PMO-Example-Smith-Johnson-Bundle2
type: Bundle
node role: treeRoot
resource.id:
  value: PMO-Example-Smith-Johnson-Bundle2
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle
resource.language:
  value: en
bundle.identifier:
  identifier.system:
    value: http://example.org/GoodHealthClinic/id
  identifier.value:
    value: 20130607100315-ExamplePMODocument
bundle.type:
  value: document
bundle.timestamp:
  value: 2024-03-29T14:25:34.001-05:00
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Composition/PMO-Example-Smith-Johnson-PMOComposition1
  bundle.entry.resource: PMO-Example-Smith-Johnson-PMOComposition1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1
  bundle.entry.resource: Example-Smith-Johnson-Patient1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
  bundle.entry.resource: Example-Kyle-Anydoc-PractitionerRole1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Practitioner/Example-Kyle-Anydoc-Practitioner
  bundle.entry.resource: Example-Kyle-Anydoc-Practitioner
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1
  bundle.entry.resource: Example-Smith-Johnson-OrganizationCustodian1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1
  bundle.entry.resource: Example-Smith-Johnson-CPR-ServiceRequest1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Observation/Example-Smith-Johnson-DocumentationObservation2
  bundle.entry.resource: Example-Smith-Johnson-DocumentationObservation2
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds
  bundle.entry.resource: ADI-Facilitator-MSW-MargaretReynolds
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Practitioner/Practitioner-MargaretReynolds
  bundle.entry.resource: Practitioner-MargaretReynolds
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Endpoint/Example-Smith-Johnson-Endpoint2
  bundle.entry.resource: Example-Smith-Johnson-Endpoint2
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit
  bundle.entry.resource: Example-Smith-Johnson-HealthcareAgentConsent-Permit
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny
  bundle.entry.resource: Example-Smith-Johnson-HealthcareAgentConsent-Deny
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
  bundle.entry.resource: Example-Smith-Johnson-HealthcareAgent1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Provenance/Example-Smith-Johnson-PMOProvenance1
  bundle.entry.resource: Example-Smith-Johnson-PMOProvenance1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationAssembler1
  bundle.entry.resource: Example-Smith-Johnson-OrganizationAssembler1
bundle.entry:
  index: -1
  bundle.entry.full url:
    value: http://www.example.org/fhir/Binary/Example-Stub-SourceForm-Smith-Johnson-Binary
  bundle.entry.resource: Example-Stub-SourceForm-Smith-Johnson-Binary

PMO-Example-Smith-Johnson-PMOComposition1
type: Composition
resource.id:
  value: PMO-Example-Smith-Johnson-PMOComposition1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1 Language: en-US Profile: ADI PMO Composition Composition Version Number: 2024-03-29T14:25:34-05:00 Data Enterer: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16) Participant: PractitionerRole: telecom = kanydoc@example.org(Work) ADI Expiration Date: 2024-03-29 14:25:34-0500 Performer: PractitionerRole: telecom = kanydoc@example.org(Work) Informant: RelatedPerson Johnson, Charles Revoke Status: deprecated Clause Clause: Example Clause Statement identifier: http://example.org/GoodHealthClinic/id/0-87f37989294a408897aacd1fc5d8fd16 status: Final type: Portable medical order form category: Clinical note, Advance healthcare directives date: 2023-03-29 14:25:34-0500 author: PractitionerRole: telecom = kanydoc@example.org(Work) title: Portable Medical Order Attesters - Mode Party * Legal PractitionerRole: telecom = kanydoc@example.org(Work) custodian: Organization example.org event detail: PractitionerRole primary performer Example-Smith-Johnson-HealthcareAgentConsent-Permit Example-Smith-Johnson-HealthcareAgentConsent-Deny
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
  extension.value string:
    value: 2024-03-29T14:25:34-05:00
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
  extension.value reference:
    link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
    reference.reference:
      value: Patient/Example-Smith-Johnson-Patient1
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
  extension.value reference:
    link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
    reference.reference:
      value: PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
  extension.value date time:
    value: 2024-03-29T14:25:34-05:00
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
  extension.value reference:
    link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
    reference.reference:
      value: PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
  extension.value reference:
    link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
    reference.reference:
      value: RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status
  extension.value code:
    value: deprecated
domain resource.extension:
  index: -1
  element.extension:
    index: -1
    extension.url:
      value: Clause
    extension.value markdown:
      value: Example Clause Statement
  extension.url:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
composition.identifier:
  identifier.system:
    value: http://example.org/GoodHealthClinic/id
composition.status:
  value: final
composition.type:
  codeable concept.coding: http://loinc.org/rdf#93037-0
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 93037-0
    coding.display:
      value: Portable medical order form
composition.category:
  index: -1
  codeable concept.coding: http://loinc.org/rdf#107903-7
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 107903-7
    coding.display:
      value: Clinical note
composition.category:
  index: -1
  codeable concept.coding: http://loinc.org/rdf#42348-3
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 42348-3
    coding.display:
      value: Advance healthcare directives
composition.subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
composition.date:
  value: 2023-03-29T14:25:34-05:00
composition.author:
  index: -1
  link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
  reference.reference:
    value: PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
composition.title:
  value: Portable Medical Order
composition.attester:
  index: -1
  composition.attester.mode:
    value: legal
  composition.attester.party:
    link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
    reference.reference:
      value: PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
composition.custodian:
  link: http://hl7.org/fhir/us/pacio-adi/Organization/Example-Smith-Johnson-OrganizationCustodian1
  reference.reference:
    value: Organization/Example-Smith-Johnson-OrganizationCustodian1
composition.event:
  index: -1
  composition.event.detail:
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds
    reference.reference:
      value: PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds
  composition.event.detail:
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit
    reference.reference:
      value: Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit
  composition.event.detail:
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny
    reference.reference:
      value: Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny
composition.section:
  index: -1
  composition.section.title:
    value: Example Source Form - Betsy Smith-Johnson
  composition.section.code:
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
      coding.code:
        value: advance_directive_source_form
  composition.section.text:
    narrative.status:
      value: additional
    narrative.div: I understand the purpose and effect of this Advance Directive, I agree with everything that is written in this form, and I have made this advance directive knowingly, willingly and after careful deliberation.
  composition.section.entry:
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/Binary/Example-Stub-SourceForm-Smith-Johnson-Binary
    reference.reference:
      value: Binary/Example-Stub-SourceForm-Smith-Johnson-Binary
composition.section:
  index: -1
  composition.section.title:
    value: Portable Medical Orders
  composition.section.code:
    codeable concept.coding: http://loinc.org/rdf#93037-0
      index: -1
      coding.system:
        value: http://loinc.org
      coding.code:
        value: 93037-0
      coding.display:
        value: Portable medical order form
  composition.section.text:
    narrative.status:
      value: generated
    narrative.div: PMO Medical Orders Order Exists: available here
  composition.section.entry:
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1
    reference.reference:
      value: ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1
composition.section:
  index: -1
  composition.section.title:
    value: Additional Documentation
  composition.section.code:
    codeable concept.coding: http://loinc.org/rdf#77599-9
      index: -1
      coding.system:
        value: http://loinc.org
      coding.code:
        value: 77599-9

Example-Smith-Johnson-Patient1
type: Patient
resource.id:
  value: Example-Smith-Johnson-Patient1
resource.meta:
  meta.last updated:
    value: 2021-03-29T14:25:34.001-05:00
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: 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#1PA3D58WH16) Active: true Marital Status: unknown Other Id: Medical Record Number/1032702 (use: usual, ) Contact Detail BetsySJ@example.com 111 Maple Court San Antonio TX 78212 US (home) 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 <td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [Race & Ethnicity - CDC (CDCREC)](https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238) code system. Detailed race concepts are grouped by and pre-mapped to the 5 OMB race categories:#xA;#xA; - American Indian or Alaska Native#xA; - Asian#xA; - Black or African American#xA; - Native Hawaiian or Other Pacific Islander#xA; - White.">US Core Race Extension: ombCategory: CDC Race and Ethnicity: 2106-3 (White) text: White
domain resource.extension:
  index: -1
  element.extension:
    index: -1
    extension.url:
      value: ombCategory
    extension.value coding:
      coding.system:
        value: urn:oid:2.16.840.1.113883.6.238
      coding.code:
        value: 2106-3
      coding.display:
        value: White
  element.extension:
    index: -1
    extension.url:
      value: text
    extension.value string:
      value: White
  extension.url:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-race
patient.identifier:
  index: -1
  identifier.use:
    value: usual
  identifier.type:
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v2-0203
      coding.code:
        value: MR
      coding.display:
        value: Medical Record Number
    codeable concept.text:
      value: Medical Record Number
  identifier.system:
    value: http://example.org/GoodHealthHospital
  identifier.value:
    value: 1032702
patient.identifier:
  index: -1
  identifier.system:
    value: http://hl7.org/fhir/sid/us-medicare
  identifier.value:
    value: 1PA3D58WH16
patient.active:
  value: true
patient.name:
  index: -1
  human name.use:
    value: usual
  human name.text:
    value: Smith-Johnson, Betsy
  human name.family:
    value: Smith-Johnson
  human name.given:
    value: Betsy
    index: -1
patient.telecom:
  index: -1
  contact point.system:
    value: email
  contact point.use:
    value: home
patient.gender:
  value: female
patient.birth date:
  value: 1950-11-15
patient.address:
  index: -1
  address.use:
    value: home
  address.type:
    value: physical
  address.line:
    value: 111 Maple Court
    index: -1
  address.city:
    value: San Antonio
  address.state:
    value: TX
  address.postal code:
    value: 78212
  address.country:
    value: US
patient.marital status:
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-NullFlavor
    coding.code:
      value: UNK
patient.contact:
  index: -1
  patient.contact.relationship:
    index: -1
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v3-RoleCode
      coding.code:
        value: SONC
  patient.contact.name:
    human name.text:
      value: Charles Johnson
  patient.contact.telecom:
    index: -1
    contact point.system:
      value: phone
    contact point.value:
      value: (210) 222-3333
  patient.contact.address:
    address.text:
      value: 111 Maple Ct, Grand Rapids, MI 49503
patient.contact:
  index: -1
  patient.contact.relationship:
    index: -1
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v3-RoleCode
      coding.code:
        value: DAUC
  patient.contact.name:
    human name.text:
      value: Debra Johnson
  patient.contact.telecom:
    index: -1
    contact point.system:
      value: phone
    contact point.value:
      value: (410) 444-5555
  patient.contact.address:
    address.text:
      value: 333 W. Camden St., Baltimore, MD 21201
patient.communication:
  index: -1
  patient.communication.language:
    codeable concept.coding:
      index: -1
      coding.system:
        value: urn:ietf:bcp:47
      coding.code:
        value: en
      coding.display:
        value: English
  patient.communication.preferred:
    value: true

Example-Kyle-Anydoc-PractitionerRole1
type: PractitionerRole
resource.id:
  value: Example-Kyle-Anydoc-PractitionerRole1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: PractitionerRole Example-Kyle-Anydoc-PractitionerRole1 Profile: US Core PractitionerRole Profile practitioner: Practitioner Kyle Anydoc telecom: kanydoc@example.org
practitioner role.practitioner:
  link: http://hl7.org/fhir/us/pacio-adi/Practitioner/Example-Kyle-Anydoc-Practitioner
  reference.reference:
    value: Practitioner/Example-Kyle-Anydoc-Practitioner
practitioner role.telecom:
  index: -1
  contact point.system:
    value: email
  contact point.use:
    value: work

Example-Kyle-Anydoc-Practitioner
type: Practitioner
resource.id:
  value: Example-Kyle-Anydoc-Practitioner
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Practitioner Example-Kyle-Anydoc-Practitioner Profile: US Core Practitioner Profile identifier: United States National Provider Identifier/1818345971 name: Kyle Anydoc telecom: kanydoc@example.org address: 567 Healthcare Drive Anytown MA 12345 US (home) gender: Male Qualifications - Code * Doctor of Medicine
practitioner.identifier:
  index: -1
  identifier.system:
    value: http://hl7.org/fhir/sid/us-npi
  identifier.value:
    value: 1818345971
practitioner.name:
  index: -1
  human name.family:
    value: Anydoc
  human name.given:
    value: Kyle
    index: -1
  human name.prefix:
    value: Dr.
    index: -1
practitioner.telecom:
  index: -1
  contact point.system:
    value: email
  contact point.use:
    value: work
practitioner.address:
  index: -1
  address.use:
    value: home
  address.line:
    value: 567 Healthcare Drive
    index: -1
  address.city:
    value: Anytown
  address.state:
    value: MA
  address.postal code:
    value: 12345
  address.country:
    value: US
practitioner.gender:
  value: male
practitioner.qualification:
  index: -1
  practitioner.qualification.code:
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/v2-0360
      coding.code:
        value: MD
      coding.display:
        value: Doctor of Medicine

Example-Smith-Johnson-OrganizationCustodian1
type: Organization
resource.id:
  value: Example-Smith-Johnson-OrganizationCustodian1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Organization Example-Smith-Johnson-OrganizationCustodian1 Profile: US Core Organization Profile identifier: United States National Provider Identifier/1234567893 active: true name: example.org telecom: +1(202)776-7700 address: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US
organization.identifier:
  index: -1
  identifier.system:
    value: http://hl7.org/fhir/sid/us-npi
  identifier.value:
    value: 1234567893
organization.active:
  value: true
organization.name:
  value: example.org
organization.telecom:
  index: -1
  contact point.system:
    value: phone
  contact point.value:
    value: +1(202)776-7700
  contact point.use:
    value: work
organization.address:
  index: -1
  address.type:
    value: physical
  address.line:
    value: 740 E. Campbell Rd. Suite 825
    index: -1
  address.city:
    value: Richardson
  address.state:
    value: TX
  address.postal code:
    value: 75081
  address.country:
    value: US

Example-Smith-Johnson-CPR-ServiceRequest1
type: ServiceRequest
resource.id:
  value: Example-Smith-Johnson-CPR-ServiceRequest1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOCPRServiceRequest
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOCPRServiceRequest
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: ServiceRequest Example-Smith-Johnson-CPR-ServiceRequest1 Profile: ADI PMO Cardiopulmonary Resuscitation ServiceRequest status: Active intent: Directive category: Cardiopulmonary resuscitation orders doNotPerform: true code: Yes CPR orderDetail: Yes CPR subject: Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16) requester: Practitioner Kyle Anydoc
service request.status:
  value: active
service request.intent:
  value: directive
service request.category:
  index: -1
  codeable concept.coding: http://loinc.org/rdf#100822-6
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 100822-6
    coding.display:
      value: Cardiopulmonary resuscitation orders
service request.do not perform:
  value: true
service request.code:
  codeable concept.coding: LA33470-8
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: LA33470-8
service request.order detail:
  index: -1
  codeable concept.coding: LA33470-8
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: LA33470-8
service request.subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
service request.requester:
  link: http://hl7.org/fhir/us/pacio-adi/Practitioner/Example-Kyle-Anydoc-Practitioner
  reference.reference:
    value: Practitioner/Example-Kyle-Anydoc-Practitioner

Example-Smith-Johnson-DocumentationObservation2
type: Observation
resource.id:
  value: Example-Smith-Johnson-DocumentationObservation2
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-adi-documentation
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-adi-documentation
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: additional
  narrative.div: PMOLST Order Observation Order Exists: available here
domain resource.extension:
  index: -1
  extension.url:
    value: http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo
  extension.value reference:
    link: http://hl7.org/fhir/us/pacio-adi/DocumentReference/Example-Smith-Johnson-DocRef-DocumentReference
    reference.reference:
      value: DocumentReference/Example-Smith-Johnson-DocRef-DocumentReference
observation.status:
  value: final
observation.code:
  codeable concept.coding: http://loinc.org/rdf#45473-6
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 45473-6
observation.subject:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
observation.effective date time:
  value: 2021-03-29T14:25:34.001-05:00
observation.performer:
  index: -1
  link: http://hl7.org/fhir/us/pacio-adi/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
  reference.reference:
    value: PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1
observation.value codeable concept:
  codeable concept.coding: http://snomed.info/id/373066001
    index: -1
    coding.system:
      value: http://snomed.info/sct
    coding.code:
      value: 373066001
    coding.display:
      value: Yes (qualifier value)

ADI-Facilitator-MSW-MargaretReynolds
type: PractitionerRole
resource.id:
  value: ADI-Facilitator-MSW-MargaretReynolds
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: PractitionerRole ADI-Facilitator-MSW-MargaretReynolds Profile: ADI Facilitator active: true practitioner: Margaret A. Reynolds organization: Example Organization code: primary performer specialty: Clinical Social Worker endpoint: Endpoint Good Health Clinic Endpoint
practitioner role.active:
  value: true
practitioner role.practitioner:
  link: http://hl7.org/fhir/us/pacio-adi/Practitioner/Practitioner-MargaretReynolds
  reference.reference:
    value: Practitioner/Practitioner-MargaretReynolds
  reference.display:
    value: Margaret A. Reynolds
practitioner role.organization:
  link: http://hl7.org/fhir/us/pacio-adi/Organization/Example-Smith-Johnson-OrganizationAssembler1
  reference.reference:
    value: Organization/Example-Smith-Johnson-OrganizationAssembler1
  reference.display:
    value: Example Organization
practitioner role.code:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-ParticipationType
    coding.code:
      value: PPRF
practitioner role.specialty:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://nucc.org/provider-taxonomy
    coding.code:
      value: 1041C0700X
    coding.display:
      value: Clinical Social Worker
practitioner role.endpoint:
  index: -1
  link: http://hl7.org/fhir/us/pacio-adi/Endpoint/Example-Smith-Johnson-Endpoint2
  reference.reference:
    value: Endpoint/Example-Smith-Johnson-Endpoint2

Practitioner-MargaretReynolds
type: Practitioner
resource.id:
  value: Practitioner-MargaretReynolds
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Practitioner Practitioner-MargaretReynolds identifier: http://example.org/fhir/MI-state-license/86420 active: true name: Margaret Q. Reynolds telecom: ph: (555) 391-9414 address: 18051 Mack Ave, Detroit, MI 48224 gender: Female
practitioner.identifier:
  index: -1
  identifier.system:
    value: http://example.org/fhir/MI-state-license
  identifier.value:
    value: 86420
practitioner.active:
  value: true
practitioner.name:
  index: -1
  human name.text:
    value: Margaret Q. Reynolds
  human name.family:
    value: Reynolds
  human name.given:
    value: Margaret
    index: -1
  human name.given:
    value: Q.
    index: -1
practitioner.telecom:
  index: -1
  contact point.system:
    value: phone
  contact point.value:
    value: (555) 391-9414
practitioner.address:
  index: -1
  address.text:
    value: 18051 Mack Ave, Detroit, MI 48224
  address.line:
    value: 18051 Mack Ave
    index: -1
  address.city:
    value: Detroit
  address.state:
    value: MI
  address.postal code:
    value: 48224
  address.country:
    value: US
practitioner.gender:
  value: female

Example-Smith-Johnson-Endpoint2
type: Endpoint
resource.id:
  value: Example-Smith-Johnson-Endpoint2
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Endpoint Example-Smith-Johnson-Endpoint2 identifier: https://example.org/GoodHealth-Clinic/PatientCorrection status: Active connectionType: Endpoint Connection Type: hl7-fhir-rest (HL7 FHIR) name: Good Health Clinic Endpoint payloadType: For documents following C-CDA constraints using a structured body address: https://example.org/address
endpoint.identifier:
  index: -1
  identifier.system:
    value: https://example.org/GoodHealth-Clinic
  identifier.value:
    value: PatientCorrection
endpoint.status:
  value: active
endpoint.connection type:
  coding.system:
    value: http://terminology.hl7.org/CodeSystem/endpoint-connection-type
  coding.code:
    value: hl7-fhir-rest
  coding.display:
    value: HL7 FHIR
endpoint.name:
  value: Good Health Clinic Endpoint
endpoint.payload type:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
    coding.code:
      value: urn:hl7-org:sdwg:ccda-nonXMLBody:1.1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes
    coding.code:
      value: urn:hl7-org:sdwg:ccda-structuredBody:1.1
  codeable concept.text:
    value: For documents following C-CDA constraints using a structured body
endpoint.address:
  value: https://example.org/address

Example-Smith-Johnson-HealthcareAgentConsent-Permit
type: Consent
resource.id:
  value: Example-Smith-Johnson-HealthcareAgentConsent-Permit
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentConsentPermit
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentConsentPermit
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: additional
  narrative.div: I am consenting for my son Charles to be my authorized personal representative (primary healthcare agent) and I am permitting him to make decisions on my behalf about intubation.
consent.status:
  value: active
consent.scope:
  codeable concept.coding: http://loinc.org/rdf#81377-4
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 81377-4
    coding.display:
      value: Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported
consent.category:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/consentcategorycodes
    coding.version:
      value: 1.0.1
    coding.code:
      value: acd
consent.patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
consent.policy:
  index: -1
  consent.policy.uri:
    value: http://example.org/healthcare-agent-policy
consent.provision:
  consent.provision.type:
    value: permit
  consent.provision.actor:
    index: -1
    consent.provision.actor.role:
      codeable concept.coding: http://loinc.org/rdf#75783-1
        index: -1
    consent.provision.actor.reference:
      link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
      reference.reference:
        value: RelatedPerson/Example-Smith-Johnson-HealthcareAgent1

Example-Smith-Johnson-HealthcareAgentConsent-Deny
type: Consent
resource.id:
  value: Example-Smith-Johnson-HealthcareAgentConsent-Deny
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentConsentDeny
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentConsentDeny
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: additional
  narrative.div: I am consenting for my son Charles to be my primary healthcare agent and I am denying him to make decisions on my behalf about nutrition.
consent.status:
  value: active
consent.scope:
  codeable concept.coding: http://loinc.org/rdf#81377-4
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 81377-4
    coding.display:
      value: Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported
consent.category:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/consentcategorycodes
    coding.version:
      value: 1.0.1
    coding.code:
      value: acd
consent.patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
consent.policy:
  index: -1
  consent.policy.uri:
    value: http://example.org/healthcare-agent-policy
consent.provision:
  consent.provision.type:
    value: deny
  consent.provision.actor:
    index: -1
    consent.provision.actor.role:
      codeable concept.coding: http://loinc.org/rdf#75783-1
        index: -1
    consent.provision.actor.reference:
      link: http://hl7.org/fhir/us/pacio-adi/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1
      reference.reference:
        value: RelatedPerson/Example-Smith-Johnson-HealthcareAgent1

Example-Smith-Johnson-HealthcareAgent1
type: RelatedPerson
resource.id:
  value: Example-Smith-Johnson-HealthcareAgent1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: additional
  narrative.div: Primary Healthcare Agent The person I choose as my Primary Healthcare Agent is: Charles Johnson (Son) CharlesSJ@example.com [SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT] [ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]
related person.active:
  value: true
related person.patient:
  link: http://hl7.org/fhir/us/pacio-adi/Patient/Example-Smith-Johnson-Patient1
  reference.reference:
    value: Patient/Example-Smith-Johnson-Patient1
related person.relationship:
  index: -1
  codeable concept.coding:
    index: -1
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/v3-RoleCode
    coding.code:
      value: SON
    coding.display:
      value: natural son
related person.name:
  index: -1
  human name.text:
    value: Johnson, Charles
  human name.family:
    value: Johnson
  human name.given:
    value: Charles
    index: -1
related person.telecom:
  index: -1
  contact point.system:
    value: email
  contact point.use:
    value: home

Example-Smith-Johnson-PMOProvenance1
type: Provenance
resource.id:
  value: Example-Smith-Johnson-PMOProvenance1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Provenance
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Provenance
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Provenance Example-Smith-Johnson-PMOProvenance1 Profile: ADI Provenance Provenance for Composition Portable Medical Order Summary Recorded 2021-03-29 14:25:34-0500 Agents Type who Assembler Organization GoodHealth Clinic
provenance.target:
  index: -1
  link: http://hl7.org/fhir/us/pacio-adi/Composition/PMO-Example-Smith-Johnson-PMOComposition1
  reference.reference:
    value: Composition/PMO-Example-Smith-Johnson-PMOComposition1
provenance.recorded:
  value: 2021-03-29T14:25:34.001-05:00
provenance.agent:
  index: -1
  provenance.agent.type:
    codeable concept.coding:
      index: -1
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/provenance-participant-type
      coding.version:
        value: 1.1.0|1.0.0
      coding.code:
        value: assembler
      coding.display:
        value: Assembler
  provenance.agent.who:
    link: http://hl7.org/fhir/us/pacio-adi/Organization/Example-Smith-Johnson-OrganizationAssembler1
    reference.reference:
      value: Organization/Example-Smith-Johnson-OrganizationAssembler1

Example-Smith-Johnson-OrganizationAssembler1
type: Organization
resource.id:
  value: Example-Smith-Johnson-OrganizationAssembler1
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
    index: -1
    link: http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization
resource.language:
  value: en
domain resource.text:
  narrative.status:
    value: generated
  narrative.div: Generated Narrative: Organization Example-Smith-Johnson-OrganizationAssembler1 Profile: US Core Organization Profile identifier: http://example.org/GoodHealthClinic/id/12c5dcee5089494ca1ca0cb428ed3fff active: true name: GoodHealth Clinic telecom: +1(202)776-7700 address: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US
organization.identifier:
  index: -1
  identifier.system:
    value: http://example.org/GoodHealthClinic/id
organization.active:
  value: true
organization.name:
  value: GoodHealth Clinic
organization.telecom:
  index: -1
  contact point.system:
    value: phone
  contact point.value:
    value: +1(202)776-7700
  contact point.use:
    value: work
organization.address:
  index: -1
  address.type:
    value: physical
  address.line:
    value: 740 E. Campbell Rd. Suite 825
    index: -1
  address.city:
    value: Richardson
  address.state:
    value: TX
  address.postal code:
    value: 75081
  address.country:
    value: US

Example-Stub-SourceForm-Smith-Johnson-Binary
type: Binary
resource.id:
  value: Example-Stub-SourceForm-Smith-Johnson-Binary
resource.meta:
  meta.profile:
    value: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADISourceFormInformation
    index: -1
    link: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADISourceFormInformation
resource.language:
  value: en
binary.content type:
  value: application/pdf

narrative.status:
  value: generated
narrative.div: PMOLST Order Observation Order Exists: available here

index: -1
link: http://hl7.org/fhir/us/pacio-adi/Observation/Example-Smith-Johnson-DocumentationObservation2
reference.reference:
  value: Observation/Example-Smith-Johnson-DocumentationObservation2

index: -1
composition.section.title:
  value: Witnesses and Notary
composition.section.code:
  codeable concept.coding: http://loinc.org/rdf#81339-4
    index: -1
    coding.system:
      value: http://loinc.org
    coding.code:
      value: 81339-4
    coding.display:
      value: Witness and Notary Document
composition.section.text:
  narrative.status:
    value: additional
  narrative.div: 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:

value: 75783-1

value: Primary healthcare agent [Reported]

value: 75783-1

value: Primary healthcare agent [Reported]