PACIO Advance Directive Interoperability Implementation Guide
2.1.0 - STU 2 United States of America flag

PACIO Advance Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

Example Bundle: PMO-Example-Smith-Johnson-Bundle2

Document Details

Generated Narrative: Bundle Portable Medical Order

Document Subject

Unable to resolve subject ''

Document Content

Portable Medical Orders

PMO Medical Orders

Order Exists: available here

Additional Documentation

PMOLST Order Observation

Order Exists: available here

Witnesses and Notary

I am emotionally and mentally competent to make this uADD. I understand the purpose and effect of this uADD, I agree with everything that is written in this uADD, and I have made this uADD knowingly, willingly and after careful deliberation.

Signature:Betsy Smith-Johnson
Date:3/29/2024

Statement of Witnesses

I declare that the person who signed this uADD, or who asked another to sign this uADD on his/her behalf, is the individual identified in the document, and he/she did so in my presence or otherwise provided satisfactory proof to me of his/her identity. I believe him/her to be of sound mind and at least 18 years of age. I personally witnessed him/her sign this document or ask the person indicated to do so, or I received proof of his/her identity that I believe is adequate, and I believe that he/she did so voluntarily. By signing this document as a witness, I certify that I am:

  • At least 18 years of age.
  • Not related to the person signing this document by blood, marriage or adoption.
  • Not a healthcare agent appointed by the person signing this document.
  • Not directly financially responsible for that person’s healthcare.
  • Not a healthcare provider directly serving the person at this time.
  • Not an employee (other than a social worker or chaplain), officer, director, or partner of a healthcare provider (or any parent organization of such healthcare provider) directly serving the person at this time.
  • Not aware that I am entitled to or have a claim against the person’s estate.

Witness Number:
Signature:
Date:

Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/PMO-Example-Smith-Johnson-PMOComposition1

Resource Composition:

Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1

Language: en-US

Profile: ADI PMO Composition

Composition Version Number: 11546d53-a054-4882-bc0a-ff02aa0ba887c

Jurisdiction: Michigan (United States)

Data Enterer: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#10A3D58WH1600)

Effective Date: 2024-03-29 14:25:34-0500 --> (ongoing)

identifier: urn:oid:2.16.840.1.113883.4.823.1.7124/0-87f37989294a408897aacd1fc5d8fd16

status: Final

type: Portable medical order form

category: Advance directives

date: 2024-03-29 14:25:34-0500

author: PractitionerRole

title: Portable Medical Order

custodian: Organization MyDirectives.com

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1

Resource Patient:

Generated Narrative: Patient Example-Smith-Johnson-Patient1

Last updated: 2021-03-29 14:25:34-0500; Language: en-US

Profile: US Core Patient Profile

Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#10A3D58WH1600)

Active:trueMarital Status:unknown
Other Id:Medical Record Number/1032702 (use: usual, )
Contact Detail
Language:English (preferred)
son:
  • Charles Johnson
  • 111 Maple Ct, Grand Rapids, MI 49503
  • ph: (210) 222-3333
daughter:
  • Debra Johnson
  • 333 W. Camden St., Baltimore, MD 21201
  • ph: (410) 444-5555
US Core Race Extension:
  • ombCategory: CDC Race and Ethnicity 2106-3: White
  • text: White

Entry 3 - fullUrl = http://www.example.org/fhir/Patient/Example-Kyle-Anydoc-PractitionerRole1

Resource PractitionerRole:

Generated Narrative: PractitionerRole Example-Kyle-Anydoc-PractitionerRole1

practitioner: Practitioner Kyle Anydoc

Entry 4 - fullUrl = http://www.example.org/fhir/Patient/Example-Kyle-Anydoc-Practitioner

Resource Practitioner:

Generated Narrative: Practitioner Example-Kyle-Anydoc-Practitioner

identifier: United States National Provider Identifier/21548796354

name: Kyle Anydoc

telecom: kanydoc@example.org

gender: Male

address: 567 Healthcare Drive Anytown MA 12345 US (home)

Qualifications

-Code
*Doctor of Medicine

Entry 5 - fullUrl = http://www.example.org/fhir/Patient/Example-Smith-Johnson-CPR-ServiceRequest1

Resource ServiceRequest:

Generated Narrative: ServiceRequest Example-Smith-Johnson-CPR-ServiceRequest1

status: Active

intent: Order

category: Cardiopulmonary resuscitation orders

doNotPerform: true

code: No display for ServiceRequest.code (concept: Cardiopulmonary resuscitation (procedure))

orderDetail: No display for ServiceRequest.orderDetail ()

subject: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#10A3D58WH1600)

requester: Practitioner Kyle Anydoc