Portable medical orders are always authored by the provider who legally authenticates the document. The signing provider is represented as the legal attester. If other care team members are involved in the creation of these types of documents, they may be included as facilitators or contributors to the process, but they may or may not be signers of the resultant document. Other care team members who sign the document are represented as professional attesters. The person/patient (or their representative) is required to sign the document and is represented as a personal attester. The PMO Composition which is being exchanged or made accessible includes a representation of the completed source form of the document. The Composition can also include information about:

• Medical orders for certain treatment interventions intended to be honored and followed by other care providers
• The person’s appointed healthcare agent,
• Administrative information; Completion information; Additional Documentation; Upon death preferences, especially organ donation, and
• Witness and notary information (if that information is required for the specific form being represented to be considered valid.)

An advance healthcare directive document must always contain the source form representation in the Source Form section. It may include other textual information organized in standard structural sections which may or may not include machine processable encoded entries.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: Composition-section-code-equals-type
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension				Content/Rules for all slices
extension:versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension		0..1	dateTime	ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction		0..*	CodeableConcept	US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Portable Medical Order Document Types (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: Advance Healthcare Directive Categories LOINC (extensible)
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core PractitionerRole Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester	S	1..*	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: legal
party		0..1	Reference(US Core Patient Profile | RelatedPerson | US Core Practitioner Profile | US Core PractitionerRole Profile | ADI Witness | ADI Notary | ADI Practitioner Role)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
section:portable_medical_orders	SC	1..1	BackboneElement	Portable Medical Orders Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Section clause, additional instructions, or information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 93037-0
display		1..1	string	Representation defined by the system Fixed Value: Portable medical order form
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry	SC	0..*	Reference(ADI PMO ServiceRequest)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:cardiopulmonary_resuscitation_service_request	SC	0..1	Reference(ADI PMO Cardiopulmonary Resuscitation ServiceRequest)	A reference to data that supports this section
entry:initial_treatment_service_request	SC	0..1	Reference(ADI PMO Initial Treatment ServiceRequest)	A reference to data that supports this section
entry:additional_orders_or_instructions_service_request	SC	0..*	Reference(ADI PMO Additional orders or instructions ServiceRequest)	A reference to data that supports this section
entry:medically_assisted_nutrition_service_request	SC	0..1	Reference(ADI PMO Medically Assisted Nutrition Service Request)	A reference to data that supports this section
entry:medically_assisted_hydration_service_request	SC	0..1	Reference(ADI PMO Medically Assisted Hydration Service Request)	A reference to data that supports this section
section:completion_information	C	0..1	BackboneElement	Portable medical order completion information Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Administrative, instructional, and/or legal information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ldo
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:orders_review	C	0..*	Reference(ADI PMO Review Observation)	A reference to data that supports this section
entry:orders_participant	C	0..*	Reference(ADI PMO Participant Observation)	A reference to data that supports this section
section:administration_information	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adm
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:adi_personal_goal	C	0..*	Reference(ADI Personal Goal)	ADI Personal Goal
entry:adi_decisional_capacity	SC	0..1	Reference(ADI Decisional Capacity)	ADI Decisional Capacity
entry:adi_pmo_hospice_observation	SC	0..1	Reference(ADI PMO Hospice Observation)	Hospice or palliative care enrollment
entry:minimal_source_form	SC	0..1	Reference(Binary)	Minimal Source Form
section:gpp_upon_death	C	0..1	BackboneElement	Goals, preferences, and priorities upon death Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	SC	0..*	Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
section:minimal_source_form	C	0..1	BackboneElement	Minimal source form Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
section:additional_documentation	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary	C	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document. Constraints: cmp-1, cmp-2
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
entry	C	0..*	Reference(ADI Healthcare Agent Participant)	A reference to data that supports this section
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Composition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Composition.status	Base	required	ADI Composition Status	📦2.0.0-ballot	This IG
Composition.type	Base	extensible	Portable Medical Order Document Types	📦20250407	VSAC v0.23
Composition.category	Base	extensible	Advance Healthcare Directive Categories LOINC	📦20250402	VSAC v0.23
Composition.attester.​mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.section:portable_medical_orders.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:completion_information.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:administration_information.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:gpp_upon_death.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:minimal_source_form.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:additional_documentation.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:witness_and_notary.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type when section is portable_medical_orders	section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
cmp-1	error	Composition.section, Composition.section:portable_medical_orders, Composition.section:completion_information, Composition.section:administration_information, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary	A section must contain at least one of text, entries, or sub-sections	text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:portable_medical_orders, Composition.section:completion_information, Composition.section:administration_information, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary	A section can only have an emptyReason if it is empty	emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from ADICompositionHeader

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: Composition-section-code-equals-type
type		1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Portable Medical Order Document Types (extensible)
author		1..*	Reference(US Core PractitionerRole Profile)	Who and/or what authored the composition
attester	S	1..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal | professional | legal | official Required Pattern: legal
party		0..1	Reference(US Core Patient Profile | RelatedPerson | US Core Practitioner Profile | US Core PractitionerRole Profile | ADI Witness | ADI Notary | ADI Practitioner Role)	Who attested the composition
event
Slices for detail				Content/Rules for all slices
detail:pmo-servicerequest		0..*	Reference(ADI PMO ServiceRequest)	ADI PMO Service Request
detail:pmo-healthcareagentconsent		0..*	Reference(ADI Healthcare Agent Consent)	ADI Healthcare Agent Consent
detail:pmo-procedure		0..*	Reference(ADI PMO Procedure)	ADI PMO Procedure
Slices for section		1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code
section:All Slices				Content/Rules for all slices
text	S	1..1	Narrative	Text summary of the section, for human interpretation
section:portable_medical_orders	S	1..1	BackboneElement	Portable Medical Orders
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Section clause, additional instructions, or information
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 93037-0
display		1..1	string	Representation defined by the system Fixed Value: Portable medical order form
Slices for entry	S	0..*	Reference(ADI PMO ServiceRequest)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:cardiopulmonary_resuscitation_service_request	S	0..1	Reference(ADI PMO Cardiopulmonary Resuscitation ServiceRequest)	A reference to data that supports this section
entry:initial_treatment_service_request	S	0..1	Reference(ADI PMO Initial Treatment ServiceRequest)	A reference to data that supports this section
entry:additional_orders_or_instructions_service_request	S	0..*	Reference(ADI PMO Additional orders or instructions ServiceRequest)	A reference to data that supports this section
entry:medically_assisted_nutrition_service_request	S	0..1	Reference(ADI PMO Medically Assisted Nutrition Service Request)	A reference to data that supports this section
entry:medically_assisted_hydration_service_request	S	0..1	Reference(ADI PMO Medically Assisted Hydration Service Request)	A reference to data that supports this section
section:completion_information		0..1	BackboneElement	Portable medical order completion information
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Administrative, instructional, and/or legal information
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ldo
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:orders_review		0..*	Reference(ADI PMO Review Observation)	A reference to data that supports this section
entry:orders_participant		0..*	Reference(ADI PMO Participant Observation)	A reference to data that supports this section
section:administration_information		0..1	BackboneElement	Observations regarding the existence of other advance directive related information
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adm
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:adi_personal_goal		0..*	Reference(ADI Personal Goal)	ADI Personal Goal
entry:adi_decisional_capacity	S	0..1	Reference(ADI Decisional Capacity)	ADI Decisional Capacity
entry:adi_pmo_hospice_observation	S	0..1	Reference(ADI PMO Hospice Observation)	Hospice or palliative care enrollment
entry:minimal_source_form	S	0..1	Reference(Binary)	Minimal Source Form
section:gpp_upon_death		0..1	BackboneElement	Goals, preferences, and priorities upon death
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
entry	S	0..*	Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
section:minimal_source_form		0..1	BackboneElement	Minimal source form
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
entry		0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
section:additional_documentation		0..1	BackboneElement	Observations regarding the existence of other advance directive related information
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
entry		0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
section:witness_and_notary		0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document.
Slices for extension				Content/Rules for all slices
extension:ClauseExtension		0..*	ClauseExtension	Clause
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
entry		0..*	Reference(ADI Healthcare Agent Participant)	A reference to data that supports this section
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Composition.type	Base	extensible	Portable Medical Order Document Types	📦20250407	VSAC v0.23

Constraints

Id	Grade	Path(s)	Description	Expression
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type when section is portable_medical_orders	section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition	C	0..*	ADICompositionHeader	A set of resources composed into a single coherent clinical statement with clinical attestation Constraints: Composition-section-code-equals-type
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension		0..1	dateTime	ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction		0..*	CodeableConcept	US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Portable Medical Order Document Types (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: Advance Healthcare Directive Categories LOINC (extensible)
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core PractitionerRole Profile)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester	S	1..*	BackboneElement	Attests to accuracy of composition
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: legal
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(US Core Patient Profile | RelatedPerson | US Core Practitioner Profile | US Core PractitionerRole Profile | ADI Witness | ADI Notary | ADI Practitioner Role)	Who attested the composition
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	Σ	0..*	BackboneElement	The clinical service(s) being documented
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
period	Σ	0..1	Period	The period covered by the documentation
Slices for detail	Σ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator	Σ	0..1	Reference(ADI Facilitator)	ADI Facilitator
detail:pmo-servicerequest	Σ	0..*	Reference(ADI PMO ServiceRequest)	ADI PMO Service Request
detail:pmo-healthcareagentconsent	Σ	0..*	Reference(ADI Healthcare Agent Consent)	ADI Healthcare Agent Consent
detail:pmo-procedure	Σ	0..*	Reference(ADI PMO Procedure)	ADI PMO Procedure
Slices for section	C	1..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by pattern:code Constraints: cmp-1, cmp-2
section:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:portable_medical_orders	SC	1..1	BackboneElement	Portable Medical Orders Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Section clause, additional instructions, or information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 93037-0
display		1..1	string	Representation defined by the system Fixed Value: Portable medical order form
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	SC	0..*	Reference(ADI PMO ServiceRequest)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:cardiopulmonary_resuscitation_service_request	SC	0..1	Reference(ADI PMO Cardiopulmonary Resuscitation ServiceRequest)	A reference to data that supports this section
entry:initial_treatment_service_request	SC	0..1	Reference(ADI PMO Initial Treatment ServiceRequest)	A reference to data that supports this section
entry:additional_orders_or_instructions_service_request	SC	0..*	Reference(ADI PMO Additional orders or instructions ServiceRequest)	A reference to data that supports this section
entry:medically_assisted_nutrition_service_request	SC	0..1	Reference(ADI PMO Medically Assisted Nutrition Service Request)	A reference to data that supports this section
entry:medically_assisted_hydration_service_request	SC	0..1	Reference(ADI PMO Medically Assisted Hydration Service Request)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:completion_information	C	0..1	BackboneElement	Portable medical order completion information Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Administrative, instructional, and/or legal information URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: ldo
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:orders_review	C	0..*	Reference(ADI PMO Review Observation)	A reference to data that supports this section
entry:orders_participant	C	0..*	Reference(ADI PMO Participant Observation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:administration_information	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: adm
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:resolve()
entry:adi_personal_goal	C	0..*	Reference(ADI Personal Goal)	ADI Personal Goal
entry:adi_decisional_capacity	SC	0..1	Reference(ADI Decisional Capacity)	ADI Decisional Capacity
entry:adi_pmo_hospice_observation	SC	0..1	Reference(ADI PMO Hospice Observation)	Hospice or palliative care enrollment
entry:minimal_source_form	SC	0..1	Reference(Binary)	Minimal Source Form
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:gpp_upon_death	C	0..1	BackboneElement	Goals, preferences, and priorities upon death Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81337-8
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	SC	0..*	Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:minimal_source_form	C	0..1	BackboneElement	Minimal source form Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: minimal_source_form
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Minimal Source Form)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:additional_documentation	C	0..1	BackboneElement	Observations regarding the existence of other advance directive related information Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 77599-9
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Documentation Observation)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:witness_and_notary	C	0..1	BackboneElement	Witness and notary information. The first witness should be the author of the document. Constraints: cmp-1, cmp-2
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title	S	1..1	string	Label for section (e.g. for ToC)
code	S	1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (Complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 81339-4
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(ADI Healthcare Agent Participant)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Composition.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Composition.status	Base	required	ADI Composition Status	📦2.0.0-ballot	This IG
Composition.type	Base	extensible	Portable Medical Order Document Types	📦20250407	VSAC v0.23
Composition.category	Base	extensible	Advance Healthcare Directive Categories LOINC	📦20250402	VSAC v0.23
Composition.attester.​mode	Base	required	CompositionAttestationMode	📍4.0.1	FHIR Std.
Composition.relatesTo.​code	Base	required	DocumentRelationshipType	📍4.0.1	FHIR Std.
Composition.event.code	Base	example	v3 Code System ActCode	📦3.0.0	THO v7.0
Composition.section.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:portable_medical_orders.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:portable_medical_orders.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:portable_medical_orders.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:portable_medical_orders.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:completion_information.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:completion_information.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:completion_information.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:completion_information.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:administration_information.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:administration_information.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:administration_information.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:administration_information.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:gpp_upon_death.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:gpp_upon_death.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:gpp_upon_death.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:gpp_upon_death.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:minimal_source_form.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:minimal_source_form.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:minimal_source_form.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:minimal_source_form.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:additional_documentation.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:additional_documentation.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:additional_documentation.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:additional_documentation.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.
Composition.section:witness_and_notary.​code	Base	example	Document Section Codes	📍4.0.1	FHIR Std.
Composition.section:witness_and_notary.​mode	Base	required	ListMode	📍4.0.1	FHIR Std.
Composition.section:witness_and_notary.​orderedBy	Base	preferred	List Order Codes	📍4.0.1	FHIR Std.
Composition.section:witness_and_notary.​emptyReason	Base	preferred	List Empty Reasons	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
Composition-section-code-equals-type	error	Composition	Composition section code must equal Composition type when section is portable_medical_orders	section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
cmp-1	error	Composition.section, Composition.section:portable_medical_orders, Composition.section:completion_information, Composition.section:administration_information, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary	A section must contain at least one of text, entries, or sub-sections	text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:portable_medical_orders, Composition.section:completion_information, Composition.section:administration_information, Composition.section:gpp_upon_death, Composition.section:minimal_source_form, Composition.section:additional_documentation, Composition.section:witness_and_notary	A section can only have an emptyReason if it is empty	emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()