<Provenance xmlns="http://hl7.org/fhir"><id value="example-create-consent"/><target><reference value="Consent/consent-example-basic/_history/1"/></target><recorded value="2021-09-10T07:08:21.722+00:00"/><activity><coding><system value="http://terminology.hl7.org/CodeSystem/v3-DataOperation"/><code value="CREATE"/><display value="create"/></coding></activity><patient><reference value="Patient/example"/></patient><agent><type><coding><system value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/><code value="assembler"/><display value="Assembler"/></coding></type><who><display value="LEAP Consent Management Service"/></who></agent><entity><role value="source"/><what><reference value="http://example.org/fhir/QuestionnaireResponse/some-questionnaire-response"/></what></entity></Provenance>