<?xml version="1.0" encoding="UTF-8"?>

<RelatedPerson xmlns="http://hl7.org/fhir">
  <id value="Example-Smith-Johnson-Notary2"/>
  <meta>
    <profile value="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="additional"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Notary</b></p><p>Charles Xavier</p></div>
  </text>
  <extension url="http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-notaryInformation-extension">
    <extension url="NotaryCommissionState">
      <valueCodeableConcept>
        <coding>
          <system value="urn:iso:std:iso:3166:-2"/>
          <code value="US-MI"/>
        </coding>
      </valueCodeableConcept>
    </extension>
  </extension>
  <active value="true"/>
  <patient>
    <reference value="Patient/Example-Smith-Johnson-Patient1"/>
  </patient>
  <relationship>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
      <code value="SON"/>
      <display value="natural son"/>
    </coding>
  </relationship>
  <name>
    <text value="Johnson, Charles"/>
    <family value="Johnson"/>
    <given value="Charles"/>
  </name>
  <telecom>
    <system value="email"/>
    <value value="CharlesSJ@example.com"/>
    <use value="home"/>
  </telecom>
</RelatedPerson>