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Example Contract/C-2121 (XML)

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Patient

Raw XML (canonical form + also see XML Format Specification)

Jump past Narrative

42 CFR Part 2 Consent Directive (id = "C-2121")

<?xml version="1.0" encoding="UTF-8"?>

<Contract xmlns="http://hl7.org/fhir">
  <id value="C-2121"/> 
  <meta> 
    <versionId value="1"/> 
    <lastUpdated value="2016-07-19T18:18:42.108-04:00"/> 
  </meta> 

  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><p> <b> Generated Narrative: Contract</b> <a name="C-2121"> </a> <a name="hcC-2121"> </a> </p> <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">Resource Contract &quot;C-2121&quot; Version &quot;1&quot; Updated &quot;2016-07-19T18:18:42.
          108-04:00&quot; </p> </div> <p> <b> status</b> : executed</p> <p> <b> contentDerivative</b> : Content Registration <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-contract-content-derivative.html">Contract Content Derivation Codes</a> #registration)</span> </p> <p> <b> issued</b> : 2013-11-01T21:18:27-04:00</p> <p> <b> applies</b> : 2013-11-01T21:18:27-04:00 --&gt; (ongoing)</p> <p> <b> subject</b> : <a href="patient-example-f201-roel.html">Patient/f201</a>  &quot;Roel&quot;</p> <p> <b> type</b> : Opt-in consent directive <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (consentdirective-type#OPTIN)</span> </p> <p> <b> subType</b> : Health Care Directive <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-consentcategorycodes.html">Consent Category Codes</a> #hcd)</span> </p> <blockquote> <p> <b> term</b> </p> <h3> Offers</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Type</b> </td> <td> <b> Decision</b> </td> <td> <b> Text</b> </td> </tr> <tr> <td style="display: none">*</td> <td> Statutory <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-contracttermtypecodes.html">Contract Term Type Codes</a> #statutory)</span> </td> <td> opt-in <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html">ActCode</a> #OPTIN)</span> </td> <td> Can't refuse</td> </tr> </table> <h3> Assets</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Period</b> </td> </tr> <tr> <td style="display: none">*</td> <td> 2013-11-01T21:18:27-04:00 --&gt; 2019-11-01T21:18:27-04:00</td> </tr> </table> <blockquote> <p> <b> action</b> </p> <p> <b> type</b> : Action A <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-contractaction.html">Contract Action Codes</a> #action-a)</span> </p> <blockquote> <p> <b> subject</b> </p> <p> <b> reference</b> : <a href="organization-example-f001-burgers.html">Organization/f001: VA Ann Arbor Healthcare System</a>  &quot;Burgers University Medical Center&quot;</p> <p> <b> role</b> : Recipient of restricted health information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (consent-actor-type#IR &quot;Recipient&quot;)</span> </p> </blockquote> <blockquote> <p> <b> subject</b> </p> <p> <b> reference</b> : <a href="organization-example-insurer.html">Organization/2: Community Mental Health Clinic</a>  &quot;XYZ Insurance&quot;</p> <p> <b> role</b> : Sender of restricted health information <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (consent-actor-type#IS &quot;Sender&quot;)</span> </p> </blockquote> <p> <b> intent</b> : health program reporting <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActReason.html">ActReason</a> #HPRGRP)</span> </p> <p> <b> status</b> : Sample <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> ()</span> </p> </blockquote> </blockquote> <blockquote> <p> <b> signer</b> </p> <p> <b> type</b> : SELF (Details: http://mdhhs.org/fhir/consent-signer-type code SELF = 'SELF',
           stated as 'null')</p> <p> <b> party</b> : <a href="patient-example-f201-roel.html">Patient/f201: Alice Recruit</a>  &quot;Roel&quot;</p> <h3> Signatures</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Type</b> </td> <td> <b> When</b> </td> <td> <b> Who</b> </td> </tr> <tr> <td style="display: none">*</td> <td> Author's Signature (Details: urn:iso-astm:E1762-95:2013 code 1.2.840.10065.1.12.1.1
               = 'Author's Signature', stated as 'null')</td> <td> Feb 8, 2017, 9:57:34 AM</td> <td> <a href="patient-example-f201-roel.html">Patient/f201</a>  &quot;Roel&quot;</td> </tr> </table> </blockquote> <h3> Legals</h3> <table class="grid"><tr> <td style="display: none">-</td> <td> <b> Content[x]</b> </td> </tr> <tr> <td style="display: none">*</td> <td/>  </tr> </table> </div> </text> <status value="executed"/> 

  <contentDerivative> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/contract-content-derivative"/> 
      <code value="registration"/> 
    </coding> 
  </contentDerivative> 

  <issued value="2013-11-01T21:18:27-04:00"/> 

  <applies> 
    <start value="2013-11-01T21:18:27-04:00"/> 
  </applies> 

  <subject> 
    <reference value="Patient/f201"/> 
  </subject> 

  <type> 
    <coding> 
      <system value="http://mdhhs.org/fhir/consentdirective-type"/> 
      <code value="OPTIN"/> 
    </coding> 
    <text value="Opt-in consent directive"/> 
  </type> 
  <subType> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/> 
      <code value="hcd"/> 
    <!--         <code value="MDHHS-5515"/>
      <display
        value="Michigan MDHHS-5515 Consent to Share Behavioral Health Information
       for Care Coordination Purposes"
      />    -->
    </coding> 
  </subType> 

  <term> 
    <offer> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/contracttermtypecodes"/> 
          <code value="statutory"/> 
        </coding> 
      </type> 
      <decision> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/> 
          <code value="OPTIN"/> 
        </coding> 
      </decision> 
      <text value="Can't refuse"/> 
    </offer> 
    
    <asset> 
      <period> 
        <start value="2013-11-01T21:18:27-04:00"/> 
        <end value="2019-11-01T21:18:27-04:00"/> 
      </period> 
          <!--   
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/>
        <code value="R"/>
        <display value="Restricted"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="ETH"/>
        <display value="substance abuse information sensitivity"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="42CFRPart2"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="TREAT"/>
        <display value="treatment"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="HPAYMT"/>
        <display value="healthcare payment"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="HOPERAT"/>
        <display value="healthcare operations"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PERSISTLABEL"/>
        <display value="persist security label"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="PRIVMARK"/>
        <display value="privacy mark"/>
      </securityLabel>
      <securityLabel>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="NORDSCLCD"/>
        <display value="no redisclosure without consent directive"/>
      </securityLabel>
       -->
    </asset> 

    <action> 
      <type> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/contractaction"/> 
          <code value="action-a"/> 
        </coding> 
      </type> 
      <subject> 
        <reference> 
          <reference value="Organization/f001"/> 
          <display value="VA Ann Arbor Healthcare System"/> 
        </reference> 
        <role> 
          <coding> 
            <system value="http://mdhhs.org/fhir/consent-actor-type"/> 
            <code value="IR"/> 
            <display value="Recipient"/> 
          </coding> 
          <text value="Recipient of restricted health information"/> 
        </role> 
      </subject> 
      <subject> 
        <reference> 
          <reference value="Organization/2"/> 
          <display value="Community Mental Health Clinic"/> 
        </reference> 
        <role> 
          <coding> 
            <system value="http://mdhhs.org/fhir/consent-actor-type"/> 
            <code value="IS"/> 
            <display value="Sender"/> 
          </coding> 
          <text value="Sender of restricted health information"/> 
        </role> 
      </subject> 
      <intent> 
        <coding> 
          <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> 
          <code value="HPRGRP"/> 
        </coding> 
      </intent> 
      <status> 
        <text value="Sample"/> 
      </status> 
    </action> 
    

  </term> 

  <signer> 
    <type> 
      <system value="http://mdhhs.org/fhir/consent-signer-type"/> 
      <code value="SELF"/> 
    </type> 
    <party> 
      <reference value="Patient/f201"/> 
      <display value="Alice Recruit"/> 
    </party> 
    <signature> 
      <type> 
        <system value="urn:iso-astm:E1762-95:2013"/> 
        <code value="1.2.840.10065.1.12.1.1"/> 
      </type> 
      <when value="2017-02-08T10:57:34+01:00"/> 
    <who> 
        <reference value="Patient/f201"/> 
    </who> 
    </signature> 
  </signer> 

  <legal> 
    <contentAttachment> 
      <contentType value="application/pdf"/> 
      <language value="en-US"/> 
      <url value="http://org.mihin.ecms/ConsentDirective-2121"/> 
      <title value="MDHHS-5515 Consent To Share Your Health Information"/> 
    </contentAttachment> 
  </legal> 
</Contract>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.