# Portable Medical Order - Advance Healthcare Directive Interoperability (cda-adi) v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **Portable Medical Order**

## Logical Model: Portable Medical Order 

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

 
This profile defines the requirements for communicating a practitioner-authored portable medical order (PMO) advance healthcare directive document using a Composition Resource. Different states may call this type of document by a number of different names: 
* MOLST (Medical Orders for Life Sustaining Treatment)
* POLST (Physician Orders for Life Sustaining Treatment)
* MOST (Medical Orders for Scope of Treatment)
* POST (Physician Orders for Scope of Treatment)
* TPOPP (Transportable Physician Orders for Patient Preferences)
* Out-of-hospital Do Not Resuscitate (DNR) Orders
* DNAR (Do Not Attempt Resuscitation) or AND (Allow Natural Death) Orders
 
It is a practitioner-generated document, authored by a practitioner with necessary credentials established for the document within its jurisdiction of use. If other 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. However, only the authoring practitioner signs the document as the legal authenticator. The signature of the person/patient who is the subject of the document also is required. If the subject is unable to sign the document, a person who is permitted to sign on their behalf may sign in place of the subject. 
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. 
The document includes a mandatory source form section to hold a pdf of the original “source form” showing the PMO completed by the practitioner and patient. It also includes a mandatory Medical Orders section. This section includes machine processable representations of–at a minimum- the directive regarding cardiopulmonary resuscitation. Other directives such as initial treatment and other types of orders may also be included to facilitate data resusability as the document is shared between systems. However, the source form remains the “source of truth” providing the full range of relevant orders. 
A PMO 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 form completion information which includes the necessary signature information, administrative information, additional documentation, upon death information, healthcare agent appointment, and notary and 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-PortableMedicalOrderDocument.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-PortableMedicalOrderDocument.csv), [Excel](StructureDefinition-PortableMedicalOrderDocument.xlsx) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "PortableMedicalOrderDocument",
  "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/PortableMedicalOrderDocument",
  "version" : "0.1.0",
  "name" : "POLSTPortableMedicalOrdersDocument",
  "title" : "Portable Medical Order",
  "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 practitioner-authored portable medical order (PMO) advance healthcare directive document using a Composition Resource. Different states may call this type of document by a number of different names:\n\n- MOLST (Medical Orders for Life Sustaining Treatment)\n- POLST (Physician Orders for Life Sustaining Treatment)\n- MOST (Medical Orders for Scope of Treatment)\n- POST (Physician Orders for Scope of Treatment)\n- TPOPP (Transportable Physician Orders for Patient Preferences)\n- Out-of-hospital Do Not Resuscitate (DNR) Orders\n- DNAR (Do Not Attempt Resuscitation) or AND (Allow Natural Death) Orders\n\nIt is a practitioner-generated document, authored by a practitioner with necessary credentials established for the document within its jurisdiction of use. If other 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. However, only the authoring practitioner signs the document as the legal authenticator. The signature of the person/patient who is the subject of the document also is required. If the subject is unable to sign the document, a person who is permitted to sign on their behalf may sign in place of the subject.\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\nThe document includes a mandatory source form section to hold a pdf of the original “source form” showing the PMO completed by the practitioner and patient. It also includes a mandatory Medical Orders section. This section includes machine processable representations of–at a minimum- the directive regarding cardiopulmonary resuscitation. Other directives such as initial treatment and other types of orders may also be included to facilitate data resusability as the document is shared between systems. However, the source form remains the “source of truth” providing the full range of relevant orders. \n\nA PMO 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 form completion information which includes the necessary signature information, administrative information, additional documentation, upon death information, healthcare agent appointment, and notary and 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/USRealmHeader",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "ClinicalDocument",
      "path" : "ClinicalDocument"
    },
    {
      "id" : "ClinicalDocument.templateId",
      "path" : "ClinicalDocument.templateId",
      "min" : 3
    },
    {
      "id" : "ClinicalDocument.templateId:pmo",
      "path" : "ClinicalDocument.templateId",
      "sliceName" : "pmo",
      "min" : 1,
      "max" : "1"
    },
    {
      "id" : "ClinicalDocument.templateId:pmo.root",
      "path" : "ClinicalDocument.templateId.root",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.9.275.1"
    },
    {
      "id" : "ClinicalDocument.templateId:pmo.extension",
      "path" : "ClinicalDocument.templateId.extension",
      "min" : 1,
      "patternString" : "2026-08-28"
    },
    {
      "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",
      "mustSupport" : true
    },
    {
      "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:pmoDocumentClass",
      "path" : "ClinicalDocument.sdtcCategory",
      "sliceName" : "pmoDocumentClass",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pmoDocumentClass.code",
      "path" : "ClinicalDocument.sdtcCategory.code",
      "short" : "Used to categorize the document type as a Provider-Authored Portable Medical Order Advance Healthcare Directive",
      "min" : 1,
      "patternCode" : "93037-0"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pmoDocumentClass.codeSystem",
      "path" : "ClinicalDocument.sdtcCategory.codeSystem",
      "min" : 1,
      "patternString" : "2.16.840.1.113883.6.1"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pmoDocumentClass.codeSystemName",
      "path" : "ClinicalDocument.sdtcCategory.codeSystemName",
      "min" : 1,
      "patternString" : "LOINC"
    },
    {
      "id" : "ClinicalDocument.sdtcCategory:pmoDocumentClass.displayName",
      "path" : "ClinicalDocument.sdtcCategory.displayName",
      "min" : 1
    },
    {
      "id" : "ClinicalDocument.code",
      "path" : "ClinicalDocument.code",
      "short" : "This profile is used to represent a provider-authored advance healthcare directive document. A provider-authored advance healthcare directive document establishes portable medical orders for the patient. \nThis sub-category of advance healthcare directive documents always is authored by a licensed physician and is represented as the legal authenticator. If other care providers are involved in the creation of these types of documents, they may be included \nas facilitators. The patient (or their representative) is required to sign the document and is represented as an authenticator (attester). Others who sign the document are represented as authenticators with their role \nsuch as witness or notary also included.\nIt includes a presentation of the original source form of the completed document. It includes information about the portable medical orders, and may additionally include administrative and completion information, \nadditional documentation, and witness and notary information if required for the form to be considered valid. \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/2.16.840.1.113762.1.4.1115.40"
      }
    },
    {
      "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:planned-procedures-pmo",
      "path" : "ClinicalDocument.component.structuredBody.component",
      "sliceName" : "planned-procedures-pmo",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "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: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: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
    }]
  }
}

```
