

action: Advance directive - request for intubation, Advance directive - request for tube feeding, Advance directive - request for life support, Advance directive - request for IV fluid and support, Advance directive - request for antibiotics, Advance directive - request for resuscitation that differs from cardiopulmonary resuscitation

purpose: power of attorney

Entry 7 - fullUrl = http://www.example.org/fhir/Binary/MHAD-Example-Smith-Johnson-Binary

Resource Binary:

Profile: ADI Minimal Source Form

contentType: application/pdf

data: (base64 data - 1,037,192 base64 chars)