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

: Portable Medical Order - XML Representation

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<Composition xmlns="http://hl7.org/fhir">
  <id value="PMO-Example-Smith-Johnson-PMOComposition1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition"/>
  </meta>
  <language value="en-US"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en-US" lang="en-US"><p class="res-header-id"><b>Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1</b></p><a name="PMO-Example-Smith-Johnson-PMOComposition1"> </a><a name="hcPMO-Example-Smith-Johnson-PMOComposition1"> </a><a name="PMO-Example-Smith-Johnson-PMOComposition1-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en-US</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-ADI-PMOComposition.html">ADI PMO Composition</a></p></div><p><b>Composition Version Number</b>: 11546d53-a054-4882-bc0a-ff02aa0ba887c</p><p><b>Jurisdiction</b>: <span title="Codes:{urn:iso:std:iso:3166:-2 US-MI}">Michigan (United States)</span></p><p><b>Data Enterer</b>: <a href="Patient-Example-Smith-Johnson-Patient1.html">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#10A3D58WH1600)</a></p><p><b>Effective Date</b>: 2024-03-29 14:25:34-0500 --&gt; (ongoing)</p><p><b>identifier</b>: <code>urn:oid:2.16.840.1.113883.4.823.1.7124</code>/0-87f37989294a408897aacd1fc5d8fd16</p><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{http://loinc.org 93037-0}">Portable medical order form</span></p><p><b>category</b>: <span title="Codes:{http://loinc.org 42348-3}">Advance directives</span></p><p><b>date</b>: 2024-03-29 14:25:34-0500</p><p><b>author</b>: <a href="PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html">PractitionerRole</a></p><p><b>title</b>: Portable Medical Order</p><p><b>custodian</b>: <a href="Organization-Example-Smith-Johnson-OrganizationCustodian1.html">Organization MyDirectives.com</a></p></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber">
    <valueString value="11546d53-a054-4882-bc0a-ff02aa0ba887c"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension">
    <valueCodeableConcept>
      <coding>
        <system value="urn:iso:std:iso:3166:-2"/>
        <code value="US-MI"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension">
    <valueReference>🔗 
      <reference value="Patient/Example-Smith-Johnson-Patient1"/>
    </valueReference>
  </extension>
  <extension
             url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension">
    <valuePeriod>
      <start value="2024-03-29T14:25:34-05:00"/>
    </valuePeriod>
  </extension>
  <identifier>
    <system value="urn:oid:2.16.840.1.113883.4.823.1.7124"/>
    <value value="0-87f37989294a408897aacd1fc5d8fd16"/>
  </identifier>
  <status value="final"/>
  <type>
    <coding>
      <system value="http://loinc.org"/>
      <code value="93037-0"/>
      <display value="Portable medical order form"/>
    </coding>
  </type>
  <category>
    <coding>
      <system value="http://loinc.org"/>
      <code value="42348-3"/>
      <display value="Advance directives"/>
    </coding>
  </category>
  <subject>🔗 
    <reference value="Patient/Example-Smith-Johnson-Patient1"/>
  </subject>
  <date value="2024-03-29T14:25:34-05:00"/>
  <author>🔗 
    <reference
               value="PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"/>
  </author>
  <title value="Portable Medical Order"/>
  <custodian>🔗 
    <reference
               value="Organization/Example-Smith-Johnson-OrganizationCustodian1"/>
  </custodian>
  <section>
    <title value="Portable Medical Orders"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="59772-4"/>
      </coding>
    </code>
    <text>
      <status value="generated"/>
      <div xmlns="http://www.w3.org/1999/xhtml"><p><b>PMO Medical Orders</b></p><p><i>Order Exists: <a href="http://www.example.com">available here</a></i></p></div>
    </text>
    <entry>🔗 
      <reference
                 value="ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"/>
    </entry>
  </section>
  <section>
    <title value="Additional Documentation"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="77599-9"/>
      </coding>
    </code>
    <text>
      <status value="generated"/>
      <div xmlns="http://www.w3.org/1999/xhtml"><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href="http://www.example.com">available here</a></i></p></div>
    </text>
    <entry>🔗 
      <reference
                 value="Observation/Example-Smith-Johnson-DocumentationObservation1"/>
    </entry>
  </section>
  <section>
    <title value="Witnesses and Notary"/>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="81339-4"/>
        <display value="Witness and Notary Document"/>
      </coding>
    </code>
    <text>
      <status value="additional"/>
      <div xmlns="http://www.w3.org/1999/xhtml"><p>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.</p><table><tbody><tr><td><b>Signature:</b></td><td>Betsy Smith-Johnson</td></tr><tr><td><b>Date:</b></td><td>3/29/2024</td></tr></tbody></table><p></p><p><b>Statement of Witnesses</b></p><p></p><p>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:</p><p></p><ul><li>At least 18 years of age.</li><li>Not related to the person signing this document by blood, marriage or adoption.</li><li>Not a healthcare agent appointed by the person signing this document.</li><li>Not directly financially responsible for that person’s healthcare.</li><li>Not a healthcare provider directly serving the person at this time.</li><li>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.</li><li>Not aware that I am entitled to or have a claim against the person’s estate.</li></ul><p></p><table><tbody><tr><td><b>Witness Number:</b></td><td></td></tr><tr><td><b>Signature:</b></td><td></td></tr><tr><td><b>Date:</b></td><td></td></tr></tbody></table></div>
    </text>
  </section>
</Composition>