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
<CarePlan xmlns="http://hl7.org/fhir">
<id value="Example-Smith-Johnson-PreferenceCarePlan1"/>
<meta>
<profile
value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PreferenceCarePlan"/>
</meta>
<text>
<status value="additional"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>status</b>: active</p><p><b>intent</b>: proposal</p><p><b>category</b>: <span title="Codes: {http://snomed.info/sct 736366004}">Advance care plan</span></p><p><b>subject</b>: <a href="Patient-Example-Smith-Johnson-Patient1.html">Betsy Smith-Johnson</a> ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15</p><p><b>addresses</b>:</p><ul><li><span>Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery</span></li><li><span>Persistent vegetative state (SNOMED CT 24473007)</span></li><li><span>Irreversible coma (SNOMED CT 73453007)</span></li></ul><p><b>goal</b>:</p><ul><li><a href="Goal-Example-Smith-Johnson-PersonalGoal1.html"><span title="Codes: {http://loinc.org 81378-2}">Goals, preferences, and priorities under certain health conditions [Reported]</span></a>; <span title="Codes: ">If I am so sick or seriously injured that I cannot express my own medical treatment preferences, and if I am not expected to live without additional treatment for my illness, disease, condition or injury, then I want my medical care team to know that these are the things that are most important to me: Avoiding prolonged dependence on machines, Not being a physical burden to my family, Dying at home</span></li><li><a href="Observation-Example-Smith-Johnson-PersonalInterventionPreference3.html"><span title="Codes: {http://loinc.org 75778-1}">Information to tell doctors if I have a severe, irreversible brain injury or illness and can't dress, feed, or bathe myself, or communicate my medical wishes, but can be kept alive [Reported]</span></a>; <span title="Codes: ">If my health ever deteriorates due to a terminal illness, and my doctors believe I will not be able to interact meaningfully with my family, friends, or surroundings, I would like for them to keep trying life-sustaining treatments until my healthcare agent decides it is time to stop and such treatments and let me die gently.</span></li><li><a href="Observation-Example-Smith-Johnson-CareExperiencePreference6.html"><span title="Codes: {http://loinc.org 81365-9}">Religious or cultural affiliation contact to notify [Reported]</span></a>; <span title="Codes: ">Please attempt to notify someone from my religion at the following phone number: If I have included one: Catholic</span></li><li><a href="Observation-Example-Smith-Johnson-CareExperiencePreference5.html"><span title="Codes: {http://loinc.org 81364-2}">Religious or cultural beliefs [Reported]</span></a>; <span title="Codes: ">If I appear to be approaching the end of my life, here are some things that I would like for my caregivers to know about my faith and my religion. Please call Father Mark if my condition warrants the services of a priest.</span></li><li><a href="Observation-Example-Smith-Johnson-CareExperiencePreference1.html"><span title="Codes: {http://loinc.org 75775-7}">Decision to inform doctors and nurses about the role religion, faith, culture, or spirituality play in my life [Reported]</span></a>; <span title="Codes: ">Here are some thoughts that I would like for my medical care team and my healthcare agent(s) to know about the role that religion, faith or spirituality play in my life: I am Catholic, please call Father Mark at Saint Catherine's on Main Street.</span></li></ul></div>
</text>
<extension
url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-goal-order-by-descending-priority-extension">
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0532"/>
<code value="Y"/>
</coding>
</valueCodeableConcept>
</extension>
<status value="active"/>
<intent value="proposal"/>
<category>
<coding>
<system
value="http://hl7.org/fhir/us/core/CodeSystem/careplan-category"/>
<code value="assess-plan"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="81378-2"/>
<display
value="Goals, preferences, and priorities under certain health conditions [Reported]"/>
</coding>
</category>
<title
value="Care Plan for Unconscious, vegetative state, coma for Smith-Johnson"/>
<subject>🔗
<reference value="Patient/Example-Smith-Johnson-Patient1"/>
</subject>
<addresses>
<display
value="Unconscious, in a coma, or in a persistent vegetative state with little or no chance of recovery"/>
</addresses>
<addresses>
<display value="Persistent vegetative state (SNOMED CT 24473007)"/>
</addresses>
<addresses>
<display value="Irreversible coma (SNOMED CT 73453007)"/>
</addresses>
<supportingInfo>🔗
<reference
value="Observation/Example-Smith-Johnson-PersonalInterventionPreference3"/>
</supportingInfo>
<supportingInfo>🔗
<reference
value="Observation/Example-Smith-Johnson-CareExperiencePreference6"/>
</supportingInfo>
<supportingInfo>🔗
<reference
value="Observation/Example-Smith-Johnson-CareExperiencePreference5"/>
</supportingInfo>
<supportingInfo>🔗
<reference
value="Observation/Example-Smith-Johnson-CareExperiencePreference1"/>
</supportingInfo>
<goal>🔗
<reference value="Goal/Example-Smith-Johnson-PersonalGoal1"/>
</goal>
</CarePlan>