# Example: Discharge Care Plan - PACIO Transitions of Care Implementation Guide v1.0.0

* [**Table of Contents**](toc.md)
* [**FHIR Artifacts**](artifacts.md)
* **Example: Discharge Care Plan**

## Example CarePlan: Example: Discharge Care Plan

| |
| :--- |
| *Page standards status:*[Informative](http://hl7.org/fhir/R4/versions.html#std-process) |

Profile: [US Core CarePlan Profile](http://hl7.org/fhir/us/core/STU8.0.1/StructureDefinition-us-core-careplan.html) version: 8.0.1

**status**: Active

**intent**: Plan

**category**: Assessment and Plan of Treatment

**subject**: [Smith-Johnson, Betsy Female, DoB: 1958-11-01 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1AA3D58WH16)](Patient-Example-Smith-Johnson-Patient1.md)

> **activity****reference**: [ServiceRequest Follow-up visit (procedure)](ServiceRequest-BSJ-PCPFollowUp.md)

> **activity****reference**: [ServiceRequest Informing doctor (procedure)](ServiceRequest-BSJ-SNFDischargeCallOrder.md)

> **activity****reference**: [ServiceRequest Occupational therapy assessment (procedure)](ServiceRequest-BSJ-SNFDischargeCallOTRefer.md)

> **activity****reference**: [ServiceRequest Speech therapy assessment (procedure)](ServiceRequest-BSJ-SNFDischargeCallSLPRefer.md)

> **activity****reference**: [ServiceRequest Decreased fat and oil diet (regime/therapy)](ServiceRequest-BSJ-SNFDischargeDietSalt.md)

> **activity****reference**: [ServiceRequest Blood chemistry (procedure)](ServiceRequest-BSJ-SNFDischargeLabOrderBMP.md)

> **activity****reference**: [ServiceRequest Complete blood count without differential (procedure)](ServiceRequest-BSJ-SNFDischargeLabOrderCBC.md)

> **activity****reference**: [ServiceRequest Physical therapy assessment (procedure)](ServiceRequest-BSJ-SNFDischargePTRefer.md)



## Resource Content

```json
{
  "resourceType" : "CarePlan",
  "id" : "BSJ-SNFDischargeCarePlan",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan|8.0.1"]
  },
  "status" : "active",
  "intent" : "plan",
  "category" : [{
    "coding" : [{
      "system" : "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
      "code" : "assess-plan",
      "display" : "Assessment and Plan of Treatment"
    }]
  }],
  "subject" : {
    "reference" : "Patient/Example-Smith-Johnson-Patient1"
  },
  "activity" : [{
    "reference" : {
      "reference" : "ServiceRequest/BSJ-PCPFollowUp"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeCallOrder"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeCallOTRefer"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeCallSLPRefer"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeDietSalt"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeLabOrderBMP"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargeLabOrderCBC"
    }
  },
  {
    "reference" : {
      "reference" : "ServiceRequest/BSJ-SNFDischargePTRefer"
    }
  }]
}

```
