# Personal Advance Care Plan - Advance Healthcare Directive Interoperability (cda-adi) v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Personal Advance Care Plan**

## Logical Model: Personal Advance Care Plan 

| | |
| :--- | :--- |
| *Official URL*:http://hl7.org/cda/us/adi/StructureDefinition/PersonalACPDocument | *Version*:0.1.0 |
| Active as of 2026-05-29 | *Computable Name*:PersonalAdvanceCarePlanDocument |

 
This profile defines the requirements for communicating a Personal Advance Care Plan (ACP) document using a Composition Resource. 
Depending on the range of content included, this type of document is known by different names: 
* Durable Medical Power of Attorney - healthcare agent appointment only
* Living Will - treatment preferences only
* Living Will and Durable Medical Power of Attorney
* Advance Care Plan - a combined Living Will and Durable Medical Power of Attorney plus additional content regarding relevant care experience preferences
 
It is a person-generated document, authored by the subject of the document. If care professionals are involved in the creation of the document, their supporting role in the advance care planning process can be represented in the service event associated with the document. If data entry assistance is provided, the person performing the data entry can be represented in the role of a data enterer. 
Additionally, the system used to assemble the document can be represented as a participant of the document in the role of Assembler. The Custodian organization responsible for maintaining the source copy of the document must be included. 
For a person authored document, the person's signature is required. Notarization or witnessing of the document also should be represented because person-authored documents typically are not considered complete without validation for the person's identity and signature. 
The document includes a mandatory source form section to hold a pdf of the original “source form” completed by the person. It also includes a healthcare agent appointment section which is mandatory in all types of PACP documents with the exception of a Living Will. If the person elects not to appoint a healthcare agent, the section includes information about the reason why. This section includes machine processable representations of the healthcare agent information and their powers and limitations to facilitate data resusability as the document is shared between systems. 
A Personal ACP document may contain additional textual information from the source form that does not have corresponding encoded entries. In this case, the section.text element is populated without corresponding section.entry elements. For minimum required information, the information in the section.text element will include corresponding section.entry elements and will be linked using the test linking mechanism. 
Optionally, the document may contain sections for treatment intervention preferences, care experience preferences, additional documentation, administrative information which includes record of the person's signature, and notary or witness information. 

**Usages:**

* This Logical Model Profile is not used by any profiles in this Specification

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/resource/hl7.cda.us.adi|current/StructureDefinition/StructureDefinition-PersonalACPDocument.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-PersonalACPDocument.csv), [Excel](StructureDefinition-PersonalACPDocument.xlsx) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "PersonalACPDocument",
  "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" : "ClinicalDocument"
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/type-profile-style",
    "valueCode" : "cda"
  },
  {
    "url" : "http://hl7.org/fhir/tools/StructureDefinition/logical-container",
    "valueUri" : "http://hl7.org/cda/stds/core/StructureDefinition/ClinicalDocument"
  }],
  "url" : "http://hl7.org/cda/us/adi/StructureDefinition/PersonalACPDocument",
  "version" : "0.1.0",
  "name" : "PersonalAdvanceCarePlanDocument",
  "title" : "Personal Advance Care Plan",
  "status" : "active",
  "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 profile defines the requirements for communicating a Personal Advance Care Plan (ACP) document using a Composition Resource. \n\nDepending on the range of content included, this type of document is known by different names:\n- Durable Medical Power of Attorney - healthcare agent appointment only\n- Living Will - treatment preferences only\n- Living Will and Durable Medical Power of Attorney\n- Advance Care Plan - a combined Living Will and Durable Medical Power of Attorney plus additional content regarding relevant care experience preferences\n\nIt is a person-generated document, authored by the subject of the document. If care professionals are involved in the creation of the document, their supporting role in the advance care planning process can be represented in the service event associated with the document. If data entry assistance is provided, the person performing the data entry can be represented in the role of a data enterer. \n\nAdditionally, the system used to assemble the document can be represented as a participant of the document in the role of Assembler. The Custodian organization responsible for maintaining the source copy of the document must be included.\n\nFor a person authored document, the person's signature is required. Notarization or witnessing of the document also should be represented because person-authored documents typically are not considered complete without validation for the person's identity and signature.\n\nThe document includes a mandatory source form section to hold a pdf of the original “source form” completed by the person. It also includes a healthcare agent appointment section which is mandatory in all types of PACP documents with the exception of a Living Will. If the person elects not to appoint a healthcare agent, the section includes information about the reason why. This section includes machine processable representations of the healthcare agent information and their powers and limitations to facilitate data resusability as the document is shared between systems.\n\nA Personal ACP document may contain additional textual information from the source form that does not have corresponding encoded entries. In this case, the section.text element is populated without corresponding section.entry elements. For minimum required information, the information in the section.text element will include corresponding section.entry elements and will be linked using the test linking mechanism.\n\nOptionally, the document may contain sections for treatment intervention preferences, care experience preferences, additional documentation, administrative information which includes record of the person's signature, and notary or witness information.",
  "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/ClinicalDocument",
  "baseDefinition" : "http://hl7.org/cda/us/ccda/StructureDefinition/USRealmHeaderforPatientGeneratedDocument",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "ClinicalDocument",
      "path" : "ClinicalDocument"
    },
    {
      "id" : "ClinicalDocument.templateId",
      "path" : "ClinicalDocument.templateId",
      "min" : 3
    },
    {
      "id" : "ClinicalDocument.templateId:personal-acp",
      "path" : "ClinicalDocument.templateId",
      "sliceName" : "personal-acp",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "ClinicalDocument.templateId:personal-acp.root",
      "path" : "ClinicalDocument.templateId.root",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.4.823.1.1.1"
    },
    {
      "id" : "ClinicalDocument.templateId:personal-acp.extension",
      "path" : "ClinicalDocument.templateId.extension",
      "min" : 1,
      "patternString" : "2026-08-28"
    },
    {
      "id" : "ClinicalDocument.id",
      "path" : "ClinicalDocument.id",
      "comment" : "This is the master identifier in a DocumentReference document indexing resource."
    },
    {
      "id" : "ClinicalDocument.sdtcCategory",
      "path" : "ClinicalDocument.sdtcCategory",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "code"
        },
        {
          "type" : "value",
          "path" : "codeSystem"
        }],
        "rules" : "open"
      },
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:ahdDocumentClass",
      "path" : "ClinicalDocument.sdtcCategory",
      "sliceName" : "ahdDocumentClass",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:ahdDocumentClass.code",
      "path" : "ClinicalDocument.sdtcCategory.code",
      "short" : "Used to categorize the document type as an Advance Healthcare Directive",
      "min" : 1,
      "patternCode" : "42348-3"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:ahdDocumentClass.codeSystem",
      "path" : "ClinicalDocument.sdtcCategory.codeSystem",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.6.1"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:ahdDocumentClass.codeSystemName",
      "path" : "ClinicalDocument.sdtcCategory.codeSystemName",
      "min" : 1,
      "patternString" : "LOINC"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:ahdDocumentClass.displayName",
      "path" : "ClinicalDocument.sdtcCategory.displayName",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pacpDocumentClass",
      "path" : "ClinicalDocument.sdtcCategory",
      "sliceName" : "pacpDocumentClass",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pacpDocumentClass.code",
      "path" : "ClinicalDocument.sdtcCategory.code",
      "short" : "Used to categorize the document type as a Patient-Authored Consent Document",
      "min" : 1,
      "patternCode" : "59284-0"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pacpDocumentClass.codeSystem",
      "path" : "ClinicalDocument.sdtcCategory.codeSystem",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.6.1"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pacpDocumentClass.codeSystemName",
      "path" : "ClinicalDocument.sdtcCategory.codeSystemName",
      "min" : 1,
      "patternString" : "LOINC"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pacpDocumentClass.displayName",
      "path" : "ClinicalDocument.sdtcCategory.displayName",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.code",
      "path" : "ClinicalDocument.code",
      "short" : "This profile is used to represent a person-authored advance healthcare directive document. A person authored advance healthcare directive document is categorized \nas a consent document. This sub-category of advance healthcare directive documents expresses the patient’s own preferences as \nopposed to provider-authored advance healthcare directive documents which establish portable medical orders for the patient. \nThis sub-category of advance healthcare directive document always is authored by the subject of the document (the patient). If care providers are involved in the \ncreation of these types of documents, they may be included as facilitators. The patient (or their representative) is required to sign the document and is \nrepresented as an authenticator. Others who sign the document are represented as authenticators with their role such as witness or notary also included.\nIt includes a presentation of the original source form of the completed document. It includes information about the person’s appointed healthcare agent(s), \nand may additionally include treatment intervention and care experience preferences under potential future health scenarios, administrative and completion information, additional \ndocumentation, and witness and notary information. \nThe document always contains the source form in the Source Form section. It may include textual information present in the source form, organized in standard structural sections which \nmay or may not include machine processable encoded entries.",
      "comment" : "SHALL contain exactly one [1..1] code.",
      "binding" : {
        "strength" : "required",
        "valueSet" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.22"
      }
    },
    {
      "id" : "ClinicalDocument.sdtcStatusCode",
      "path" : "ClinicalDocument.sdtcStatusCode",
      "comment" : "sdtc:statusCode is #completed is for documents where all activities required for a valid document have been completed, #new is for new documents or document versions that have not been completed yet.",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.effectiveTime",
      "path" : "ClinicalDocument.effectiveTime",
      "short" : "The system origination time",
      "comment" : "Use miliseconds and the relevant timezone offset from UTC to explicitly state the timezone of the document's author and to support federated document management."
    },
    {
      "id" : "ClinicalDocument.setId",
      "path" : "ClinicalDocument.setId",
      "short" : "Identifier a single logical document",
      "comment" : "Identifies all versions of a single logical document",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.versionNumber",
      "path" : "ClinicalDocument.versionNumber",
      "short" : "The distinct version of a logical document",
      "comment" : "Used in conjunction with setId to identify a distinct version of a logical document",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "slicing" : {
        "discriminator" : [{
          "type" : "profile",
          "path" : "section"
        }],
        "rules" : "open"
      },
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:source-form",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "source-form",
      "min" : 1,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:source-form.section",
      "path" : "ClinicalDocument.component.structuredBody.component.section",
      "short" : "Person's signature and Information about Witnesses or Notary required to complete a valid document",
      "comment" : "SHOULD contain 0..* Esignature ObservationMedia Entry where the id references the associated authenticator in the header.",
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Section",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/WitnessAndNotarySection"]
      }]
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:healthcare-agent-appointment",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "healthcare-agent-appointment",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:healthcare-agent-appointment.section",
      "path" : "ClinicalDocument.component.structuredBody.component.section",
      "short" : "Consent information that appoints healthcare agents",
      "comment" : "SHOULD contain 0..1 Healthcare Agent Consent Entry. This entry includes options for expressing why no healthcare agent(s) were appointed.",
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Section",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/HealthcareAgentAppointmentSection"]
      }]
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:treatment-intervention-preferences",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "treatment-intervention-preferences",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:treatment-intervention-preferences.section",
      "path" : "ClinicalDocument.component.structuredBody.component.section",
      "short" : "Persion's conditional treatment intervention preferences",
      "comment" : "SHOULD contain 0..* Treatment Intervention Preference Entry",
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Section",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/TreatmentInterventionPreferencesSection"]
      }]
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:care-experience-preferences",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "care-experience-preferences",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:care-experience-preferences.section",
      "path" : "ClinicalDocument.component.structuredBody.component.section",
      "short" : "Person's conditional care experience preferences",
      "comment" : "SHOULD contain 0..* Care Experience Preference Entry.",
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Section",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/CareExperiencePreferencesSection"]
      }]
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:upon-death-preferences",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "upon-death-preferences",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:additional-documentation",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "additional-documentation",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:administrative-information",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "administrative-information",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:administrative-information.section",
      "path" : "ClinicalDocument.component.structuredBody.component.section",
      "short" : "Information collected for administrative reasons",
      "comment" : "SHOULD contain 0..* Advance Healthcare Directive Observation Entry.",
      "type" : [{
        "code" : "http://hl7.org/cda/stds/core/StructureDefinition/Section",
        "profile" : ["http://hl7.org/cda/us/adi/StructureDefinition/AdministrativeInformationSection"]
      }]
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:completion-information",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "completion-information",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.component.structuredBody.component:witness-and-notary",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "witness-and-notary",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    }]
  }
}

```
