PACIO Advance Directive Interoperability Implementation Guide
2.1.0 - STU 2
PACIO Advance Directive Interoperability Implementation Guide
2.1.0 - STU 2
PACIO Advance Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-adi/ and changes regularly. See the Directory of published versions
Document Subject
Document Content
Entry 1 - fullUrl = http://www.example.org/fhir/Composition/Example-McBee-PACPComposition1
Resource Composition:
Generated Narrative: Composition Example-McBee-PACPComposition1
Language: en-US
identifier:
urn:oid:2.16.840.1.113883.4.823.1.7124/20130607100315-CCDA-CCDstatus: Final
type: Patient Personal advance care plan
category: Advance directives
date: 2018-08-28 08:49:58-0400
author: author name in PDF attachment
title: Personal Advance Care Plan Document for Roger McBee
custodian: Organization MyDirectives.com
Entry 2 - fullUrl = http://www.example.org/fhir/Patient/Example-McBee-Patient1
Resource Patient:
Generated Narrative: Patient Example-McBee-Patient1
Last updated: 2021-04-07 19:55:22+0000; Language: en-US
Profile: US Core Patient Profile
McBee, Roger Rienman Male, DoB: 1945-04-01 ( Social Beneficiary Identifier: United States Social Security Number#555-12-1246)
Active: true Marital Status: NoInformation Other Id: Driver's License Number/33487 Contact Detail
- +1(469)238-2858
- +1(214)497-9529
- rogerb@example.com
- 12345 Main Street Orlando FL 75219 US
Entry 3 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-McBee-HealthcareAgent1
Resource RelatedPerson:
Primary Healthcare Agent
The person I choose as my Primary Healthcare Agent is:
Sally Bobbins (daughter)
SallyBobbins@example.com
[SELECTED to act as a healthcare agent on 3/23/2018, at 9:13 AM CST]
[As of 12/6/2019, at 1:11 AM CDT, a response is still PENDING]
Entry 4 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-McBee-HealthcareAgent2
Resource RelatedPerson:
First Alternate Healthcare Agent
If this healthcare agent is unable or unwilling to make medical treatment decisions for me, or if my spouse is designated as my primary healthcare agent and our marriage is annulled, or we are divorced or legally separated, then my next choice for a healthcare agent is:
S. Leonard Susskind (Friend)
ssuskind@example.com
[SELECTED to act as a healthcare agent on 3/23/2018, at 9:13 AM CST]
[ACCEPTED to act as a healthcare agent on 3/23/2018, at 9:14 AM CST]
Entry 5 - fullUrl = http://www.example.org/fhir/Consent/Example-McBee-HealthcareAgentConsent
Resource Consent:
status: active
scope: Powers granted to healthcare agent [Reported]
category: Advance Directive
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: Bobbins Sally ; SallyBobbins@example.com
actor
role: First alternate healthcare agent [Reported]
reference: unrelated friend; Susskind S. Leonard ; ssuskind@example.com
action: Advance directive - request for intubation, Advance directive - request for tube feeding, Advance directive - request for life support
purpose: power of attorney
Entry 6 - fullUrl = http://www.example.org/fhir/CarePlan/Example-McBee-PreferenceCarePlan1
Resource CarePlan:
Generated Narrative: CarePlan Example-McBee-PreferenceCarePlan1
status: Active
intent: Proposal
category: Assessment and Plan of Treatment, Goals, preferences, and priorities under certain health conditions [Reported]
title: Care Plan for Unconscious, vegetative state, coma for McBee
addresses:
- No display for CarePlan.addresses
- reference: ->display: string (PrimitiveType/Bundle.entry[5].resource.addresses[0].reference.display): native = string -> Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery
- No display for CarePlan.addresses
- reference: ->display: string (PrimitiveType/Bundle.entry[5].resource.addresses[1].reference.display): native = string -> Persistent vegetative state (SNOMED CT 24473007)
- No display for CarePlan.addresses
- reference: ->display: string (PrimitiveType/Bundle.entry[5].resource.addresses[2].reference.display): native = string -> Irreversible coma (SNOMED CT 73453007)
supportingInfo:
- Observation Preference on consulting a supportive and palliative care team to help treat physical, emotional, and spiritual discomfort and support family [Reported]
- Observation Information to tell doctors if my health deteriorates due to a terminal illness and I am unable to interact meaningfully with family, friends, or surroundings [Reported]
- Observation Thoughts on artificial nutrition and hydration [Reported]
- Observation Information to tell doctors if I have a severe, irreversible brain injury or illness and can't dress, feed, or bathe myself, or communicate my medical wishes, but can be kept alive [Reported]
- Observation Thoughts on cardiopulmonary resuscitation (CPR) [Reported]
- Observation Thoughts on cardiopulmonary resuscitation (CPR) [Reported]
- Observation Preferred location to spend final days if possible to choose [Reported]
Entry 7 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-CareExperiencePreference1
Resource Observation:
My likes / joys: Here are some examples of the things that I would like to have near me, music that I’d like to hear, and other details of my care that would help to keep me happy and relaxed:
Like Bach, especially the cantatas. St. Martin in the Fields
Entry 8 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-CareExperiencePreference2
Resource Observation:
How to care for me: If I become incapacitated and cannot express myself, here is what I would like to tell my healthcare agent, family and friends about how I would like for them to care for me:
I don’t like being treated like an object. I would like to be greeted like a person before working on me.
Entry 9 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-CareExperiencePreference3
Resource Observation:
Please attempt to notify someone from my religion at the following phone number: (If I have included one)
Not Religious
Entry 10 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-CareExperiencePreference4
Resource Observation:
My unfinished business: If it appears that I am approaching the end of my life, and I cannot communicate with persons around me, I would want my doctors and nurses, my family, and my friends to know about some unfinished business that I need to address:
I am awaiting a message from the Noble Committee. Please keep me alive if I look promising this year.
Entry 11 - fullUrl = http://www.example.org/fhir/List/Example-McBee-PersonalPrioritiesOrganizer1
Resource List:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
- Being at peace with my God
- Dying at home
- Being able to feed, bathe, and take care of myself
- Being free from pain
- Resolving conflicts
- Being with my family
- Not being a financial burden to my family
Entry 12 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference1
Resource Observation:
If I am having significant pain or suffering, I would like my doctors to consult a Supportive and Palliative Care Team to help treat my physical, emotional and spiritual discomfort, and to support my family.
Entry 13 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference2
Resource Observation:
If my health ever deteriorates due to a terminal illness, and my doctors believe I will not be able to interact meaningfully with my family, friends, or surroundings, I prefer that they stop all life-sustaining treatments and let me die as gently as possible. I realize that I will not receive life-sustaining treatments including but not limited to breathing machines, blood transfusions, dialysis, heart machines, and IV drugs to keep my heart working. I also realize that medical personnel will not attempt cardiopulmonary resuscitation (CPR), and they will allow me to die naturally.
Entry 14 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference3
Resource Observation:
If my response above indicates that I do not want life-sustaining treatments,
I expressly authorize my attending physician to withhold or withdraw artificial nutrition and hydration and instruct my healthcare agent (or, if I have not designated a healthcare agent, my default surrogate), my family and the doctors and nurses who are taking care of me to respect this request.
Entry 15 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference4
Resource Observation:
If I have a severe, irreversible brain injury or illness and can’t dress, feed, or bathe myself, or communicate my medical wishes, but doctors can keep me alive in this condition for a long period of time, I would like for them to keep trying life-sustaining treatments for 2 months.
Entry 16 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference5
Resource Observation:
Although I understand that, depending on the situation and circumstances, medical personnel may not be able to follow my wishes, here are my general thoughts on cardiopulmonary resuscitation (CPR):
I want my healthcare agent to make the decision, but if my chances are slim to none that I'll leave the hospital, even if they resuscitate me, then I absolutely do not want CPR.
Entry 17 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference6
Resource Observation:
Although I understand that, depending on the situation and circumstances, medical personnel may not be able to follow my wishes, here are my general thoughts on cardiopulmonary resuscitation (CPR):
I want my healthcare agent to make the decision, but if my chances are slim to none that I'll leave the hospital, even if they resuscitate me, then I absolutely do not want CPR.
Entry 18 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference7
Resource Observation:
If it were possible to choose, here is where I would like to spend my final days:
At home.I would like to receive hospice care at home if possible.
Entry 19 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-PersonalInterventionPreference8
Resource Observation:
Here are my thoughts on funeral or burial plans:
If I were to pass away: I have a plot. My wife has the details, also my secretary, Ms. Williams, will know.
Entry 20 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal1
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Being at peace with my God
Entry 21 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal2
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Dying at home
Entry 22 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal3
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Being able to feed, bathe, and take care of myself
Entry 23 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal4
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Being free from pain
Entry 24 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal5
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Resolving conflicts
Entry 25 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal6
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Being with my family
Entry 26 - fullUrl = http://www.example.org/fhir/Goal/Example-McBee-PersonalGoal7
Resource Goal:
If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me:
Not being a financial burden to my family
Entry 27 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-OrganDonationObservation1
Resource Observation:
Consent to Donate
I don’t want to donate my organs.
Entry 28 - fullUrl = http://www.example.org/fhir/Observation/Example-McBee-AutopsyObservation1
Resource Observation:
Autopsy
I want an autopsy if my doctor thinks it will help others.
Entry 29 - fullUrl = http://www.example.org/fhir/Organization/Example-McBee-OrganizationCustodian1
Resource Organization:
Generated Narrative: Organization Example-McBee-OrganizationCustodian1
identifier: United States National Provider Identifier/1234567893
active: true
name: MyDirectives.com
Contacts
Telecom Address +1(202)776-7700 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US
IG © 2021+ HL7 International / Patient Empowerment. Package hl7.fhir.us.pacio-adi#2.1.0 based on FHIR 4.0.1. Generated 2024-07-26
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