# ADI Source Form Entry - Advance Healthcare Directive Interoperability (cda-adi) v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **ADI Source Form Entry**

## Logical Model: ADI Source Form Entry 

| | |
| :--- | :--- |
| *Official URL*:http://hl7.org/cda/us/adi/StructureDefinition/Source.Form.Entry | *Version*:0.1.0 |
| Draft as of 2026-05-29 | *Computable Name*:Source_Form_Entry |
| *Other Identifiers:*urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.4.823.1.4.24:2026-08-28 | |

 
This entry includes the Source Form document and info about the jurisdiction for the form. If the form is copyrighted by an organization, the organization's name may be included in an author participation. 

**Usages:**

* Use this Logical Model Profile: [Source Form Section](StructureDefinition-SourceFormSection.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.cda.us.adi|current/StructureDefinition/StructureDefinition-Source.Form.Entry.json)

### Formal Views of Template Content

 [Description of Template, Differentials, Snapshots and how the different presentations work](http://hl7.org/fhir/R5/profiling.html#presentation). 

 

Other representations of profile: [CSV](StructureDefinition-Source.Form.Entry.csv), [Excel](StructureDefinition-Source.Form.Entry.xlsx) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "Source.Form.Entry",
  "extension" : [{
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/logical-target",
    "_valueBoolean" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
        "valueCode" : "not-applicable"
      }]
    }
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/xml-namespace",
    "valueUri" : "urn:hl7-org:v3"
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/xml-name",
    "valueString" : "observationMedia"
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/logical-container",
    "valueUri" : "http://hl7.org/cda/stds/core/StructureDefinition/ClinicalDocument"
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/type-profile-style",
    "valueCode" : "cda"
  }],
  "url" : "http://hl7.org/cda/us/adi/StructureDefinition/Source.Form.Entry",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:hl7ii:2.16.840.1.113883.4.823.1.4.24:2026-08-28"
  }],
  "version" : "0.1.0",
  "name" : "Source_Form_Entry",
  "title" : "ADI Source Form Entry",
  "status" : "draft",
  "date" : "2026-05-29T13:15:02+00:00",
  "publisher" : "Health Level Seven",
  "contact" : [{
    "name" : "Health Level Seven",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/structure"
    }]
  }],
  "description" : "This entry includes the Source Form document and info about the jurisdiction for the form.\nIf the form is copyrighted by an organization, the organization's name may be included in an author participation.",
  "fhirVersion" : "5.0.0",
  "mapping" : [{
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  }],
  "kind" : "logical",
  "abstract" : false,
  "type" : "http://hl7.org/cda/stds/core/StructureDefinition/ObservationMedia",
  "baseDefinition" : "http://hl7.org/cda/stds/core/StructureDefinition/ObservationMedia",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "ObservationMedia",
      "path" : "ObservationMedia"
    },
    {
      "id" : "ObservationMedia.templateId",
      "path" : "ObservationMedia.templateId",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "root"
        },
        {
          "type" : "value",
          "path" : "extension"
        }],
        "rules" : "open"
      },
      "min" : 1
    },
    {
      "id" : "ObservationMedia.templateId:source-form",
      "path" : "ObservationMedia.templateId",
      "sliceName" : "source-form",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "ObservationMedia.templateId:source-form.root",
      "path" : "ObservationMedia.templateId.root",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.4.823.1.4.24"
    },
    {
      "id" : "ObservationMedia.templateId:source-form.extension",
      "path" : "ObservationMedia.templateId.extension",
      "min" : 1,
      "patternString" : "2026-08-28"
    },
    {
      "id" : "ObservationMedia.id",
      "path" : "ObservationMedia.id",
      "comment" : "MUST contain at least one [1..*] id.",
      "min" : 1
    },
    {
      "id" : "ObservationMedia.value.mediaType",
      "path" : "ObservationMedia.value.mediaType",
      "min" : 1,
      "patternCode" : "application/pdf"
    },
    {
      "id" : "ObservationMedia.author",
      "path" : "ObservationMedia.author",
      "comment" : "author.assignedAuthor.representedOrganization.name may include the name of the organization holding the copyright for the form.",
      "mustSupport" : true
    },
    {
      "id" : "ObservationMedia.entryRelationship",
      "path" : "ObservationMedia.entryRelationship",
      "slicing" : {
        "discriminator" : [{
          "type" : "profile",
          "path" : "observation"
        }],
        "rules" : "open"
      },
      "mustSupport" : true
    },
    {
      "id" : "ObservationMedia.entryRelationship:jurisdiction-part",
      "path" : "ObservationMedia.entryRelationship",
      "sliceName" : "jurisdiction-part",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ObservationMedia.entryRelationship:jurisdiction-part.typeCode",
      "path" : "ObservationMedia.entryRelationship.typeCode",
      "comment" : "SHALL contain exactly one [1..1] @typeCode=\"COMP\" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002).",
      "fixedCode" : "COMP"
    },
    {
      "id" : "ObservationMedia.entryRelationship:jurisdiction-part.inversionInd",
      "path" : "ObservationMedia.entryRelationship.inversionInd",
      "fixedBoolean" : false
    },
    {
      "id" : "ObservationMedia.entryRelationship:jurisdiction-part.observation",
      "path" : "ObservationMedia.entryRelationship.observation",
      "min" : 1,
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Observation",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/Jurisdiction.Part"]
      }]
    },
    {
      "id" : "ObservationMedia.entryRelationship:form-title-part",
      "path" : "ObservationMedia.entryRelationship",
      "sliceName" : "form-title-part",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ObservationMedia.entryRelationship:form-title-part.typeCode",
      "path" : "ObservationMedia.entryRelationship.typeCode",
      "comment" : "SHALL contain exactly one [1..1] @typeCode=\"COMP\" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002).",
      "fixedCode" : "COMP"
    },
    {
      "id" : "ObservationMedia.entryRelationship:form-title-part.inversionInd",
      "path" : "ObservationMedia.entryRelationship.inversionInd",
      "fixedBoolean" : false
    },
    {
      "id" : "ObservationMedia.entryRelationship:form-title-part.observation",
      "path" : "ObservationMedia.entryRelationship.observation",
      "min" : 1,
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Observation",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/Form.Title.Part"]
      }],
      "mustSupport" : true
    }]
  }
}

```
