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 - XML Representation

Page standards status: Informative

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    <Composition xmlns="http://hl7.org/fhir">
      <id value="PMO-Example-Smith-Johnson-PMOComposition1"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition"/>
      </meta>
      <language value="en-US"/>
      <text>
        <status value="extensions"/>
        <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>
    </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>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber">
        <valueString value="2024-03-29T14:25:34-05:00"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension">
        <valueReference>🔗
          <reference value="Patient/Example-Smith-Johnson-Patient1"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension">
        <valueReference>🔗
          <reference
                     value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension">
        <valueDateTime value="2024-03-29T14:25:34-05:00"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension">
        <valueReference>🔗
          <reference
                     value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension">
        <valueReference>🔗
          <reference
                     value="RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"/>
        </valueReference>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status">
        <valueCode value="deprecated"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension">
        <extension url="Clause">
          <valueMarkdown
                         value="&lt;div xmlns=&quot;http://www.w3.org/1999/xhtml&quot;&gt;&lt;p&gt;Example Clause Statement&lt;/p&gt;&lt;/div&gt;"/>
        </extension>
      </extension>
      <identifier>
        <system value="http://example.org/GoodHealthClinic/id"/>
        <value value="0-87f37989294a408897aacd1fc5d8fd16"/>
      </identifier>
      <status value="final"/>
      <type>
        <coding>
          <system value="http://loinc.org"/>
          <code value="93037-0"/>
          <display value="Portable medical order form"/>
        </coding>
      </type>
      <category>
        <coding>
          <system value="http://loinc.org"/>
          <code value="42348-3"/>
          <display value="Advance healthcare directives"/>
        </coding>
      </category>
      <subject>🔗
        <reference value="Patient/Example-Smith-Johnson-Patient1"/>
      </subject>
      <date value="2023-03-29T14:25:34-05:00"/>
      <author>🔗
        <reference
                   value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
      </author>
      <title value="Portable Medical Order"/>
      <attester>
        <mode value="legal"/>
        <party>🔗
          <reference
                     value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
        </party>
      </attester>
      <custodian>🔗
        <reference
                   value="Organization/Example-Smith-Johnson-OrganizationCustodian1"/>
      </custodian>
      <event>
        <detail>🔗
          <reference
                     value="PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds"/>
        </detail>
        <detail>🔗
          <reference
                     value="Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit"/>
        </detail>
        <detail>🔗
          <reference
                     value="Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny"/>
        </detail>
      </event>
      <section>
        <title value="Portable Medical Orders"/>
        <code>
          <coding>
            <system value="http://loinc.org"/>
            <code value="93037-0"/>
            <display value="Portable medical order form"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <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>
        </text>
        <entry>🔗
          <reference
                     value="ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"/>
        </entry>
      </section>
      <section>
        <title value="Additional Documentation"/>
        <code>
          <coding>
            <system value="http://loinc.org"/>
            <code value="77599-9"/>
          </coding>
        </code>
        <text>
          <status value="generated"/>
          <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>
        </text>
        <entry>🔗
          <reference
                     value="Observation/Example-Smith-Johnson-DocumentationObservation2"/>
        </entry>
      </section>
      <section>
        <title value="Witnesses and Notary"/>
        <code>
          <coding>
            <system value="http://loinc.org"/>
            <code value="81339-4"/>
            <display value="Witness and Notary Document"/>
          </coding>
        </code>
        <text>
          <status value="additional"/>
          <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>
        </text>
      </section>
    </Composition>