PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot
PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot
This page is part of the PACIO Advance Directive Information Implementation Guide (v2.0.0-ballot: STU 2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 1.0.0. For a full list of available versions, see the Directory of published versions
<Bundle xmlns="http://hl7.org/fhir">
<id value="PMO-Example-Smith-Johnson-Bundle2"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle"/>
</meta>
<identifier>
<system value="http://example.org/GoodHealthClinic/id"/>
<value value="20130607100315-ExamplePMODocument"/>
</identifier>
<type value="document"/>
<timestamp value="2024-03-29T14:25:34.001-05:00"/>
<entry>
<fullUrl
value="http://www.example.org/fhir/Composition/PMO-Example-Smith-Johnson-PMOComposition1"/>
<resource>
<Composition>
<id value="PMO-Example-Smith-Johnson-PMOComposition1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition"/>
</meta>
<language value="en-US"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><a name="Composition_PMO-Example-Smith-Johnson-PMOComposition1"> </a><p class="res-header-id"><b>Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1</b></p><a name="PMO-Example-Smith-Johnson-PMOComposition1"> </a><a name="hcPMO-Example-Smith-Johnson-PMOComposition1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en-US</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ADI-PMOComposition.html">ADI PMO Composition</a></p></div><p><b>Composition Version Number</b>: 2024-03-29T14:25:34-05:00</p><p><b>Data Enterer</b>: <a href="Patient-Example-Smith-Johnson-Patient1.html">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</a></p><p><b>Participant</b>: <a href="PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>ADI Expiration Date</b>: 2024-03-29 14:25:34-0500</p><p><b>Performer</b>: <a href="PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>Informant</b>: <a href="RelatedPerson-Example-Smith-Johnson-HealthcareAgent1.html">RelatedPerson Johnson, Charles</a></p><p><b>Revoke Status</b>: deprecated</p><blockquote><p><b>Clause</b></p><ul><li>Clause: </li></ul></blockquote><div><p><div xmlns="http://www.w3.org/1999/xhtml"><p>Example Clause Statement</p></div></p>
</div><p><b>identifier</b>: <code>http://example.org/GoodHealthClinic/id</code>/0-87f37989294a408897aacd1fc5d8fd16</p><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{http://loinc.org 93037-0}">Portable medical order form</span></p><p><b>category</b>: <span title="Codes:{http://loinc.org 42348-3}">Advance healthcare directives</span></p><p><b>date</b>: 2023-03-29 14:25:34-0500</p><p><b>author</b>: <a href="PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>title</b>: Portable Medical Order</p><h3>Attesters</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Mode</b></td><td><b>Party</b></td></tr><tr><td style="display: none">*</td><td>Legal</td><td><a href="PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html">PractitionerRole: telecom = kanydoc@example.org(Work)</a></td></tr></table><p><b>custodian</b>: <a href="Organization-Example-Smith-Johnson-OrganizationCustodian1.html">Organization example.org</a></p><blockquote><p><b>event</b></p><p><b>detail</b>: </p><ul><li><a href="PractitionerRole-ADI-Facilitator-MSW-MargaretReynolds.html">PractitionerRole primary performer</a></li><li><a href="Consent-Example-Smith-Johnson-HealthcareAgentConsent-Permit.html">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li><li><a href="Consent-Example-Smith-Johnson-HealthcareAgentConsent-Deny.html">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li></ul></blockquote></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber">
<valueString value="2024-03-29T14:25:34-05:00"/>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension">
<valueReference>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension">
<valueReference>🔗
<reference
value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension">
<valueDateTime value="2024-03-29T14:25:34-05:00"/>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension">
<valueReference>🔗
<reference
value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension">
<valueReference>🔗
<reference
value="RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"/>
</valueReference>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status">
<valueCode value="deprecated"/>
</extension>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension">
<extension url="Clause">
<valueMarkdown
value="<div xmlns="http://www.w3.org/1999/xhtml"><p>Example Clause Statement</p></div>"/>
</extension>
</extension>
<identifier>
<system value="http://example.org/GoodHealthClinic/id"/>
<value value="0-87f37989294a408897aacd1fc5d8fd16"/>
</identifier>
<status value="final"/>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="93037-0"/>
<display value="Portable medical order form"/>
</coding>
</type>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="42348-3"/>
<display value="Advance healthcare directives"/>
</coding>
</category>
<subject>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</subject>
<date value="2023-03-29T14:25:34-05:00"/>
<author>🔗
<reference
value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
</author>
<title value="Portable Medical Order"/>
<attester>
<mode value="legal"/>
<party>🔗
<reference
value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
</party>
</attester>
<custodian>🔗
<reference
value="Organization/Example-Smith-Johnson-OrganizationCustodian1"/>
</custodian>
<event>
<detail>🔗
<reference
value="PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds"/>
</detail>
<detail>🔗
<reference
value="Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit"/>
</detail>
<detail>🔗
<reference
value="Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny"/>
</detail>
</event>
<section>
<title value="Portable Medical Orders"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="93037-0"/>
<display value="Portable medical order form"/>
</coding>
</code>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>PMO Medical Orders</b></p><p><i>Order Exists: <a href="http://www.example.com">available here</a></i></p></div>
</text>
<entry>🔗
<reference
value="ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"/>
</entry>
</section>
<section>
<title value="Additional Documentation"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="77599-9"/>
</coding>
</code>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href="http://www.example.com">available here</a></i></p></div>
</text>
<entry>🔗
<reference
value="Observation/Example-Smith-Johnson-DocumentationObservation2"/>
</entry>
</section>
<section>
<title value="Witnesses and Notary"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="81339-4"/>
<display value="Witness and Notary Document"/>
</coding>
</code>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p>I am emotionally and mentally competent to make this uADD. I understand the purpose and effect of this uADD, I agree with everything that is written in this uADD, and I have made this uADD knowingly, willingly and after careful deliberation.</p><table><tbody><tr><td><b>Signature:</b></td><td>Betsy Smith-Johnson</td></tr><tr><td><b>Date:</b></td><td>3/29/2024</td></tr></tbody></table><p/><p><b>Statement of Witnesses</b></p><p/><p>I declare that the person who signed this uADD, or who asked another to sign this uADD on his/her behalf, is the individual identified in the document, and he/she did so in my presence or otherwise provided satisfactory proof to me of his/her identity. I believe him/her to be of sound mind and at least 18 years of age. I personally witnessed him/her sign this document or ask the person indicated to do so, or I received proof of his/her identity that I believe is adequate, and I believe that he/she did so voluntarily. By signing this document as a witness, I certify that I am:</p><p/><ul><li>At least 18 years of age.</li><li>Not related to the person signing this document by blood, marriage or adoption.</li><li>Not a healthcare agent appointed by the person signing this document.</li><li>Not directly financially responsible for that person’s healthcare.</li><li>Not a healthcare provider directly serving the person at this time.</li><li>Not an employee (other than a social worker or chaplain), officer, director, or partner of a healthcare provider (or any parent organization of such healthcare provider) directly serving the person at this time.</li><li>Not aware that I am entitled to or have a claim against the person’s estate.</li></ul><p/><table><tbody><tr><td><b>Witness Number:</b></td><td/></tr><tr><td><b>Signature:</b></td><td/></tr><tr><td><b>Date:</b></td><td/></tr></tbody></table></div>
</text>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1"/>
<resource>
<Patient>
<id value="Example-Smith-Johnson-Patient1"/>
<meta>
<lastUpdated value="2021-03-29T14:25:34.001-05:00"/>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"/>
</meta>
<language value="en-US"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><a name="Patient_Example-Smith-Johnson-Patient1"> </a><p class="res-header-id"><b>Generated Narrative: Patient Example-Smith-Johnson-Patient1</b></p><a name="Example-Smith-Johnson-Patient1"> </a><a name="hcExample-Smith-Johnson-Patient1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2021-03-29 14:25:34-0500; Language: en-US</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html">US Core Patient Profile</a></p></div><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Record is active">Active:</td><td>true</td><td style="background-color: #f3f5da" title="Known Marital status of Patient">Marital Status:</td><td colspan="3"><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}">unknown</span></td></tr><tr><td style="background-color: #f3f5da" title="Other Id (see the one above)">Other Id:</td><td colspan="3">Medical Record Number/1032702 (use: usual, )</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3"><ul><li><a href="mailto:BetsySJ@example.com">BetsySJ@example.com</a></li><li>111 Maple Court San Antonio TX 78212 US (home)</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Language spoken">Language:</td><td colspan="3"><span title="Codes:{urn:ietf:bcp:47 en}">English</span> (preferred)</td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: son">son:</td><td colspan="3"><ul><li>Charles Johnson</li><li>111 Maple Ct, Grand Rapids, MI 49503</li><li>ph: (210) 222-3333</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Nominated Contact: daughter">daughter:</td><td colspan="3"><ul><li>Debra Johnson</li><li>333 W. Camden St., Baltimore, MD 21201</li><li>ph: (410) 444-5555</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White.">US Core Race Extension:</td><td colspan="3"><ul><li>ombCategory: CDC Race and Ethnicity 2106-3: White</li><li>text: White</li></ul></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2106-3"/>
<display value="White"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="White"/>
</extension>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
<text value="Medical Record Number"/>
</type>
<system value="http://example.org/GoodHealthHospital"/>
<value value="1032702"/>
</identifier>
<identifier>
<system value="http://hl7.org/fhir/sid/us-medicare"/>
<value value="1PA3D58WH16"/>
</identifier>
<active value="true"/>
<name>
<use value="usual"/>
<text value="Smith-Johnson, Betsy"/>
<family value="Smith-Johnson"/>
<given value="Betsy"/>
</name>
<telecom>
<system value="email"/>
<value value="BetsySJ@example.com"/>
<use value="home"/>
</telecom>
<gender value="female"/>
<birthDate value="1950-11-15"/>
<address>
<use value="home"/>
<type value="physical"/>
<line value="111 Maple Court"/>
<city value="San Antonio"/>
<state value="TX"/>
<postalCode value="78212"/>
<country value="US"/>
</address>
<maritalStatus>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
<code value="UNK"/>
</coding>
</maritalStatus>
<contact>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="SONC"/>
</coding>
</relationship>
<name>
<text value="Charles Johnson"/>
</name>
<telecom>
<system value="phone"/>
<value value="(210) 222-3333"/>
</telecom>
<address>
<text value="111 Maple Ct, Grand Rapids, MI 49503"/>
</address>
</contact>
<contact>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="DAUC"/>
</coding>
</relationship>
<name>
<text value="Debra Johnson"/>
</name>
<telecom>
<system value="phone"/>
<value value="(410) 444-5555"/>
</telecom>
<address>
<text value="333 W. Camden St., Baltimore, MD 21201"/>
</address>
</contact>
<communication>
<language>
<coding>
<system value="urn:ietf:bcp:47"/>
<code value="en"/>
<display value="English"/>
</coding>
</language>
<preferred value="true"/>
</communication>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
<resource>
<PractitionerRole>
<id value="Example-Kyle-Anydoc-PractitionerRole1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_Example-Kyle-Anydoc-PractitionerRole1"> </a><p class="res-header-id"><b>Generated Narrative: PractitionerRole Example-Kyle-Anydoc-PractitionerRole1</b></p><a name="Example-Kyle-Anydoc-PractitionerRole1"> </a><a name="hcExample-Kyle-Anydoc-PractitionerRole1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitionerrole.html">US Core PractitionerRole Profile</a></p></div><p><b>practitioner</b>: <a href="Practitioner-Example-Kyle-Anydoc-Practitioner.html">Practitioner Kyle Anydoc </a></p><p><b>telecom</b>: <a href="mailto:kanydoc@example.org">kanydoc@example.org</a></p></div>
</text>
<practitioner>🔗
<reference value="Practitioner/Example-Kyle-Anydoc-Practitioner"/>
</practitioner>
<telecom>
<system value="email"/>
<value value="kanydoc@example.org"/>
<use value="work"/>
</telecom>
</PractitionerRole>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Practitioner/Example-Kyle-Anydoc-Practitioner"/>
<resource>
<Practitioner>
<id value="Example-Kyle-Anydoc-Practitioner"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_Example-Kyle-Anydoc-Practitioner"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner Example-Kyle-Anydoc-Practitioner</b></p><a name="Example-Kyle-Anydoc-Practitioner"> </a><a name="hcExample-Kyle-Anydoc-Practitioner"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html">US Core Practitioner Profile</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1818345971</p><p><b>name</b>: Kyle Anydoc </p><p><b>telecom</b>: <a href="mailto:kanydoc@example.org">kanydoc@example.org</a></p><p><b>address</b>: 567 Healthcare Drive Anytown MA 12345 US (home)</p><p><b>gender</b>: Male</p><h3>Qualifications</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0360 MD}">Doctor of Medicine</span></td></tr></table></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1818345971"/>
</identifier>
<name>
<family value="Anydoc"/>
<given value="Kyle"/>
<prefix value="Dr."/>
</name>
<telecom>
<system value="email"/>
<value value="kanydoc@example.org"/>
<use value="work"/>
</telecom>
<address>
<use value="home"/>
<line value="567 Healthcare Drive"/>
<city value="Anytown"/>
<state value="MA"/>
<postalCode value="12345"/>
<country value="US"/>
</address>
<gender value="male"/>
<qualification>
<code>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0360"/>
<code value="MD"/>
<display value="Doctor of Medicine"/>
</coding>
</code>
</qualification>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1"/>
<resource>
<Organization>
<id value="Example-Smith-Johnson-OrganizationCustodian1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_Example-Smith-Johnson-OrganizationCustodian1"> </a><p class="res-header-id"><b>Generated Narrative: Organization Example-Smith-Johnson-OrganizationCustodian1</b></p><a name="Example-Smith-Johnson-OrganizationCustodian1"> </a><a name="hcExample-Smith-Johnson-OrganizationCustodian1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-organization.html">US Core Organization Profile</a></p></div><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.5.0/NamingSystem-npi.html" title="National Provider Identifier">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>name</b>: example.org</p><p><b>telecom</b>: <a href="tel:+1(202)776-7700">+1(202)776-7700</a></p><p><b>address</b>: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US </p></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="1234567893"/>
</identifier>
<active value="true"/>
<name value="example.org"/>
<telecom>
<system value="phone"/>
<value value="+1(202)776-7700"/>
<use value="work"/>
</telecom>
<address>
<type value="physical"/>
<line value="740 E. Campbell Rd. Suite 825"/>
<city value="Richardson"/>
<state value="TX"/>
<postalCode value="75081"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"/>
<resource>
<ServiceRequest>
<id value="Example-Smith-Johnson-CPR-ServiceRequest1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOCPRServiceRequest"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="ServiceRequest_Example-Smith-Johnson-CPR-ServiceRequest1"> </a><p class="res-header-id"><b>Generated Narrative: ServiceRequest Example-Smith-Johnson-CPR-ServiceRequest1</b></p><a name="Example-Smith-Johnson-CPR-ServiceRequest1"> </a><a name="hcExample-Smith-Johnson-CPR-ServiceRequest1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ADI-PMOCPRServiceRequest.html">ADI PMO Cardiopulmonary Resuscitation ServiceRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Directive</p><p><b>category</b>: <span title="Codes:{http://loinc.org 100822-6}">Cardiopulmonary resuscitation orders</span></p><p><b>doNotPerform</b>: true</p><p><b>code</b>: <span title="Codes:{http://loinc.org LA33470-8}">Yes CPR</span></p><p><b>orderDetail</b>: <span title="Codes:{http://loinc.org LA33470-8}">Yes CPR</span></p><p><b>subject</b>: <a href="Patient-Example-Smith-Johnson-Patient1.html">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</a></p><p><b>requester</b>: <a href="Practitioner-Example-Kyle-Anydoc-Practitioner.html">Practitioner Kyle Anydoc </a></p></div>
</text>
<status value="active"/>
<intent value="directive"/>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="100822-6"/>
<display value="Cardiopulmonary resuscitation orders"/>
</coding>
</category>
<doNotPerform value="true"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="LA33470-8"/>
</coding>
</code>
<orderDetail>
<coding>
<system value="http://loinc.org"/>
<code value="LA33470-8"/>
</coding>
</orderDetail>
<subject>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</subject>
<requester>🔗
<reference value="Practitioner/Example-Kyle-Anydoc-Practitioner"/>
</requester>
</ServiceRequest>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/Example-Smith-Johnson-DocumentationObservation2"/>
<resource>
<Observation>
<id value="Example-Smith-Johnson-DocumentationObservation2"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation"/>
</meta>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_Example-Smith-Johnson-DocumentationObservation2"> </a><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href="http://www.example.com">available here</a></i></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="42348-3"/>
<display value="Advance healthcare directives"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</subject>
<effectiveDateTime value="2016-05-18T22:33:22Z"/>
<performer>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="697978002"/>
<display value="Provider orders for life-sustaining treatment"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds"/>
<resource>
<PractitionerRole>
<id value="ADI-Facilitator-MSW-MargaretReynolds"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="PractitionerRole_ADI-Facilitator-MSW-MargaretReynolds"> </a><p class="res-header-id"><b>Generated Narrative: PractitionerRole ADI-Facilitator-MSW-MargaretReynolds</b></p><a name="ADI-Facilitator-MSW-MargaretReynolds"> </a><a name="hcADI-Facilitator-MSW-MargaretReynolds"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ADI-Facilitator.html">ADI Facilitator</a></p></div><p><b>active</b>: true</p><p><b>practitioner</b>: <a href="Practitioner-Practitioner-MargaretReynolds.html">Margaret A. Reynolds</a></p><p><b>organization</b>: <a href="Organization-Example-Smith-Johnson-OrganizationAssembler1.html">Example Organization</a></p><p><b>code</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-ParticipationType PPRF}">primary performer</span></p><p><b>specialty</b>: <span title="Codes:{http://nucc.org/provider-taxonomy 1041C0700X}">Clinical Social Worker</span></p><p><b>endpoint</b>: <a href="Endpoint-Example-Smith-Johnson-Endpoint2.html">Endpoint Good Health Clinic Endpoint</a></p></div>
</text>
<active value="true"/>
<practitioner>🔗
<reference value="Practitioner/Practitioner-MargaretReynolds"/>
<display value="Margaret A. Reynolds"/>
</practitioner>
<organization>🔗
<reference
value="Organization/Example-Smith-Johnson-OrganizationAssembler1"/>
<display value="Example Organization"/>
</organization>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
<code value="PPRF"/>
</coding>
</code>
<specialty>
<coding>
<system value="http://nucc.org/provider-taxonomy"/>
<code value="1041C0700X"/>
<display value="Clinical Social Worker"/>
</coding>
</specialty>
<endpoint>🔗
<reference value="Endpoint/Example-Smith-Johnson-Endpoint2"/>
</endpoint>
</PractitionerRole>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Practitioner/Practitioner-MargaretReynolds"/>
<resource>
<Practitioner>
<id value="Practitioner-MargaretReynolds"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_Practitioner-MargaretReynolds"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner Practitioner-MargaretReynolds</b></p><a name="Practitioner-MargaretReynolds"> </a><a name="hcPractitioner-MargaretReynolds"> </a><p><b>identifier</b>: <code>http://example.org/fhir/MI-state-license</code>/86420</p><p><b>active</b>: true</p><p><b>name</b>: Margaret Q. Reynolds</p><p><b>telecom</b>: ph: (555) 391-9414</p><p><b>address</b>: 18051 Mack Ave, Detroit, MI 48224</p><p><b>gender</b>: Female</p></div>
</text>
<identifier>
<system value="http://example.org/fhir/MI-state-license"/>
<value value="86420"/>
</identifier>
<active value="true"/>
<name>
<text value="Margaret Q. Reynolds"/>
<family value="Reynolds"/>
<given value="Margaret"/>
<given value="Q."/>
</name>
<telecom>
<system value="phone"/>
<value value="(555) 391-9414"/>
</telecom>
<address>
<text value="18051 Mack Ave, Detroit, MI 48224"/>
<line value="18051 Mack Ave"/>
<city value="Detroit"/>
<state value="MI"/>
<postalCode value="48224"/>
<country value="US"/>
</address>
<gender value="female"/>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Endpoint/Example-Smith-Johnson-Endpoint2"/>
<resource>
<Endpoint>
<id value="Example-Smith-Johnson-Endpoint2"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Endpoint_Example-Smith-Johnson-Endpoint2"> </a><p class="res-header-id"><b>Generated Narrative: Endpoint Example-Smith-Johnson-Endpoint2</b></p><a name="Example-Smith-Johnson-Endpoint2"> </a><a name="hcExample-Smith-Johnson-Endpoint2"> </a><p><b>identifier</b>: <code>https://example.org/GoodHealth-Clinic</code>/PatientCorrection</p><p><b>status</b>: Active</p><p><b>connectionType</b>: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-endpoint-connection-type.html#endpoint-connection-type-hl7-fhir-rest">Endpoint Connection Type hl7-fhir-rest</a>: HL7 FHIR</p><p><b>name</b>: Good Health Clinic Endpoint</p><p><b>payloadType</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes urn:hl7-org:sdwg:ccda-nonXMLBody:1.1}, {http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes urn:hl7-org:sdwg:ccda-structuredBody:1.1}">For documents following C-CDA constraints using a structured body</span></p><p><b>address</b>: <a href="https://example.org/address">https://example.org/address</a></p></div>
</text>
<identifier>
<system value="https://example.org/GoodHealth-Clinic"/>
<value value="PatientCorrection"/>
</identifier>
<status value="active"/>
<connectionType>
<system
value="http://terminology.hl7.org/CodeSystem/endpoint-connection-type"/>
<code value="hl7-fhir-rest"/>
<display value="HL7 FHIR"/>
</connectionType>
<name value="Good Health Clinic Endpoint"/>
<payloadType>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes"/>
<code value="urn:hl7-org:sdwg:ccda-nonXMLBody:1.1"/>
</coding>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes"/>
<code value="urn:hl7-org:sdwg:ccda-structuredBody:1.1"/>
</coding>
<text
value="For documents following C-CDA constraints using a structured body"/>
</payloadType>
<address value="https://example.org/address"/>
</Endpoint>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit"/>
<resource>
<Consent>
<id value="Example-Smith-Johnson-HealthcareAgentConsent-Permit"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentPermit"/>
</meta>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Consent_Example-Smith-Johnson-HealthcareAgentConsent-Permit"> </a><p>I am consenting for my son Charles to be my authorized personal representative (primary healthcare agent) and I am permitting him to make decisions on my behalf about intubation.</p></div>
</text>
<status value="active"/>
<scope>
<coding>
<system value="http://loinc.org"/>
<code value="81377-4"/>
<display
value="Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported"/>
</coding>
</scope>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/>
<version value="1.0.0"/>
<code value="acd"/>
</coding>
</category>
<patient>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</patient>
<policy>
<uri value="http://example.org/healthcare-agent-policy"/>
</policy>
<provision>
<type value="permit"/>
<actor>
<role>
<coding>
<system value="http://loinc.org"/>
<code value="75783-1"/>
<display value="Primary healthcare agent [Reported]"/>
</coding>
</role>
<reference>🔗
<reference
value="RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"/>
</reference>
</actor>
</provision>
</Consent>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny"/>
<resource>
<Consent>
<id value="Example-Smith-Johnson-HealthcareAgentConsent-Deny"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentDeny"/>
</meta>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Consent_Example-Smith-Johnson-HealthcareAgentConsent-Deny"> </a><p>I am consenting for my son Charles to be my primary healthcare agent and I am denying him to make decisions on my behalf about nutrition.</p></div>
</text>
<status value="active"/>
<scope>
<coding>
<system value="http://loinc.org"/>
<code value="81377-4"/>
<display
value="Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported"/>
</coding>
</scope>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/>
<version value="1.0.0"/>
<code value="acd"/>
</coding>
</category>
<patient>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</patient>
<policy>
<uri value="http://example.org/healthcare-agent-policy"/>
</policy>
<provision>
<type value="deny"/>
<actor>
<role>
<coding>
<system value="http://loinc.org"/>
<code value="75783-1"/>
<display value="Primary healthcare agent [Reported]"/>
</coding>
</role>
<reference>🔗
<reference
value="RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"/>
</reference>
</actor>
</provision>
</Consent>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"/>
<resource>
<RelatedPerson>
<id value="Example-Smith-Johnson-HealthcareAgent1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant"/>
</meta>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_Example-Smith-Johnson-HealthcareAgent1"> </a><p><b>Primary Healthcare Agent</b></p><p>The person I choose as my Primary Healthcare Agent is:</p><p><i>Charles Johnson</i></p><p><i>(Son)</i></p><p><i>CharlesSJ@example.com</i></p><p>[SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT]</p><p>[ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]</p></div>
</text>
<patient>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="SON"/>
<display value="natural son"/>
</coding>
</relationship>
<name>
<text value="Johnson, Charles"/>
<family value="Johnson"/>
<given value="Charles"/>
</name>
<telecom>
<system value="email"/>
<value value="CharlesSJ@example.com"/>
<use value="home"/>
</telecom>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Provenance/Example-Smith-Johnson-PMOProvenance1"/>
<resource>
<Provenance>
<id value="Example-Smith-Johnson-PMOProvenance1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Provenance"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Provenance_Example-Smith-Johnson-PMOProvenance1"> </a><p class="res-header-id"><b>Generated Narrative: Provenance Example-Smith-Johnson-PMOProvenance1</b></p><a name="Example-Smith-Johnson-PMOProvenance1"> </a><a name="hcExample-Smith-Johnson-PMOProvenance1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ADI-Provenance.html">ADI Provenance</a></p></div><p>Provenance for <a href="Composition-PMO-Example-Smith-Johnson-PMOComposition1.html">Composition Portable Medical Order</a></p><p>Summary</p><table class="grid"><tr><td>Recorded</td><td>2021-03-29 14:25:34-0500</td></tr></table><p><b>Agents</b></p><table class="grid"><tr><td><b>Type</b></td><td><b>who</b></td></tr><tr><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/provenance-participant-type assembler}">Assembler</span></td><td><a href="Organization-Example-Smith-Johnson-OrganizationAssembler1.html">Organization GoodHealth Clinic</a></td></tr></table></div>
</text>
<target>🔗
<reference
value="Composition/PMO-Example-Smith-Johnson-PMOComposition1"/>
</target>
<recorded value="2021-03-29T14:25:34.001-05:00"/>
<agent>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>
<version value="1.0.0"/>
<code value="assembler"/>
<display value="Assembler"/>
</coding>
</type>
<who>🔗
<reference
value="Organization/Example-Smith-Johnson-OrganizationAssembler1"/>
</who>
</agent>
</Provenance>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationAssembler1"/>
<resource>
<Organization>
<id value="Example-Smith-Johnson-OrganizationAssembler1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_Example-Smith-Johnson-OrganizationAssembler1"> </a><p class="res-header-id"><b>Generated Narrative: Organization Example-Smith-Johnson-OrganizationAssembler1</b></p><a name="Example-Smith-Johnson-OrganizationAssembler1"> </a><a name="hcExample-Smith-Johnson-OrganizationAssembler1"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-organization.html">US Core Organization Profile</a></p></div><p><b>identifier</b>: <code>http://example.org/GoodHealthClinic/id</code>/12c5dcee5089494ca1ca0cb428ed3fff</p><p><b>active</b>: true</p><p><b>name</b>: GoodHealth Clinic</p><p><b>telecom</b>: <a href="tel:+1(202)776-7700">+1(202)776-7700</a></p><p><b>address</b>: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US </p></div>
</text>
<identifier>
<system value="http://example.org/GoodHealthClinic/id"/>
<value value="12c5dcee5089494ca1ca0cb428ed3fff"/>
</identifier>
<active value="true"/>
<name value="GoodHealth Clinic"/>
<telecom>
<system value="phone"/>
<value value="+1(202)776-7700"/>
<use value="work"/>
</telecom>
<address>
<type value="physical"/>
<line value="740 E. Campbell Rd. Suite 825"/>
<city value="Richardson"/>
<state value="TX"/>
<postalCode value="75081"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
</Bundle>
IG © 2021+ HL7 International / Patient Empowerment. Package hl7.fhir.us.pacio-adi#2.0.0-ballot based on FHIR 4.0.1. Generated 2025-08-04
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