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

## : Portable Medical Order - JSON Representation

Page standards status: Informative

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    {
      "resourceType" : "Composition",
      "id" : "PMO-Example-Smith-Johnson-PMOComposition1",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition"
        ]
      },
      "language" : "en-US",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p class=\"res-header-id\"><b>Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1</b></p><a name=\"PMO-Example-Smith-Johnson-PMOComposition1\"> </a><a name=\"hcPMO-Example-Smith-Johnson-PMOComposition1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en-US</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ADI-PMOComposition.html\">ADI PMO Composition</a></p></div><p><b>Composition Version Number</b>: 2024-03-29T14:25:34-05:00</p><p><b>Data Enterer</b>: <a href=\"Patient-Example-Smith-Johnson-Patient1.html\">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</a></p><p><b>Participant</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>ADI Expiration Date</b>: 2024-03-29 14:25:34-0500</p><p><b>Performer</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>Informant</b>: <a href=\"RelatedPerson-Example-Smith-Johnson-HealthcareAgent1.html\">RelatedPerson Johnson, Charles</a></p><p><b>Revoke Status</b>: deprecated</p><blockquote><p><b>Clause</b></p><ul><li>Clause: </li></ul></blockquote><div><p>&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;&lt;p&gt;Example Clause Statement&lt;/p&gt;&lt;/div&gt;</p>\n</div><p><b>identifier</b>: <code>http://example.org/GoodHealthClinic/id</code>/0-87f37989294a408897aacd1fc5d8fd16</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{http://loinc.org 93037-0}\">Portable medical order form</span></p><p><b>category</b>: <span title=\"Codes:{http://loinc.org 42348-3}\">Advance healthcare directives</span></p><p><b>date</b>: 2023-03-29 14:25:34-0500</p><p><b>author</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>title</b>: Portable Medical Order</p><h3>Attesters</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Mode</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td>Legal</td><td><a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></td></tr></table><p><b>custodian</b>: <a href=\"Organization-Example-Smith-Johnson-OrganizationCustodian1.html\">Organization example.org</a></p><blockquote><p><b>event</b></p><p><b>detail</b>: </p><ul><li><a href=\"PractitionerRole-ADI-Facilitator-MSW-MargaretReynolds.html\">PractitionerRole primary performer</a></li><li><a href=\"Consent-Example-Smith-Johnson-HealthcareAgentConsent-Permit.html\">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li><li><a href=\"Consent-Example-Smith-Johnson-HealthcareAgentConsent-Deny.html\">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li></ul></blockquote></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber",
          "valueString" : "2024-03-29T14:25:34-05:00"
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension",
          "valueReference" : {
            🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension",
          "valueReference" : {
            🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension",
          "valueDateTime" : "2024-03-29T14:25:34-05:00"
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension",
          "valueReference" : {
            🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension",
          "valueReference" : {
            🔗 "reference" : "RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status",
          "valueCode" : "deprecated"
        },
        {
          "extension" : [
            {
              "url" : "Clause",
              "valueMarkdown" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Example Clause Statement</p></div>"
            }
          ],
          "url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension"
        }
      ],
      "identifier" : {
        "system" : "http://example.org/GoodHealthClinic/id",
        "value" : "0-87f37989294a408897aacd1fc5d8fd16"
      },
      "status" : "final",
      "type" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "93037-0",
            "display" : "Portable medical order form"
          }
        ]
      },
      "category" : [
        {
          "coding" : [
            {
              "system" : "http://loinc.org",
              "code" : "42348-3",
              "display" : "Advance healthcare directives"
            }
          ]
        }
      ],
      "subject" : {
        🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
      },
      "date" : "2023-03-29T14:25:34-05:00",
      "author" : [
        {
          🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
        }
      ],
      "title" : "Portable Medical Order",
      "attester" : [
        {
          "mode" : "legal",
          "party" : {
            🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
          }
        }
      ],
      "custodian" : {
        🔗 "reference" : "Organization/Example-Smith-Johnson-OrganizationCustodian1"
      },
      "event" : [
        {
          "detail" : [
            {
              🔗 "reference" : "PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds"
            },
            {
              🔗 "reference" : "Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit"
            },
            {
              🔗 "reference" : "Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny"
            }
          ]
        }
      ],
      "section" : [
        {
          "title" : "Portable Medical Orders",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "93037-0",
                "display" : "Portable medical order form"
              }
            ]
          },
          "text" : {
            "status" : "generated",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>PMO Medical Orders</b></p><p><i>Order Exists: <a href=\"http://www.example.com\">available here</a></i></p></div>"
          },
          "entry" : [
            {
              🔗 "reference" : "ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"
            }
          ]
        },
        {
          "title" : "Additional Documentation",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "77599-9"
              }
            ]
          },
          "text" : {
            "status" : "generated",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href=\"http://www.example.com\">available here</a></i></p></div>"
          },
          "entry" : [
            {
              🔗 "reference" : "Observation/Example-Smith-Johnson-DocumentationObservation2"
            }
          ]
        },
        {
          "title" : "Witnesses and Notary",
          "code" : {
            "coding" : [
              {
                "system" : "http://loinc.org",
                "code" : "81339-4",
                "display" : "Witness and Notary Document"
              }
            ]
          },
          "text" : {
            "status" : "additional",
            "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>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.</p><table><tbody><tr><td><b>Signature:</b></td><td>Betsy Smith-Johnson</td></tr><tr><td><b>Date:</b></td><td>3/29/2024</td></tr></tbody></table><p/><p><b>Statement of Witnesses</b></p><p/><p>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:</p><p/><ul><li>At least 18 years of age.</li><li>Not related to the person signing this document by blood, marriage or adoption.</li><li>Not a healthcare agent appointed by the person signing this document.</li><li>Not directly financially responsible for that person’s healthcare.</li><li>Not a healthcare provider directly serving the person at this time.</li><li>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.</li><li>Not aware that I am entitled to or have a claim against the person’s estate.</li></ul><p/><table><tbody><tr><td><b>Witness Number:</b></td><td/></tr><tr><td><b>Signature:</b></td><td/></tr><tr><td><b>Date:</b></td><td/></tr></tbody></table></div>"
          }
        }
      ]
    }