PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/pacio-adi/ and changes regularly. See the Directory of published versions

## Example Bundle: MHAD-Example-Smith-Johnson-Bundle3

Document Details

Document Subject

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
US Core Race Extension: | ombCategory: CDC Race and Ethnicity 2106-3: White text: White

Document Content

## Appointment of a Primary Healthcare Agent and Alternate Healthcare Agents

I am appointing my son, Charles Johnson, as my healthcare agent

## MHAD Minimal Source Form for Betsy Smith-Johnson

I am emotionally and mentally competent to make this Mental Health Advance Directive (MHAD). I understand the purpose and effect of this MHAD, I agree with everything that is written in this uADD, and I have made this MHAD knowingly, willingly and after careful deliberation.

## Additional Resources Included in Document

Entry 2 - fullUrl = http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1

Resource Organization:

> Profile: US Core Organization Profile

> identifier: United States National Provider Identifier/1234567893

> active: true

> name: example.org

> ### Contacts

> - | Telecom | Address
> * | +1(202)776-7700 | 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US

Entry 3 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1

Resource Patient:

> 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
> US Core Race Extension: | ombCategory: CDC Race and Ethnicity 2106-3: White text: White

Entry 4 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-Notary2

Resource RelatedPerson:

> Notary

> Charles Xavier

Entry 5 - fullUrl = http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent3

Resource RelatedPerson:

> 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]

Entry 6 - fullUrl = http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent2

Resource Consent:

> 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

Entry 7 - fullUrl = http://www.example.org/fhir/Binary/MHAD-Example-Smith-Johnson-Binary

Resource Binary:

> Profile: ADI Minimal Source Form

> contentType: application/pdf

> data: (base64 data - 1,037,192 base64 chars)