PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot
PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot
PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/pacio-adi/ and changes regularly. See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "PMO-Example-Smith-Johnson-Bundle2",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Bundle"
]
},
"identifier" : {
"system" : "http://example.org/GoodHealthClinic/id",
"value" : "20130607100315-ExamplePMODocument"
},
"type" : "document",
"timestamp" : "2024-03-29T14:25:34.001-05:00",
"entry" : [
{
"fullUrl" : "http://www.example.org/fhir/Composition/PMO-Example-Smith-Johnson-PMOComposition1",
"resource" : {
"resourceType" : "Composition",
"id" : "PMO-Example-Smith-Johnson-PMOComposition1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOComposition"
]
},
"language" : "en-US",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><a name=\"Composition_PMO-Example-Smith-Johnson-PMOComposition1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Composition PMO-Example-Smith-Johnson-PMOComposition1</b></p><a name=\"PMO-Example-Smith-Johnson-PMOComposition1\"> </a><a name=\"hcPMO-Example-Smith-Johnson-PMOComposition1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en-US</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ADI-PMOComposition.html\">ADI PMO Composition</a></p></div><p><b>Composition Version Number</b>: 2024-03-29T14:25:34-05:00</p><p><b>Data Enterer</b>: <a href=\"Patient-Example-Smith-Johnson-Patient1.html\">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</a></p><p><b>Participant</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>ADI Expiration Date</b>: 2024-03-29 14:25:34-0500</p><p><b>Performer</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>Informant</b>: <a href=\"RelatedPerson-Example-Smith-Johnson-HealthcareAgent1.html\">RelatedPerson Johnson, Charles</a></p><p><b>Revoke Status</b>: deprecated</p><blockquote><p><b>Clause</b></p><ul><li>Clause: </li></ul></blockquote><div><p><div xmlns="http://www.w3.org/1999/xhtml"><p>Example Clause Statement</p></div></p>\n</div><p><b>identifier</b>: <code>http://example.org/GoodHealthClinic/id</code>/0-87f37989294a408897aacd1fc5d8fd16</p><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{http://loinc.org 93037-0}\">Portable medical order form</span></p><p><b>category</b>: <span title=\"Codes:{http://loinc.org 42348-3}\">Advance healthcare directives</span></p><p><b>date</b>: 2023-03-29 14:25:34-0500</p><p><b>author</b>: <a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></p><p><b>title</b>: Portable Medical Order</p><h3>Attesters</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Mode</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td>Legal</td><td><a href=\"PractitionerRole-Example-Kyle-Anydoc-PractitionerRole1.html\">PractitionerRole: telecom = kanydoc@example.org(Work)</a></td></tr></table><p><b>custodian</b>: <a href=\"Organization-Example-Smith-Johnson-OrganizationCustodian1.html\">Organization example.org</a></p><blockquote><p><b>event</b></p><p><b>detail</b>: </p><ul><li><a href=\"PractitionerRole-ADI-Facilitator-MSW-MargaretReynolds.html\">PractitionerRole primary performer</a></li><li><a href=\"Consent-Example-Smith-Johnson-HealthcareAgentConsent-Permit.html\">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li><li><a href=\"Consent-Example-Smith-Johnson-HealthcareAgentConsent-Deny.html\">Consent: status = active; scope = Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported; category = Advance Directive</a></li></ul></blockquote></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber",
"valueString" : "2024-03-29T14:25:34-05:00"
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension",
"valueReference" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
}
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension",
"valueReference" : {
🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
}
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension",
"valueDateTime" : "2024-03-29T14:25:34-05:00"
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension",
"valueReference" : {
🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
}
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension",
"valueReference" : {
🔗 "reference" : "RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"
}
},
{
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status",
"valueCode" : "deprecated"
},
{
"extension" : [
{
"url" : "Clause",
"valueMarkdown" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>Example Clause Statement</p></div>"
}
],
"url" : "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension"
}
],
"identifier" : {
"system" : "http://example.org/GoodHealthClinic/id",
"value" : "0-87f37989294a408897aacd1fc5d8fd16"
},
"status" : "final",
"type" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "93037-0",
"display" : "Portable medical order form"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://loinc.org",
"code" : "42348-3",
"display" : "Advance healthcare directives"
}
]
}
],
"subject" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"date" : "2023-03-29T14:25:34-05:00",
"author" : [
{
🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
}
],
"title" : "Portable Medical Order",
"attester" : [
{
"mode" : "legal",
"party" : {
🔗 "reference" : "PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1"
}
}
],
"custodian" : {
🔗 "reference" : "Organization/Example-Smith-Johnson-OrganizationCustodian1"
},
"event" : [
{
"detail" : [
{
🔗 "reference" : "PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds"
},
{
🔗 "reference" : "Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit"
},
{
🔗 "reference" : "Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny"
}
]
}
],
"section" : [
{
"title" : "Portable Medical Orders",
"code" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "93037-0",
"display" : "Portable medical order form"
}
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>PMO Medical Orders</b></p><p><i>Order Exists: <a href=\"http://www.example.com\">available here</a></i></p></div>"
},
"entry" : [
{
🔗 "reference" : "ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1"
}
]
},
{
"title" : "Additional Documentation",
"code" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "77599-9"
}
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href=\"http://www.example.com\">available here</a></i></p></div>"
},
"entry" : [
{
🔗 "reference" : "Observation/Example-Smith-Johnson-DocumentationObservation2"
}
]
},
{
"title" : "Witnesses and Notary",
"code" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "81339-4",
"display" : "Witness and Notary Document"
}
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>I am emotionally and mentally competent to make this uADD. I understand the purpose and effect of this uADD, I agree with everything that is written in this uADD, and I have made this uADD knowingly, willingly and after careful deliberation.</p><table><tbody><tr><td><b>Signature:</b></td><td>Betsy Smith-Johnson</td></tr><tr><td><b>Date:</b></td><td>3/29/2024</td></tr></tbody></table><p/><p><b>Statement of Witnesses</b></p><p/><p>I declare that the person who signed this uADD, or who asked another to sign this uADD on his/her behalf, is the individual identified in the document, and he/she did so in my presence or otherwise provided satisfactory proof to me of his/her identity. I believe him/her to be of sound mind and at least 18 years of age. I personally witnessed him/her sign this document or ask the person indicated to do so, or I received proof of his/her identity that I believe is adequate, and I believe that he/she did so voluntarily. By signing this document as a witness, I certify that I am:</p><p/><ul><li>At least 18 years of age.</li><li>Not related to the person signing this document by blood, marriage or adoption.</li><li>Not a healthcare agent appointed by the person signing this document.</li><li>Not directly financially responsible for that person’s healthcare.</li><li>Not a healthcare provider directly serving the person at this time.</li><li>Not an employee (other than a social worker or chaplain), officer, director, or partner of a healthcare provider (or any parent organization of such healthcare provider) directly serving the person at this time.</li><li>Not aware that I am entitled to or have a claim against the person’s estate.</li></ul><p/><table><tbody><tr><td><b>Witness Number:</b></td><td/></tr><tr><td><b>Signature:</b></td><td/></tr><tr><td><b>Date:</b></td><td/></tr></tbody></table></div>"
}
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Patient/Example-Smith-Johnson-Patient1",
"resource" : {
"resourceType" : "Patient",
"id" : "Example-Smith-Johnson-Patient1",
"meta" : {
"lastUpdated" : "2021-03-29T14:25:34.001-05:00",
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><a name=\"Patient_Example-Smith-Johnson-Patient1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient Example-Smith-Johnson-Patient1</b></p><a name=\"Example-Smith-Johnson-Patient1\"> </a><a name=\"hcExample-Smith-Johnson-Patient1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2021-03-29 14:25:34-0500; Language: en-US</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-patient.html\">US Core Patient Profile</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td>true</td><td style=\"background-color: #f3f5da\" title=\"Known Marital status of Patient\">Marital Status:</td><td colspan=\"3\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Other Id (see the one above)\">Other Id:</td><td colspan=\"3\">Medical Record Number/1032702\u00a0(use:\u00a0usual,\u00a0)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\"><ul><li><a href=\"mailto:BetsySJ@example.com\">BetsySJ@example.com</a></li><li>111 Maple Court San Antonio TX 78212 US (home)</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Language spoken\">Language:</td><td colspan=\"3\"><span title=\"Codes:{urn:ietf:bcp:47 en}\">English</span> (preferred)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Nominated Contact: son\">son:</td><td colspan=\"3\"><ul><li>Charles Johnson</li><li>111 Maple Ct, Grand Rapids, MI 49503</li><li>ph: (210) 222-3333</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Nominated Contact: daughter\">daughter:</td><td colspan=\"3\"><ul><li>Debra Johnson</li><li>333 W. Camden St., Baltimore, MD 21201</li><li>ph: (410) 444-5555</li></ul></td></tr><tr><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 [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:\n\n - American Indian or Alaska Native\n - Asian\n - Black or African American\n - Native Hawaiian or Other Pacific Islander\n - White.\">US Core Race Extension:</td><td colspan=\"3\"><ul><li>ombCategory: CDC Race and Ethnicity 2106-3: White</li><li>text: White</li></ul></td></tr></table></div>"
},
"extension" : [
{
"extension" : [
{
"url" : "ombCategory",
"valueCoding" : {
"system" : "urn:oid:2.16.840.1.113883.6.238",
"code" : "2106-3",
"display" : "White"
}
},
{
"url" : "text",
"valueString" : "White"
}
],
"url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
}
],
"identifier" : [
{
"use" : "usual",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MR",
"display" : "Medical Record Number"
}
],
"text" : "Medical Record Number"
},
"system" : "http://example.org/GoodHealthHospital",
"value" : "1032702"
},
{
"system" : "http://hl7.org/fhir/sid/us-medicare",
"value" : "1PA3D58WH16"
}
],
"active" : true,
"name" : [
{
"use" : "usual",
"text" : "Smith-Johnson, Betsy",
"family" : "Smith-Johnson",
"given" : [
"Betsy"
]
}
],
"telecom" : [
{
"system" : "email",
"value" : "BetsySJ@example.com",
"use" : "home"
}
],
"gender" : "female",
"birthDate" : "1950-11-15",
"address" : [
{
"use" : "home",
"type" : "physical",
"line" : [
"111 Maple Court"
],
"city" : "San Antonio",
"state" : "TX",
"postalCode" : "78212",
"country" : "US"
}
],
"maritalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code" : "UNK"
}
]
},
"contact" : [
{
"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code" : "SONC"
}
]
}
],
"name" : {
"text" : "Charles Johnson"
},
"telecom" : [
{
"system" : "phone",
"value" : "(210) 222-3333"
}
],
"address" : {
"text" : "111 Maple Ct, Grand Rapids, MI 49503"
}
},
{
"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code" : "DAUC"
}
]
}
],
"name" : {
"text" : "Debra Johnson"
},
"telecom" : [
{
"system" : "phone",
"value" : "(410) 444-5555"
}
],
"address" : {
"text" : "333 W. Camden St., Baltimore, MD 21201"
}
}
],
"communication" : [
{
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en",
"display" : "English"
}
]
},
"preferred" : true
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/PractitionerRole/Example-Kyle-Anydoc-PractitionerRole1",
"resource" : {
"resourceType" : "PractitionerRole",
"id" : "Example-Kyle-Anydoc-PractitionerRole1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"PractitionerRole_Example-Kyle-Anydoc-PractitionerRole1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: PractitionerRole Example-Kyle-Anydoc-PractitionerRole1</b></p><a name=\"Example-Kyle-Anydoc-PractitionerRole1\"> </a><a name=\"hcExample-Kyle-Anydoc-PractitionerRole1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitionerrole.html\">US Core PractitionerRole Profile</a></p></div><p><b>practitioner</b>: <a href=\"Practitioner-Example-Kyle-Anydoc-Practitioner.html\">Practitioner Kyle Anydoc </a></p><p><b>telecom</b>: <a href=\"mailto:kanydoc@example.org\">kanydoc@example.org</a></p></div>"
},
"practitioner" : {
🔗 "reference" : "Practitioner/Example-Kyle-Anydoc-Practitioner"
},
"telecom" : [
{
"system" : "email",
"value" : "kanydoc@example.org",
"use" : "work"
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Practitioner/Example-Kyle-Anydoc-Practitioner",
"resource" : {
"resourceType" : "Practitioner",
"id" : "Example-Kyle-Anydoc-Practitioner",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_Example-Kyle-Anydoc-Practitioner\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner Example-Kyle-Anydoc-Practitioner</b></p><a name=\"Example-Kyle-Anydoc-Practitioner\"> </a><a name=\"hcExample-Kyle-Anydoc-Practitioner\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-practitioner.html\">US Core Practitioner Profile</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1818345971</p><p><b>name</b>: Kyle Anydoc </p><p><b>telecom</b>: <a href=\"mailto:kanydoc@example.org\">kanydoc@example.org</a></p><p><b>address</b>: 567 Healthcare Drive Anytown MA 12345 US (home)</p><p><b>gender</b>: Male</p><h3>Qualifications</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0360 MD}\">Doctor of Medicine</span></td></tr></table></div>"
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1818345971"
}
],
"name" : [
{
"family" : "Anydoc",
"given" : [
"Kyle"
],
"prefix" : [
"Dr."
]
}
],
"telecom" : [
{
"system" : "email",
"value" : "kanydoc@example.org",
"use" : "work"
}
],
"address" : [
{
"use" : "home",
"line" : [
"567 Healthcare Drive"
],
"city" : "Anytown",
"state" : "MA",
"postalCode" : "12345",
"country" : "US"
}
],
"gender" : "male",
"qualification" : [
{
"code" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0360",
"code" : "MD",
"display" : "Doctor of Medicine"
}
]
}
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationCustodian1",
"resource" : {
"resourceType" : "Organization",
"id" : "Example-Smith-Johnson-OrganizationCustodian1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_Example-Smith-Johnson-OrganizationCustodian1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization Example-Smith-Johnson-OrganizationCustodian1</b></p><a name=\"Example-Smith-Johnson-OrganizationCustodian1\"> </a><a name=\"hcExample-Smith-Johnson-OrganizationCustodian1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-organization.html\">US Core Organization Profile</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/1234567893</p><p><b>active</b>: true</p><p><b>name</b>: example.org</p><p><b>telecom</b>: <a href=\"tel:+1(202)776-7700\">+1(202)776-7700</a></p><p><b>address</b>: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US </p></div>"
},
"identifier" : [
{
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1234567893"
}
],
"active" : true,
"name" : "example.org",
"telecom" : [
{
"system" : "phone",
"value" : "+1(202)776-7700",
"use" : "work"
}
],
"address" : [
{
"type" : "physical",
"line" : [
"740 E. Campbell Rd. Suite 825"
],
"city" : "Richardson",
"state" : "TX",
"postalCode" : "75081",
"country" : "US"
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/ServiceRequest/Example-Smith-Johnson-CPR-ServiceRequest1",
"resource" : {
"resourceType" : "ServiceRequest",
"id" : "Example-Smith-Johnson-CPR-ServiceRequest1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PMOCPRServiceRequest"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ServiceRequest_Example-Smith-Johnson-CPR-ServiceRequest1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ServiceRequest Example-Smith-Johnson-CPR-ServiceRequest1</b></p><a name=\"Example-Smith-Johnson-CPR-ServiceRequest1\"> </a><a name=\"hcExample-Smith-Johnson-CPR-ServiceRequest1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ADI-PMOCPRServiceRequest.html\">ADI PMO Cardiopulmonary Resuscitation ServiceRequest</a></p></div><p><b>status</b>: Active</p><p><b>intent</b>: Directive</p><p><b>category</b>: <span title=\"Codes:{http://loinc.org 100822-6}\">Cardiopulmonary resuscitation orders</span></p><p><b>doNotPerform</b>: true</p><p><b>code</b>: <span title=\"Codes:{http://loinc.org LA33470-8}\">Yes CPR</span></p><p><b>orderDetail</b>: <span title=\"Codes:{http://loinc.org LA33470-8}\">Yes CPR</span></p><p><b>subject</b>: <a href=\"Patient-Example-Smith-Johnson-Patient1.html\">Smith-Johnson, Betsy Female, DoB: 1950-11-15 ( http://hl7.org/fhir/sid/us-medicare#United States Medicare Number#1PA3D58WH16)</a></p><p><b>requester</b>: <a href=\"Practitioner-Example-Kyle-Anydoc-Practitioner.html\">Practitioner Kyle Anydoc </a></p></div>"
},
"status" : "active",
"intent" : "directive",
"category" : [
{
"coding" : [
{
"system" : "http://loinc.org",
"code" : "100822-6",
"display" : "Cardiopulmonary resuscitation orders"
}
]
}
],
"doNotPerform" : true,
"code" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "LA33470-8"
}
]
},
"orderDetail" : [
{
"coding" : [
{
"system" : "http://loinc.org",
"code" : "LA33470-8"
}
]
}
],
"subject" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"requester" : {
🔗 "reference" : "Practitioner/Example-Kyle-Anydoc-Practitioner"
}
}
},
{
"fullUrl" : "http://www.example.org/fhir/Observation/Example-Smith-Johnson-DocumentationObservation2",
"resource" : {
"resourceType" : "Observation",
"id" : "Example-Smith-Johnson-DocumentationObservation2",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-DocumentationObservation"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Observation_Example-Smith-Johnson-DocumentationObservation2\"> </a><p><b>PMOLST Order Observation</b></p><p><i>Order Exists: <a href=\"http://www.example.com\">available here</a></i></p></div>"
},
"status" : "final",
"code" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "42348-3",
"display" : "Advance healthcare directives"
}
]
},
"subject" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"effectiveDateTime" : "2016-05-18T22:33:22Z",
"performer" : [
{
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
}
],
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "697978002",
"display" : "Provider orders for life-sustaining treatment"
}
]
}
}
},
{
"fullUrl" : "http://www.example.org/fhir/PractitionerRole/ADI-Facilitator-MSW-MargaretReynolds",
"resource" : {
"resourceType" : "PractitionerRole",
"id" : "ADI-Facilitator-MSW-MargaretReynolds",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"PractitionerRole_ADI-Facilitator-MSW-MargaretReynolds\"> </a><p class=\"res-header-id\"><b>Generated Narrative: PractitionerRole ADI-Facilitator-MSW-MargaretReynolds</b></p><a name=\"ADI-Facilitator-MSW-MargaretReynolds\"> </a><a name=\"hcADI-Facilitator-MSW-MargaretReynolds\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ADI-Facilitator.html\">ADI Facilitator</a></p></div><p><b>active</b>: true</p><p><b>practitioner</b>: <a href=\"Practitioner-Practitioner-MargaretReynolds.html\">Margaret A. Reynolds</a></p><p><b>organization</b>: <a href=\"Organization-Example-Smith-Johnson-OrganizationAssembler1.html\">Example Organization</a></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ParticipationType PPRF}\">primary performer</span></p><p><b>specialty</b>: <span title=\"Codes:{http://nucc.org/provider-taxonomy 1041C0700X}\">Clinical Social Worker</span></p><p><b>endpoint</b>: <a href=\"Endpoint-Example-Smith-Johnson-Endpoint2.html\">Endpoint Good Health Clinic Endpoint</a></p></div>"
},
"active" : true,
"practitioner" : {
🔗 "reference" : "Practitioner/Practitioner-MargaretReynolds",
"display" : "Margaret A. Reynolds"
},
"organization" : {
🔗 "reference" : "Organization/Example-Smith-Johnson-OrganizationAssembler1",
"display" : "Example Organization"
},
"code" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code" : "PPRF"
}
]
}
],
"specialty" : [
{
"coding" : [
{
"system" : "http://nucc.org/provider-taxonomy",
"code" : "1041C0700X",
"display" : "Clinical Social Worker"
}
]
}
],
"endpoint" : [
{
🔗 "reference" : "Endpoint/Example-Smith-Johnson-Endpoint2"
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Practitioner/Practitioner-MargaretReynolds",
"resource" : {
"resourceType" : "Practitioner",
"id" : "Practitioner-MargaretReynolds",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Practitioner_Practitioner-MargaretReynolds\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Practitioner Practitioner-MargaretReynolds</b></p><a name=\"Practitioner-MargaretReynolds\"> </a><a name=\"hcPractitioner-MargaretReynolds\"> </a><p><b>identifier</b>: <code>http://example.org/fhir/MI-state-license</code>/86420</p><p><b>active</b>: true</p><p><b>name</b>: Margaret Q. Reynolds</p><p><b>telecom</b>: ph: (555) 391-9414</p><p><b>address</b>: 18051 Mack Ave, Detroit, MI 48224</p><p><b>gender</b>: Female</p></div>"
},
"identifier" : [
{
"system" : "http://example.org/fhir/MI-state-license",
"value" : "86420"
}
],
"active" : true,
"name" : [
{
"text" : "Margaret Q. Reynolds",
"family" : "Reynolds",
"given" : [
"Margaret",
"Q."
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "(555) 391-9414"
}
],
"address" : [
{
"text" : "18051 Mack Ave, Detroit, MI 48224",
"line" : [
"18051 Mack Ave"
],
"city" : "Detroit",
"state" : "MI",
"postalCode" : "48224",
"country" : "US"
}
],
"gender" : "female"
}
},
{
"fullUrl" : "http://www.example.org/fhir/Endpoint/Example-Smith-Johnson-Endpoint2",
"resource" : {
"resourceType" : "Endpoint",
"id" : "Example-Smith-Johnson-Endpoint2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Endpoint_Example-Smith-Johnson-Endpoint2\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Endpoint Example-Smith-Johnson-Endpoint2</b></p><a name=\"Example-Smith-Johnson-Endpoint2\"> </a><a name=\"hcExample-Smith-Johnson-Endpoint2\"> </a><p><b>identifier</b>: <code>https://example.org/GoodHealth-Clinic</code>/PatientCorrection</p><p><b>status</b>: Active</p><p><b>connectionType</b>: <a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-endpoint-connection-type.html#endpoint-connection-type-hl7-fhir-rest\">Endpoint Connection Type hl7-fhir-rest</a>: HL7 FHIR</p><p><b>name</b>: Good Health Clinic Endpoint</p><p><b>payloadType</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes urn:hl7-org:sdwg:ccda-nonXMLBody:1.1}, {http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes urn:hl7-org:sdwg:ccda-structuredBody:1.1}\">For documents following C-CDA constraints using a structured body</span></p><p><b>address</b>: <a href=\"https://example.org/address\">https://example.org/address</a></p></div>"
},
"identifier" : [
{
"system" : "https://example.org/GoodHealth-Clinic",
"value" : "PatientCorrection"
}
],
"status" : "active",
"connectionType" : {
"system" : "http://terminology.hl7.org/CodeSystem/endpoint-connection-type",
"code" : "hl7-fhir-rest",
"display" : "HL7 FHIR"
},
"name" : "Good Health Clinic Endpoint",
"payloadType" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes",
"code" : "urn:hl7-org:sdwg:ccda-nonXMLBody:1.1"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-HL7DocumentFormatCodes",
"code" : "urn:hl7-org:sdwg:ccda-structuredBody:1.1"
}
],
"text" : "For documents following C-CDA constraints using a structured body"
}
],
"address" : "https://example.org/address"
}
},
{
"fullUrl" : "http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Permit",
"resource" : {
"resourceType" : "Consent",
"id" : "Example-Smith-Johnson-HealthcareAgentConsent-Permit",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentPermit"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Consent_Example-Smith-Johnson-HealthcareAgentConsent-Permit\"> </a><p>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.</p></div>"
},
"status" : "active",
"scope" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "81377-4",
"display" : "Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentcategorycodes",
"version" : "1.0.0",
"code" : "acd"
}
]
}
],
"patient" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"policy" : [
{
"uri" : "http://example.org/healthcare-agent-policy"
}
],
"provision" : {
"type" : "permit",
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "75783-1",
"display" : "Primary healthcare agent [Reported]"
}
]
},
"reference" : {
🔗 "reference" : "RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"
}
}
]
}
}
},
{
"fullUrl" : "http://www.example.org/fhir/Consent/Example-Smith-Johnson-HealthcareAgentConsent-Deny",
"resource" : {
"resourceType" : "Consent",
"id" : "Example-Smith-Johnson-HealthcareAgentConsent-Deny",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-ADIConsentDeny"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Consent_Example-Smith-Johnson-HealthcareAgentConsent-Deny\"> </a><p>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.</p></div>"
},
"status" : "active",
"scope" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "81377-4",
"display" : "Goals, preferences, and priorities regarding the appointment of healthcare agents Narrative - Reported"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentcategorycodes",
"version" : "1.0.0",
"code" : "acd"
}
]
}
],
"patient" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"policy" : [
{
"uri" : "http://example.org/healthcare-agent-policy"
}
],
"provision" : {
"type" : "deny",
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://loinc.org",
"code" : "75783-1",
"display" : "Primary healthcare agent [Reported]"
}
]
},
"reference" : {
🔗 "reference" : "RelatedPerson/Example-Smith-Johnson-HealthcareAgent1"
}
}
]
}
}
},
{
"fullUrl" : "http://www.example.org/fhir/RelatedPerson/Example-Smith-Johnson-HealthcareAgent1",
"resource" : {
"resourceType" : "RelatedPerson",
"id" : "Example-Smith-Johnson-HealthcareAgent1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-HealthcareAgentParticipant"
]
},
"text" : {
"status" : "additional",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"RelatedPerson_Example-Smith-Johnson-HealthcareAgent1\"> </a><p><b>Primary Healthcare Agent</b></p><p>The person I choose as my Primary Healthcare Agent is:</p><p><i>Charles Johnson</i></p><p><i>(Son)</i></p><p><i>CharlesSJ@example.com</i></p><p>[SELECTED to act as a healthcare agent on 3/29/2021, at 2:25 PM CDT]</p><p>[ACCEPTED to act as a healthcare agent on 4/1/2021, at 3:39 PM CDT]</p></div>"
},
"patient" : {
🔗 "reference" : "Patient/Example-Smith-Johnson-Patient1"
},
"relationship" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code" : "SON",
"display" : "natural son"
}
]
}
],
"name" : [
{
"text" : "Johnson, Charles",
"family" : "Johnson",
"given" : [
"Charles"
]
}
],
"telecom" : [
{
"system" : "email",
"value" : "CharlesSJ@example.com",
"use" : "home"
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Provenance/Example-Smith-Johnson-PMOProvenance1",
"resource" : {
"resourceType" : "Provenance",
"id" : "Example-Smith-Johnson-PMOProvenance1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Provenance"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Provenance_Example-Smith-Johnson-PMOProvenance1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Provenance Example-Smith-Johnson-PMOProvenance1</b></p><a name=\"Example-Smith-Johnson-PMOProvenance1\"> </a><a name=\"hcExample-Smith-Johnson-PMOProvenance1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ADI-Provenance.html\">ADI Provenance</a></p></div><p>Provenance for <a href=\"Composition-PMO-Example-Smith-Johnson-PMOComposition1.html\">Composition Portable Medical Order</a></p><p>Summary</p><table class=\"grid\"><tr><td>Recorded</td><td>2021-03-29 14:25:34-0500</td></tr></table><p><b>Agents</b></p><table class=\"grid\"><tr><td><b>Type</b></td><td><b>who</b></td></tr><tr><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/provenance-participant-type assembler}\">Assembler</span></td><td><a href=\"Organization-Example-Smith-Johnson-OrganizationAssembler1.html\">Organization GoodHealth Clinic</a></td></tr></table></div>"
},
"target" : [
{
🔗 "reference" : "Composition/PMO-Example-Smith-Johnson-PMOComposition1"
}
],
"recorded" : "2021-03-29T14:25:34.001-05:00",
"agent" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"version" : "1.0.0",
"code" : "assembler",
"display" : "Assembler"
}
]
},
"who" : {
🔗 "reference" : "Organization/Example-Smith-Johnson-OrganizationAssembler1"
}
}
]
}
},
{
"fullUrl" : "http://www.example.org/fhir/Organization/Example-Smith-Johnson-OrganizationAssembler1",
"resource" : {
"resourceType" : "Organization",
"id" : "Example-Smith-Johnson-OrganizationAssembler1",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_Example-Smith-Johnson-OrganizationAssembler1\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization Example-Smith-Johnson-OrganizationAssembler1</b></p><a name=\"Example-Smith-Johnson-OrganizationAssembler1\"> </a><a name=\"hcExample-Smith-Johnson-OrganizationAssembler1\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU8/StructureDefinition-us-core-organization.html\">US Core Organization Profile</a></p></div><p><b>identifier</b>: <code>http://example.org/GoodHealthClinic/id</code>/12c5dcee5089494ca1ca0cb428ed3fff</p><p><b>active</b>: true</p><p><b>name</b>: GoodHealth Clinic</p><p><b>telecom</b>: <a href=\"tel:+1(202)776-7700\">+1(202)776-7700</a></p><p><b>address</b>: 740 E. Campbell Rd. Suite 825 Richardson TX 75081 US </p></div>"
},
"identifier" : [
{
"system" : "http://example.org/GoodHealthClinic/id",
"value" : "12c5dcee5089494ca1ca0cb428ed3fff"
}
],
"active" : true,
"name" : "GoodHealth Clinic",
"telecom" : [
{
"system" : "phone",
"value" : "+1(202)776-7700",
"use" : "work"
}
],
"address" : [
{
"type" : "physical",
"line" : [
"740 E. Campbell Rd. Suite 825"
],
"city" : "Richardson",
"state" : "TX",
"postalCode" : "75081",
"country" : "US"
}
]
}
}
]
}
IG © 2021+ HL7 International / Patient Empowerment. Package hl7.fhir.us.pacio-adi#2.0.0-ballot based on FHIR 4.0.1. Generated 2025-08-04
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