{
  "resourceType": "Provenance",
  "id": "consent-signature",
  "target": [
    {
      "reference": "Consent/consent-example-basic/_history/1"
    }
  ],
  "recorded": "2016-05-26T00:41:10-04:00",
  "activity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-DocumentCompletion",
        "code": "AU",
        "display": "authenticated"
      }
    ]
  },
  "patient": {
    "reference": "Patient/example"
  },
  "agent": [
    {
      "role": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
              "code": "AUT"
            }
          ]
        }
      ],
      "who": {
        "reference": "Patient/72"
      }
    }
  ],
  "signature": [
    {
      "type": [
        {
          "system": "urn:iso-astm:E1762-95:2013",
          "code": "1.2.840.10065.1.12.1.1",
          "display": "Author\u0027s Signature"
        }
      ],
      "when": "2016-05-26T00:41:10-04:00",
      "who": {
        "reference": "Patient/72"
      },
      "targetFormat": "application/fhir+xml",
      "sigFormat": "application/signature+xml",
      "data": "dGhpcyBibG9iIGlzIHNuaXBwZWQ\u003d"
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}