Example-Smith-Johnson-PACP-Bundle1
type: Bundle
node role: treeRoot
id:
  v: Example-Smith-Johnson-PACP-Bundle1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
identifier:
  system:
    v: http://example.org/GoodHealthClinic/id
  value:
    v: 20130607100315-CCDA-CCD
type:
  v: document
timestamp:
  v: 2021-03-29T14:25:34.001-05:00
entry:
  full url:
    v: http://www.example.org/fhir/Composition/Example-Smith-Johnson-PACPComposition1
  resource: Example-Smith-Johnson-PACPComposition1
entry:
  full url:
    v: http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1
  resource: Example-Smith-Johnson-Patient1
entry:
  full url:
    v: http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-Notary1
  resource: Example-Smith-Johnson-Notary1
entry:
  full url:
    v: http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
  resource: Example-Smith-Johnson-HealthcareAgent1
entry:
  full url:
    v: http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent2
  resource: Example-Smith-Johnson-HealthcareAgent2
entry:
  full url:
    v: http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent3
  resource: Example-Smith-Johnson-HealthcareAgent3
entry:
  full url:
    v: http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent
  resource: Example-Smith-Johnson-HealthcareAgentConsent
entry:
  full url:
    v: http://www.example.org/fhir/CarePlan/Example-Smith-Johnson-PreferenceCarePlan1
  resource: Example-Smith-Johnson-PreferenceCarePlan1
entry:
  full url:
    v: http://www.example.org/fhir/CarePlan/Example-Smith-Johnson-PreferenceCarePlan2
  resource: Example-Smith-Johnson-PreferenceCarePlan2
entry:
  full url:
    v: http://www.example.org/fhir/CarePlan/Example-Smith-Johnson-PreferenceCarePlan3
  resource: Example-Smith-Johnson-PreferenceCarePlan3
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference1
  resource: Example-Smith-Johnson-CareExperiencePreference1
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference2
  resource: Example-Smith-Johnson-CareExperiencePreference2
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference3
  resource: Example-Smith-Johnson-CareExperiencePreference3
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference4
  resource: Example-Smith-Johnson-CareExperiencePreference4
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference5
  resource: Example-Smith-Johnson-CareExperiencePreference5
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference6
  resource: Example-Smith-Johnson-CareExperiencePreference6
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference7
  resource: Example-Smith-Johnson-CareExperiencePreference7
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-CareExperiencePreference8
  resource: Example-Smith-Johnson-CareExperiencePreference8
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-PersonalInterventionPreference1
  resource: Example-Smith-Johnson-PersonalInterventionPreference1
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-PersonalInterventionPreference3
  resource: Example-Smith-Johnson-PersonalInterventionPreference3
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-PersonalInterventionPreference5
  resource: Example-Smith-Johnson-PersonalInterventionPreference5
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-PersonalInterventionPreference6
  resource: Example-Smith-Johnson-PersonalInterventionPreference6
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-OrganDonationObservation1
  resource: Example-Smith-Johnson-OrganDonationObservation1
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-AutopsyObservation1
  resource: Example-Smith-Johnson-AutopsyObservation1
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-UponDeathPreference1
  resource: Example-Smith-Johnson-UponDeathPreference1
entry:
  full url:
    v: http://www.example.org/fhir/Observation/Example-Smith-Johnson-DocumentationObservation1
  resource: Example-Smith-Johnson-DocumentationObservation1
entry:
  full url:
    v: http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1
  resource: Example-Smith-Johnson-OrganizationCustodian1

Example-Smith-Johnson-PACPComposition1
type: Composition
id:
  v: Example-Smith-Johnson-PACPComposition1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PACPComposition
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PACPComposition
language:
  v: en-US
text:
  status:
    v: extensions
  div: Generated Narrative: Composition Example-Smith-Johnson-PACPComposition1 Language: en-US Profile: ADI PtAuthored Composition Composition Version Number: 2022-03-29T14:25:34-05:00 Data Enterer: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16) ADI Expiration Date: 2028-03-29 14:25:34-0500 identifier: http://example.org/GoodHealthClinic/id/0-87f37989294a408897aacd1fc5d8fd16 status: Final type: Patient Personal advance care plan category: Advance healthcare directives date: 2021-03-29 14:25:34-0500 author: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16) title: Personal Advance Care Plan Attesters - Mode Party * Personal Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16) custodian: Organization example.org
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
  value: string
    v: 2022-03-29T14:25:34-05:00
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
  value: Reference
    link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
    reference:
      v: Patient/Example-Smith-Johnson-Patient1
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
  value: dateTime
    v: 2028-03-29T14:25:34-05:00
identifier:
  system:
    v: http://example.org/GoodHealthClinic/id
status:
  v: final
type:
  coding: https://loinc.org/rdf/81334-5
    system:
      v: http://loinc.org
    code:
      v: 81334-5
    display:
      v: Patient Personal advance care plan
category:
  coding: https://loinc.org/rdf/42348-3
    system:
      v: http://loinc.org
    code:
      v: 42348-3
    display:
      v: Advance healthcare directives
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
date:
  v: 2021-03-29T14:25:34-05:00
author:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
title:
  v: Personal Advance Care Plan
attester:
  mode:
    v: personal
  party:
    link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
    reference:
      v: Patient/Example-Smith-Johnson-Patient1
custodian:
  link: http://hl7.org/fhir/us/pacio-adi/Organization/Example-Smith-Johnson-OrganizationCustodian1
  reference:
    v: Organization/Example-Smith-Johnson-OrganizationCustodian1
section:
  title:
    v: Appointment of a Primary Healthcare Agent and Alternate Healthcare Agents
  code:
    coding: https://loinc.org/rdf/81335-2
      system:
        v: http://loinc.org
      code:
        v: 81335-2
      display:
        v: Healthcare Agent
  text:
    status:
      v: additional
    div: IF THIS PART OF THE uADD™ IS LEFT BLANK, I DO NOT WANT TO DESIGNATE A HEALTHCARE AGENT AT THIS TIME, AND I DO NOT WANT A DEFAULT HEALTHCARE AGENT DESIGNATED FOR ME UNDER APPLICABLE LAW. I TRUST THE DOCTORS AND NURSES TREATING ME TO MAKE MEDICAL TREATMENT DECISIONS REGARDING MY TREATMENT AND CARE. I am appointing the person or persons below as my healthcare agent and, if applicable, as my alternate healthcare agent(s), and I am granting to each of them the legal authority to make medical treatment decisions on my behalf and to consult with my physician and others. The power to make medical treatment decisions that I am granting to my healthcare agent(s) is expressly subject to, and limited by, the choices that I have expressed elsewhere in my uADD. If my medical treatment choices are not clear, I am authorizing and directing my healthcare agent to make decisions in my best interests and based on what is known of my wishes. Primary Healthcare Agent The person I choose as my Primary Healthcare Agent is: Charles Johnson (Son) CharlesSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT] 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: Debra Johnson (Daughter) DebraSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [As of 4/1/2021, at 3:40 PM CDT, a response is still PENDING] My Healthcare Agent’s General Authority Subject to my medical treatment choices expressed elsewhere in this uADD™ and applicable law that requires otherwise, I grant to my healthcare agent the power to make all choices and medical treatment decisions for me. If I cannot express my own wishes for medical treatment, I would…
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-Notary1
    reference:
      v: RelatedPerson/Example-Smith-Johnson-Notary1
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
    reference:
      v: RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent2
    reference:
      v: RelatedPerson/Example-Smith-Johnson-HealthcareAgent2
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Consent/Example-Smith-Johnson-HealthcareAgentConsent
    reference:
      v: Consent/Example-Smith-Johnson-HealthcareAgentConsent
section:
  title:
    v: Patient Goals, Preferences, and Priorities for Care Experience
  code:
    coding: https://loinc.org/rdf/81338-6
      system:
        v: http://loinc.org
      code:
        v: 81338-6
      display:
        v: Patient Goals, Preferences, and Priorities for Care Experience
  text:
    status:
      v: additional
    div: MyDirectives® offers people a list of optional questions that can be answered by typing text in a text box or by uploading a video or audio file for each question. Only those questions answered by Betsy Smith-Johnson appear here. For a complete list of questions in My Thoughts, please visit www.example.org. In case I’m being cared for by a person(s) who doesn't know me very well, I’d like my following thoughts to be known. 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: I love the smell of lavender and the feeling of sunshine on my face. My dislikes / fears: Here is a list of things that I would like to avoid if at all possible, people that I don’t wish to see, and concerns I have about particular family members, pets, and so on: I do not like my feet to be cold. 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 want photos of my family where I can see them. My religion: If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest. Please attempt to notify someone from my religion at the following phone number: If I have included one Catholic 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 want my sister and I to talk again, and miss her. I wish we hadn't disagreed all those years ago and regret the time it has cost us. I'd like to see her face if I were very ill and needed the comfort of family at my side. Laughter: T…
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference1
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference1
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference2
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference2
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference3
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference3
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference4
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference4
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference5
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference5
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference6
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference6
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference7
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference7
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference8
    reference:
      v: Observation/Example-Smith-Johnson-CareExperiencePreference8
section:
  title:
    v: Patient Goals, preferences, and priorities under certain conditions
  code:
    coding: https://loinc.org/rdf/81336-0
      system:
        v: http://loinc.org
      code:
        v: 81336-0
      display:
        v: Patient Goals, preferences, and priorities under certain health conditions
  text:
    status:
      v: additional
    div: Care Plan 1 status: active intent: proposal category: Advance care plan subject: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15 addresses: Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery Persistent vegetative state (SNOMED CT 24473007) Irreversible coma (SNOMED CT 73453007) goal: Goals, preferences, and priorities under certain health conditions - Reported; 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: Avoiding prolonged dependence on machines, Not being a physical burden to my family, Dying at home 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; 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 would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently. Religious or cultural affiliation contact to notify - Reported; Please attempt to notify someone from my religion at the following phone number: If I have included one: Catholic Religious or cultural beliefs - Reported; If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest. Decision to inform doctors and nurses about the role religion, faith, culture, or spirituality play in my life - Reported; Here are some thoughts that I would like for my medical care team and …
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/CarePlan/Example-Smith-Johnson-PreferenceCarePlan1
    reference:
      v: CarePlan/Example-Smith-Johnson-PreferenceCarePlan1
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/CarePlan/Example-Smith-Johnson-PreferenceCarePlan2
    reference:
      v: CarePlan/Example-Smith-Johnson-PreferenceCarePlan2
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/CarePlan/Example-Smith-Johnson-PreferenceCarePlan3
    reference:
      v: CarePlan/Example-Smith-Johnson-PreferenceCarePlan3
section:
  title:
    v: Goals, Preferences and Priorities Upon Death
  code:
    coding: https://loinc.org/rdf/81337-8
      system:
        v: http://loinc.org
      code:
        v: 81337-8
      display:
        v: Patient Goals, Preferences, and Priorities Upon Death
  text:
    status:
      v: additional
    div: Consent to Donate I consent to donate all organs and tissues. Autopsy I want an autopsy only if there are questions about my death. Here are my thoughts on funeral or burial plans: If I were to pass away: Please call Jim Houston, my lawyer, for arrangements I have already made.
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-OrganDonationObservation1
    reference:
      v: Observation/Example-Smith-Johnson-OrganDonationObservation1
  entry:
    link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-AutopsyObservation1
    reference:
      v: Observation/Example-Smith-Johnson-AutopsyObservation1

Example-Smith-Johnson-Patient1
type: Patient
id:
  v: Example-Smith-Johnson-Patient1
meta:
  last updated:
    v: 2021-03-29T14:25:34.001-05:00
  profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
language:
  v: en-US
text:
  status:
    v: generated
  div: 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#1PA3D58WH16) 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 <td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:#xA;#xA; - American Indian or Alaska Native#xA; - Asian#xA; - Black or African American#xA; - Native Hawaiian or Other Pacific Islander#xA; - White.">US Core Race Extension: ombCategory: CDC Race and Ethnicity 2106-3: White text: White
extension:
  extension:
    url:
      v: ombCategory
    value: Coding
      system:
        v: urn:oid:2.16.840.1.113883.6.238
      code:
        v: 2106-3
      display:
        v: White
  extension:
    url:
      v: text
    value: string
      v: White
  url:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
identifier:
  use:
    v: usual
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: MR
      display:
        v: Medical Record Number
    text:
      v: Medical Record Number
  system:
    v: http://example.org/GoodHealthHospital
  value:
    v: 1032702
identifier:
  system:
    v: http://hl7.org/fhir/sid/us-medicare
  value:
    v: 1PA3D58WH16
active:
  v: true
name:
  use:
    v: usual
  text:
    v: Smith-Johnson, Betsy
  family:
    v: Smith-Johnson
  given:
    v: Betsy
telecom:
  system:
    v: email
  use:
    v: home
gender:
  v: female
birth date:
  v: 1950-11-15
address:
  use:
    v: home
  type:
    v: physical
  line:
    v: 111 Maple Court
  city:
    v: San Antonio
  state:
    v: TX
  postal code:
    v: 78212
  country:
    v: US
marital status:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
    code:
      v: UNK
contact:
  relationship:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
      code:
        v: SONC
  name:
    text:
      v: Charles Johnson
  telecom:
    system:
      v: phone
    value:
      v: (210) 222-3333
  address:
    text:
      v: 111 Maple Ct, Grand Rapids, MI 49503
contact:
  relationship:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
      code:
        v: DAUC
  name:
    text:
      v: Debra Johnson
  telecom:
    system:
      v: phone
    value:
      v: (410) 444-5555
  address:
    text:
      v: 333 W. Camden St., Baltimore, MD 21201
communication:
  language:
    coding:
      system:
        v: urn:ietf:bcp:47
      code:
        v: en
      display:
        v: English
  preferred:
    v: true

Example-Smith-Johnson-Notary1
type: RelatedPerson
id:
  v: Example-Smith-Johnson-Notary1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
text:
  status:
    v: additional
  div: Notary Charles Xavier
patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
name:
  text:
    v: Xavier, Charles
  family:
    v: Xavier
  given:
    v: Charles
telecom:
  system:
    v: email
  use:
    v: work

Example-Smith-Johnson-HealthcareAgent1
type: RelatedPerson
id:
  v: Example-Smith-Johnson-HealthcareAgent1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
text:
  status:
    v: additional
  div: Primary Healthcare Agent The person I choose as my Primary Healthcare Agent is: Charles Johnson (Son) CharlesSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]
patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: SON
    display:
      v: natural son
name:
  text:
    v: Johnson, Charles
  family:
    v: Johnson
  given:
    v: Charles
telecom:
  system:
    v: email
  use:
    v: home

Example-Smith-Johnson-HealthcareAgent2
type: RelatedPerson
id:
  v: Example-Smith-Johnson-HealthcareAgent2
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
text:
  status:
    v: additional
  div: 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: Debra Johnson (Daughter) DebraSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [As of 4/1/2021, at 3:40 PM CDT, a response is still PENDING]
patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: DAU
    display:
      v: natural daughter
name:
  text:
    v: Johnson, Debra
  family:
    v: Johnson
  given:
    v: Debra
telecom:
  system:
    v: email
  use:
    v: home

Example-Smith-Johnson-HealthcareAgent3
type: RelatedPerson
id:
  v: Example-Smith-Johnson-HealthcareAgent3
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
text:
  status:
    v: additional
  div: Primary Healthcare Agent The person I choose as my Primary Healthcare Agent is: Charles Johnson (Son) CharlesSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]
patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
relationship:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    code:
      v: SON
    display:
      v: natural son
name:
  text:
    v: Johnson, Charles
  family:
    v: Johnson
  given:
    v: Charles
telecom:
  system:
    v: email
  use:
    v: home

Example-Smith-Johnson-HealthcareAgentConsent
type: Consent
id:
  v: Example-Smith-Johnson-HealthcareAgentConsent
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentPermit
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentPermit
text:
  status:
    v: additional
  div: status: active scope: Powers granted to healthcare agent - Reported category: Advance Directive patient: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15 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: natural son; Charles Johnson ; CharlesSJ@example.com actor role: First alternate healthcare agent - Reported reference: First alternate healthcare agent - Reported, natural daughter; Debra Johnson ; DebraSJ@example.com action: Advance directive - request for intubation, Advance directive - request for tube feeding, Advance directive - request for life support, Advance directive - request for IV fluid and support, Advance directive - request for antibiotics, Advance directive - request for resuscitation that differs from cardiopulmonary resuscitation purpose: power of attorney
status:
  v: active
scope:
  coding: https://loinc.org/rdf/81377-4
    system:
      v: http://loinc.org
    code:
      v: 81377-4
    display:
      v: Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported
category:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/consentcategorycodes
    version:
      v: 1.0.0
    code:
      v: acd
    display:
      v: Advance Directive
patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
date time:
  v: 2020-08-03
policy:
  uri:
    v: http://example.org/healthcare-agent-policy
provision:
  type:
    v: permit
  actor:
    role:
      coding: https://loinc.org/rdf/75783-1
    reference:
      link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
      reference:
        v: RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
  actor:
    role:
      coding: https://loinc.org/rdf/75784-9
    reference:
      link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent3
      reference:
        v: RelatedPerson/Example-Smith-Johnson-HealthcareAgent3
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: intubation
      display:
        v: Intubation
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: tube-feeding
      display:
        v: Tube feeding
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: life-support
      display:
        v: Life support
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: iv-fluid-and-support
      display:
        v: IV fluid and support
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: antibiotics
      display:
        v: Antibiotics
  action:
    coding:
      system:
        v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIHCADecisionsCS
      code:
        v: resuscitation-non-cpr
      display:
        v: Non-CPR Resuscitation
  purpose:
    system:
      v: http://terminology.hl7.org/CodeSystem/v3-ActReason
    code:
      v: PWATRNY

Example-Smith-Johnson-PreferenceCarePlan1
type: CarePlan
id:
  v: Example-Smith-Johnson-PreferenceCarePlan1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
text:
  status:
    v: generated
  div: status: active intent: proposal category: Advance care plan subject: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15 addresses: Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery Persistent vegetative state (SNOMED CT 24473007) Irreversible coma (SNOMED CT 73453007) goal: Goals, preferences, and priorities under certain health conditions - Reported; 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: Avoiding prolonged dependence on machines, Not being a physical burden to my family, Dying at home 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; 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 would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently. Religious or cultural affiliation contact to notify - Reported; Please attempt to notify someone from my religion at the following phone number: If I have included one: Catholic Religious or cultural beliefs - Reported; If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest. Decision to inform doctors and nurses about the role religion, faith, culture, or spirituality play in my life - Reported; Here are some thoughts that I would like for my medical care team and my healthcar…
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-goal-order-by-descending-priority-extension
  value: CodeableConcept
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0532
      code:
        v: Y
status:
  v: active
intent:
  v: proposal
category:
  coding: https://loinc.org/rdf/81378-2
    system:
      v: http://loinc.org
    code:
      v: 81378-2
    display:
      v: Goals, preferences, and priorities under certain health conditions Narrative - Reported
title:
  v: Care Plan for Unconscious, vegetative state, coma for Smith-Johnson
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
addresses:
  display:
    v: Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery
addresses:
  display:
    v: Persistent vegetative state (SNOMED CT 24473007)
addresses:
  display:
    v: Irreversible coma (SNOMED CT 73453007)
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference1
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference1
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference5
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference5
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference6
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference6

Example-Smith-Johnson-PreferenceCarePlan2
type: CarePlan
id:
  v: Example-Smith-Johnson-PreferenceCarePlan2
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
text:
  status:
    v: generated
  div: status: active intent: proposal category: Advance care plan subject: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15 addresses: Permanent, severe brain damage and I am unable to recognize my family and friends goal: Goals, preferences, and priorities under certain health conditions - Reported; 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: Avoiding prolonged dependence on machines, Not being a physical burden to my family, Dying at home 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; 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 would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently. Religious or cultural beliefs - Reported; If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest.
status:
  v: active
intent:
  v: proposal
category:
  coding: https://loinc.org/rdf/81378-2
    system:
      v: http://loinc.org
    code:
      v: 81378-2
    display:
      v: Goals, preferences, and priorities under certain health conditions Narrative - Reported
title:
  v: Care Plan for Permanent, severe brain damage
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
addresses:
  display:
    v: Permanent, severe brain damage and I am unable to recognize my family and friends
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference5
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference5

Example-Smith-Johnson-PreferenceCarePlan3
type: CarePlan
id:
  v: Example-Smith-Johnson-PreferenceCarePlan3
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan
text:
  status:
    v: generated
  div: status: active intent: proposal category: Advance care plan subject: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15 addresses: Terminal illness, lack of meaningful interaction goal: Goals, preferences, and priorities under certain health conditions - Reported; 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: Avoiding prolonged dependence on machines, Not being a physical burden to my family, Dying at home Decision to inform doctors and nurses about the role religion, faith, culture, or spirituality play in my life - Reported; Here are some thoughts that I would like for my medical care team and my healthcare agent(s) to know about the role that religion, faith or spirituality play in my life: I am Catholic, please call Father Mark at Saint Catherine's on Main Street. My likes and joys - Reported; 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: I love the smell of lavender and the feeling of sunshine on my face. My dislikes and fears - Reported; Here is a list of things that I would like to avoid if at all possible, people that I don’t wish to see, and concerns I have about particular family members, pets, and so on: I do not like my feet to be cold. Goals, preferences, and priorities for care experience - Reported; 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 want photos of my family where I can see them. Religious or cultural beliefs - Reported; If I appear to be approaching the end of my life, here are some…
status:
  v: active
intent:
  v: proposal
category:
  coding: https://loinc.org/rdf/81378-2
    system:
      v: http://loinc.org
    code:
      v: 81378-2
    display:
      v: Goals, preferences, and priorities under certain health conditions Narrative - Reported
title:
  v: Care Plan for Terminal illness, lack of meaningful interaction
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
addresses:
  display:
    v: Terminal illness, lack of meaningful interaction
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference1
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference1
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference2
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference2
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference3
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference3
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference4
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference4
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference5
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference5
supporting info:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-CareExperiencePreference7
  reference:
    v: Observation/Example-Smith-Johnson-CareExperiencePreference7

Example-Smith-Johnson-CareExperiencePreference1
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: Here are some thoughts that I would like for my medical care team and my healthcare agent(s) to know about the role that religion, faith or spirituality play in my life: I am Catholic, please call Father Mark at Saint Catherine's on Main Street.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: Here are some thoughts that I would like for my medical care team and my healthcare agent(s) to know about the role that religion, faith or spirituality play in my life
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/75775-7
    system:
      v: http://loinc.org
    code:
      v: 75775-7
    display:
      v: Decision to inform doctors and nurses about the role religion, faith, culture, or spirituality play in my life Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I am Catholic, please call Father Mark at Saint Catherine's on Main Street.

Example-Smith-Johnson-CareExperiencePreference2
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference2
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: 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: I love the smell of lavender and the feeling of sunshine on my face.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: 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
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81360-0
    system:
      v: http://loinc.org
    code:
      v: 81360-0
    display:
      v: My likes and joys Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I love the smell of lavender and the feeling of sunshine on my face.

Example-Smith-Johnson-CareExperiencePreference3
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference3
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: My dislikes / fears: Here is a list of things that I would like to avoid if at all possible, people that I don’t wish to see, and concerns I have about particular family members, pets, and so on: I do not like my feet to be cold.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: Here is a list of things that I would like to avoid if at all possible, people that I don’t wish to see, and concerns I have about particular family members, pets, and so on
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81362-6
    system:
      v: http://loinc.org
    code:
      v: 81362-6
    display:
      v: My dislikes and fears Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I do not like my feet to be cold.

Example-Smith-Johnson-CareExperiencePreference4
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference4
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: 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 want photos of my family where I can see them.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: 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
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81380-8
    system:
      v: http://loinc.org
    code:
      v: 81380-8
    display:
      v: Goals, preferences, and priorities for care experience Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I want photos of my family where I can see them.

Example-Smith-Johnson-CareExperiencePreference5
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference5
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: My religion: If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion.
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81364-2
    system:
      v: http://loinc.org
    code:
      v: 81364-2
    display:
      v: Religious or cultural beliefs Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Please call Father Mark if my condition warrants the services of a priest.

Example-Smith-Johnson-CareExperiencePreference6
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference6
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: Please attempt to notify someone from my religion at the following phone number: If I have included one Catholic
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: Please attempt to notify someone from my religion at the following phone number If I have included one
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81365-9
    system:
      v: http://loinc.org
    code:
      v: 81365-9
    display:
      v: Religious or cultural affiliation contact to notify - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Catholic

Example-Smith-Johnson-CareExperiencePreference7
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference7
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: 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 want my sister and I to talk again, and miss her. I wish we hadn't disagreed all those years ago and regret the time it has cost us. I'd like to see her face if I were very ill and needed the comfort of family at my side.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: 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
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81366-7
    system:
      v: http://loinc.org
    code:
      v: 81366-7
    display:
      v: Unfinished business Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I want my sister and I to talk again, and miss her. I wish we hadn't disagreed all those years ago and regret the time it has cost us. I'd like to see her face if I were very ill and needed the comfort of family at my side.

Example-Smith-Johnson-CareExperiencePreference8
type: Observation
id:
  v: Example-Smith-Johnson-CareExperiencePreference8
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-CareExperiencePreference
text:
  status:
    v: generated
  div: Laughter: These are some of my fondest memories from life that have always brought a smile to my face or made me laugh: My dogs make me laugh when they play together, and my grandchildren make me laugh when they put on plays for me. They bring me great joy.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: These are some of my fondest memories from life that have always brought a smile to my face or made me laugh
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: care-experience-preference
    display:
      v: Care experience preference
code:
  coding: https://loinc.org/rdf/81361-8
    system:
      v: http://loinc.org
    code:
      v: 81361-8
    display:
      v: Things that make me laugh Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: My dogs make me laugh when they play together, and my grandchildren make me laugh when they put on plays for me. They bring me great joy.

Example-Smith-Johnson-PersonalInterventionPreference1
type: Observation
id:
  v: Example-Smith-Johnson-PersonalInterventionPreference1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
text:
  status:
    v: generated
  div: 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.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: If I am having significant pain or suffering
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: intervention-preference
    display:
      v: Intervention preference
code:
  coding: https://loinc.org/rdf/75780-7
    system:
      v: http://loinc.org
    code:
      v: 75780-7
    display:
      v: Preferred location to spend final days if possible to choose Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: 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.

Example-Smith-Johnson-PersonalInterventionPreference3
type: Observation
id:
  v: Example-Smith-Johnson-PersonalInterventionPreference3
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
text:
  status:
    v: generated
  div: 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 would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: 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
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: intervention-preference
    display:
      v: Intervention preference
code:
  coding: https://loinc.org/rdf/75778-1
    system:
      v: http://loinc.org
    code:
      v: 75778-1
    display:
      v: 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 Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: I would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently.

Example-Smith-Johnson-PersonalInterventionPreference5
type: Observation
id:
  v: Example-Smith-Johnson-PersonalInterventionPreference5
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
text:
  status:
    v: generated
  div: 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.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: If it were possible to choose, here is where I would like to spend my final days
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: intervention-preference
    display:
      v: Intervention preference
code:
  coding: https://loinc.org/rdf/75780-7
    system:
      v: http://loinc.org
    code:
      v: 75780-7
    display:
      v: Preferred location to spend final days if possible to choose Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: At home.I would like to receive hospice care at home if possible.

Example-Smith-Johnson-PersonalInterventionPreference6
type: Observation
id:
  v: Example-Smith-Johnson-PersonalInterventionPreference6
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PersonalInterventionPreference
text:
  status:
    v: generated
  div: Here are my thoughts on funeral or burial plans: If I were to pass away: Please call Jim Houston, my lawyer, for arrangements I have already made.
extension:
  url:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-enclosedPrecondition-extension
  value: CodeableConcept
    text:
      v: If I were to pass away
status:
  v: final
category:
  coding:
    system:
      v: http://hl7.org/fhir/us/pacio-adi/CodeSystem/ADIPreferenceCategoryCS
    code:
      v: intervention-preference
    display:
      v: Intervention preference
code:
  coding: https://loinc.org/rdf/81356-8
    system:
      v: http://loinc.org
    code:
      v: 81356-8
    display:
      v: Death arrangements Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Please call Jim Houston, my lawyer, for arrangements I have already made.

Example-Smith-Johnson-OrganDonationObservation1
type: Observation
id:
  v: Example-Smith-Johnson-OrganDonationObservation1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-OrganDonationObservation
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-OrganDonationObservation
text:
  status:
    v: generated
  div: Consent to Donate I consent to donate all organs and tissues.
status:
  v: final
code:
  coding: https://loinc.org/rdf/75781-5
    system:
      v: http://loinc.org
    code:
      v: 75781-5
    display:
      v: Thoughts on organ and tissue donations Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Consent to Donate: I consent to donate all organs and tissues.

Example-Smith-Johnson-AutopsyObservation1
type: Observation
id:
  v: Example-Smith-Johnson-AutopsyObservation1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-AutopsyObservation
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-AutopsyObservation
text:
  status:
    v: generated
  div: Autopsy preferences I want an autopsy only if there are questions about my death.
status:
  v: final
code:
  coding: https://loinc.org/rdf/75782-3
    system:
      v: http://loinc.org
    code:
      v: 75782-3
    display:
      v: Thoughts regarding autopsy Narrative - Reported
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Autopsy: I want an autopsy: only if there are questions about my death.

Example-Smith-Johnson-UponDeathPreference1
type: Observation
id:
  v: Example-Smith-Johnson-UponDeathPreference1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-UponDeathPreferences
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-UponDeathPreferences
text:
  status:
    v: generated
  div: Upon Death Preferences I want a military style funderal at the local Veterans Hall.
status:
  v: final
code:
  coding: https://loinc.org/rdf/81356-8
    system:
      v: http://loinc.org
    code:
      v: 81356-8
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2022-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: string
  v: Upon death preference: I want a military style funderal at the local Veterans Hall.

Example-Smith-Johnson-DocumentationObservation1
type: Observation
id:
  v: Example-Smith-Johnson-DocumentationObservation1
meta:
  profile:
    v: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation
text:
  status:
    v: additional
  div: PMOLST Order Observation Order Exists: available here
status:
  v: final
code:
  coding: https://loinc.org/rdf/42348-3
    system:
      v: http://loinc.org
    code:
      v: 42348-3
    display:
      v: Advance healthcare directives
subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
effective: dateTime
  v: 2016-05-18T22:33:22Z
performer:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference:
    v: Patient/Example-Smith-Johnson-Patient1
value: CodeableConcept
  coding: http://snomed.info/id/697978002
    system:
      v: http://snomed.info/sct
    code:
      v: 697978002
    display:
      v: Provider orders for life-sustaining treatment

Example-Smith-Johnson-OrganizationCustodian1
type: Organization
id:
  v: Example-Smith-Johnson-OrganizationCustodian1
meta:
  profile:
    v: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
text:
  status:
    v: generated
  div: Generated Narrative: Organization Example-Smith-Johnson-OrganizationCustodian1 Profile: US Core Organization Profile identifier: United States National Provider Identifier/1234567893 active: true name: example.org telecom: +1(202)776-7700 address: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US
identifier:
  system:
    v: http://hl7.org/fhir/sid/us-npi
  value:
    v: 1234567893
active:
  v: true
name:
  v: example.org
telecom:
  system:
    v: phone
  value:
    v: +1(202)776-7700
  use:
    v: work
address:
  type:
    v: physical
  line:
    v: 740 E. Campbell Rd. Suite 825
  city:
    v: Richardson
  state:
    v: TX
  postal code:
    v: 75081
  country:
    v: US

link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-PersonalInterventionPreference1
reference:
  v: Observation/Example-Smith-Johnson-PersonalInterventionPreference1

link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-PersonalInterventionPreference3
reference:
  v: Observation/Example-Smith-Johnson-PersonalInterventionPreference3

link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-PersonalInterventionPreference5
reference:
  v: Observation/Example-Smith-Johnson-PersonalInterventionPreference5

link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-PersonalInterventionPreference6
reference:
  v: Observation/Example-Smith-Johnson-PersonalInterventionPreference6

link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-UponDeathPreference1
reference:
  v: Observation/Example-Smith-Johnson-UponDeathPreference1

title:
  v: Additional Documentation
code:
  coding: https://loinc.org/rdf/77599-9
    system:
      v: http://loinc.org
    code:
      v: 77599-9
text:
  status:
    v: generated
  div: PMOLST Order Observation Order Exists: available here
entry:
  link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-DocumentationObservation1
  reference:
    v: Observation/Example-Smith-Johnson-DocumentationObservation1

title:
  v: Witnesses and Notary
code:
  coding: https://loinc.org/rdf/81339-4
    system:
      v: http://loinc.org
    code:
      v: 81339-4
    display:
      v: Witness and Notary Document
text:
  status:
    v: additional
  div: 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: 3/29/2021 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: At least 18 years of age. Not related to the person signing this document by blood, marriage or adoption. Not a healthcare agent appointed by the person signing this document. Not directly financially responsible for that person’s healthcare. Not a healthcare provider directly serving the person at this time. Not an employee (other than a social worker or chaplain), officer, director, or partner of a healthcare provider (or any parent organization of such healthcare provider) directly serving the person at this time. Not aware that I am entitled to or have a claim against the person’s estate. Witness Number: Signature: Date:

v: 75783-1

v: Primary healthcare agent [Reported]

v: 75784-9

v: First alternate healthcare agent [Reported]