Release 4B Ballot #1
This page is part of the FHIR Specification (v4.1.0: Release 4B Ballot #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3
Contract-example-42cfr-part2.xml

Financial Management Work Group
Maturity Level: N/A
Standards Status: Informative
Compartments: Not linked to any defined compartments
Raw XML (canonical form + also see XML Format Specification)
Jump past Narrative
42 CFR Part 2 Consent Directive (id = "C-2121")
<?xml version="1.0" encoding="UTF-8"?>

<Contract xmlns="http://hl7.org/fhir">
  <id value="C-2121"/> 
  <meta> 
    <versionId value="1"/> 
    <lastUpdated value="2016-07-19T18:18:42.108-04:00"/> 
  </meta> 

  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative</b> </p> <p> <b> status</b> : executed</p> <p> <b> contentDerivative</b> : <span> Content Registration</span> </p> <p> <b> issued</b> : 2 Nov. 2013, 12:18:27 pm</p> <p> <b> applies</b> : 2 Nov. 2013, 12:18:27 pm --&gt; (ongoing)</p> <p> <b> subject</b> : <a> Generated Summary: BSN: 123456789 (OFFICIAL), BSN: 123456789 (OFFICIAL); active; Roel(OFFICIAL);
           Phone: +31612345678, Phone: +31201234567; gender: male; birthDate: 1960-03-13; <span> Legally married</span> ; </a> </p> <p> <b> type</b> : <span> Opt-in consent directive</span> </p> <p> <b> subType</b> : <span> Health Care Directive</span> </p> <blockquote> <p> <b> term</b> </p> <h3> Offers</h3> <table> <tr> <td> -</td> <td> <b> Type</b> </td> <td> <b> Decision</b> </td> <td> <b> Text</b> </td> </tr> <tr> <td> *</td> <td> <span> Statutory</span> </td> <td> <span> opt-in</span> </td> <td> Can't refuse</td> </tr> </table> <h3> Assets</h3> <table> <tr> <td> -</td> <td> <b> Period</b> </td> </tr> <tr> <td> *</td> <td> 2 Nov. 2013, 12:18:27 pm --&gt; 2 Nov. 2019, 12:18:27 pm</td> </tr> </table> <blockquote> <p> <b> action</b> </p> <p> <b> type</b> : <span> Action A</span> </p> <blockquote> <p> <b> subject</b> </p> <p> <b> reference</b> : <a> VA Ann Arbor Healthcare System. Generated Summary: id: 91654 (OFFICIAL), id: 17-0112278
                 (USUAL); <span> University Medical Hospital</span> ; name: Burgers University Medical Center; Phone: 022-655 2300</a> </p> <p> <b> role</b> : <span> Recipient of restricted health information</span> </p> </blockquote> <blockquote> <p> <b> subject</b> </p> <p> <b> reference</b> : <a> Community Mental Health Clinic. Generated Summary: id: 666666; name: XYZ Insurance; alias:
                 ABC Insurance</a> </p> <p> <b> role</b> : <span> Sender of restricted health information</span> </p> </blockquote> <p> <b> intent</b> : <span> health program reporting</span> </p> <p> <b> status</b> : <span> Sample</span> </p> </blockquote> </blockquote> <blockquote> <p> <b> signer</b> </p> <p> <b> type</b> : <span> SELF</span> </p> <p> <b> party</b> : <a> Alice Recruit. Generated Summary: BSN: 123456789 (OFFICIAL), BSN: 123456789 (OFFICIAL);
             active; Roel(OFFICIAL); Phone: +31612345678, Phone: +31201234567; gender: male; birthDate:
             1960-03-13; <span> Legally married</span> ; </a> </p> <h3> Signatures</h3> <table> <tr> <td> -</td> </tr> <tr> <td> *</td> </tr> </table> </blockquote> <h3> Legals</h3> <table> <tr> <td> -</td> <td> <b> Content[x]</b> </td> </tr> <tr> <td> *</td> <td/>  </tr> </table> </div> </text> <status value="executed"/> 

  <contentDerivative> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/contract-content-derivative"/> 
      <code value="registration"/> 
    </coding> 
  </contentDerivative> 

  <issued value="2013-11-01T21:18:27-04:00"/> 

  <applies> 
    <start value="2013-11-01T21:18:27-04:00"/> 
  </applies> 

  <subject> 
    <reference value="Patient/f201"/> 
  </subject> 

  <type> 
    <coding> 
      <system value="http://mdhhs.org/fhir/consentdirective-type"/> 
      <code value="OPTIN"/> 
    </coding> 
    <text value="Opt-in consent directive"/> 
  </type> 
  <subType> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/> 
      <code value="hcd"/> 
<!--         <code value="MDHHS-5515"/>
      <display
        value="Michigan MDHHS-5515 Consent to Share Behavioral Health Information for
       Care Coordination Purposes"
      />    -->
    </coding> 
  </subType> 

  <term> 
    <offer> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/contracttermtypecodes"/> 
          <code value="statutory"/> 
        </coding> 
      </type> 
      <decision> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
          <code value="OPTIN"/> 
        </coding> 
      </decision> 
      <text value="Can't refuse"/> 
    </offer> 
    
    <asset> 
      <period> 
        <start value="2013-11-01T21:18:27-04:00"/> 
        <end value="2019-11-01T21:18:27-04:00"/> 
      </period> 
      <!--   
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/>
        <code value="R"/>
        <display value="Restricted"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="ETH"/>
        <display value="substance abuse information sensitivity"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="42CFRPart2"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="TREAT"/>
        <display value="treatment"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="HPAYMT"/>
        <display value="healthcare payment"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="HOPERAT"/>
        <display value="healthcare operations"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PERSISTLABEL"/>
        <display value="persist security label"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PRIVMARK"/>
        <display value="privacy mark"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="NORDSCLCD"/>
        <display value="no redisclosure without consent directive"/>
      </securityLabel>
       -->
    </asset> 

    <action> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/contractaction"/> 
          <code value="action-a"/> 
        </coding> 
      </type> 
      <subject> 
        <reference> 
          <reference value="Organization/f001"/> 
          <display value="VA Ann Arbor Healthcare System"/> 
        </reference> 
        <role> 
          <coding> 
            <system value="http://mdhhs.org/fhir/consent-actor-type"/> 
            <code value="IR"/> 
            <display value="Recipient"/> 
          </coding> 
          <text value="Recipient of restricted health information"/> 
        </role> 
      </subject> 
      <subject> 
        <reference> 
          <reference value="Organization/2"/> 
          <display value="Community Mental Health Clinic"/> 
        </reference> 
        <role> 
          <coding> 
            <system value="http://mdhhs.org/fhir/consent-actor-type"/> 
            <code value="IS"/> 
            <display value="Sender"/> 
          </coding> 
          <text value="Sender of restricted health information"/> 
        </role> 
      </subject> 
      <intent> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> 
          <code value="HPRGRP"/> 
        </coding> 
      </intent> 
      <status> 
        <text value="Sample"/> 
      </status> 
    </action> 
    

  </term> 

  <signer> 
    <type> 
      <system value="http://mdhhs.org/fhir/consent-signer-type"/> 
      <code value="SELF"/> 
    </type> 
    <party> 
      <reference value="Patient/f201"/> 
      <display value="Alice Recruit"/> 
    </party> 
    <signature> 
      <type> 
        <system value="urn:iso-astm:E1762-95:2013"/> 
        <code value="1.2.840.10065.1.12.1.1"/> 
      </type> 
      <when value="2017-02-08T10:57:34+01:00"/> 
    <who> 
        <reference value="Patient/f201"/> 
    </who> 
    </signature> 
  </signer> 

  <legal> 
    <contentAttachment> 
      <contentType value="application/pdf"/> 
      <language value="en-US"/> 
      <url value="http://org.mihin.ecms/ConsentDirective-2121"/> 
      <title value="MDHHS-5515 Consent To Share Your Health Information"/> 
    </contentAttachment> 
  </legal> 
</Contract>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.