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
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Document Content
PMO Medical Orders
Order Exists: available here
PMOLST Order Observation
Order Exists: available here
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.
Signature: | Betsy Smith-Johnson |
Date: | 3/29/2024 |
Statement of Witnesses
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:
Witness Number: | |
Signature: | |
Date: |
Entry 1 - fullUrl = http://www.example.org/fhir/Composition/PMO-Example-Smith-Johnson-PMOComposition1
Resource Composition:
Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1
Language: en-US
Profile: ADI PMO Composition
Composition Version Number: 11546d53-a054-4882-bc0a-ff02aa0ba887c
Jurisdiction: Michigan (United States)
Effective Date: 2024-03-29 14:25:34-0500 --> (ongoing)
identifier:
urn:oid:2.16.840.1.113883.4.823.1.7124
/0-87f37989294a408897aacd1fc5d8fd16status: Final
type: Portable medical order form
category: Advance directives
date: 2024-03-29 14:25:34-0500
author: PractitionerRole
title: Portable Medical Order
custodian: Organization MyDirectives.com
Entry 2 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1
Resource Patient:
Generated Narrative: Patient Example-Smith-Johnson-Patient1
Last updated: 2021-03-29 14:25:34-0500; Language: en-US
Profile: US Core Patient Profile
Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#10A3D58WH1600)
Active: true Marital Status: unknown Other Id: Medical Record Number/1032702 (use: usual, ) Contact Detail
- BetsySJ@example.com
- 111 Maple Court San Antonio TX 78212 US (home)
Language: English (preferred) son:
- Charles Johnson
- 111 Maple Ct, Grand Rapids, MI 49503
- ph: (210) 222-3333
daughter:
- Debra Johnson
- 333 W. Camden St., Baltimore, MD 21201
- ph: (410) 444-5555
US Core Race Extension:
- ombCategory: CDC Race and Ethnicity 2106-3: White
- text: White
Entry 3 - fullUrl = http://www.example.org/fhir/Patient/Example-Kyle-Anydoc-PractitionerRole1
Resource PractitionerRole:
Generated Narrative: PractitionerRole Example-Kyle-Anydoc-PractitionerRole1
practitioner: Practitioner Kyle Anydoc
Entry 4 - fullUrl = http://www.example.org/fhir/Patient/Example-Kyle-Anydoc-Practitioner
Resource Practitioner:
Generated Narrative: Practitioner Example-Kyle-Anydoc-Practitioner
identifier: United States National Provider Identifier/7894563210
name: Kyle Anydoc
telecom: kanydoc@example.org
gender: Male
address: 567 Healthcare Drive Anytown MA 12345 US (home)
Qualifications
Code Doctor of Medicine
Entry 5 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-CPR-ServiceRequest1
Resource ServiceRequest:
Generated Narrative: ServiceRequest Example-Smith-Johnson-CPR-ServiceRequest1
status: Active
intent: Order
category: Cardiopulmonary resuscitation orders
doNotPerform: true
code: No display for ServiceRequest.code (concept: Cardiopulmonary resuscitation (procedure))
orderDetail: No display for ServiceRequest.orderDetail ()
requester: Practitioner Kyle Anydoc