{
  "resourceType": "Provenance",
  "id": "example4",
  "target": [
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/targetPath",
          "valueString": "Patient.extension(\u0027http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\u0027)"
        }
      ],
      "reference": "Patient/pat3/_history/1"
    }
  ],
  "recorded": "2021-12-08T16:54:24+11:00",
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
            "code": "ADM"
          }
        ]
      },
      "who": {
        "reference": "Practitioner/f007"
      }
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}