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

PACP Guidance

ADI Content Type 1 Document Structure

The ADI Content Type 1 document defines 7 sections:

1. Healthcare Agent - Healthcare agents, healthcare agent advisors, and consent by the subject regarding the stated designees’ roles, powers, and limitations.
2. Goals, Preferences, and Priorities for Certain Conditions – Preferences to be used in treatment or care planning that express a person’s goals, preferences, and priorities for care to be considered under specific situations or conditions.
3. Goals, Preferences, and Priorities Personal Care Experience – Characteristically these concepts express a person’s priorities for Quality of Life and the related care delivery experiences, personal goals, and preferences for that experience, which can be further grouped and placed into a Personal Priorities Organizer.
4. Goals, Preferences, and Priorities Upon Death - Goals, preferences, and priorities a person expresses for those events that occur at the time of, or soon after, their death.
5. Additional Documentation - Observations regarding the existence of other advance directive related information.
6. Witness & Notary - References and information regarding witnesses and notary.
7. Administrative Information - Administrative information associated with the personal advance care plan and/or advance directive information.

The content in these categories of advance directive could include, but are not limited to:

• Healthcare agent designation
• Antibiotics administration preference
• Artificial nutrition and hydration administration preference
• Intubation and ventilation procedure preference
• Resuscitation procedure preference
• Diagnostic testing procedure preference
• Preferences relating to palliative and supportive care
• Preferences relating to hospice care at the end of life
• Organ donation preference
• Death arrangement preference
• Religious, spiritual, cultural or faith-based values that are important to the individual receiving care
• Specific individuals or contacts to notify, likes & joys, dislikes & fears, and various messages or information to be made available

Content type 1 also includes identifying the presence of any type of Portable Medical Order (PMO) such as a POLST or MOLST, and orders such as Do Not Resuscitate (DNR) orders. It also includes identifying other types of person-authored ADI that might exist outside of the document being reviewed. It does not include the specifics of the structured information content of other PMO and/or DNR documents, but instead creates awareness as to the presence of the documents.