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Source1

{
  "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": "<!-- snip (see above) -->"
  },
  "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>"
      }
    }
  ]
}