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Source1

{
  "resourceType": "Provenance",
  "id": "Example-DataStandardsWales-Provenance-DocumentReferenceDemographics",
  "meta": {
    "profile": [
      "https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-Provenance"
    ]
  },
  "extension": [
    {
      "extension": [
        {
          "url": "identifier",
          "valueIdentifier": {
            "system": "https://fhir.hduhb.nhs.wales/Id/pas-identifier",
            "value": "A111111"
          }
        },
        {
          "url": "name",
          "valueHumanName": {
            "family": "SMITH",
            "given": [
              "JOHN",
              "BRIAN"
            ],
            "prefix": [
              "Mr"
            ]
          }
        },
        {
          "url": "birthDate",
          "valueDate": "1963-04-28"
        }
      ],
      "url": "https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-CDR-demographicsAsRecorded"
    }
  ],
  "target": [
    {
      "reference": "DocumentReference/Example-DataStandardsWales-DocumentReference/_history/1"
    }
  ],
  "recorded": "2025-07-22T11:20:17+00:00",
  "activity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/iso-21089-lifecycle",
        "code": "verify",
        "display": "Verify Record Lifecycle Event"
      }
    ]
  },
  "agent": [
    {
      "type": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
            "code": "composer",
            "display": "Composer"
          }
        ]
      },
      "who": {
        "reference": "Device/Example-DataStandardsWales-Device-WCP",
        "display": "Welsh Clinical Portal"
      }
    }
  ]
}