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Section 1a: Clinical Document Architecture (CDA®)
Section 3: Implementation Guides

HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2


The PACP document is a CDA document template designed to share information created by an individual to express his or her care and medical treatment goals, preferences, and priorities for some future point in time, under certain circumstances when the individual cannot make medical treatment decisions or communicate his or her goals, preferences, and priorities with the care team.  The purpose of the PACP document is to ensure that the information created by the individual is available and considered in clinical care planning, and the focus of the standard is sharing patient generated information.  It should not matter if the source information is documented on a piece of paper, in a video recording, or in a consumer-controlled application that exists for this purpose. The standard provides a means to share this information in a standard way with a system that maintains a clinical record for the person. It is not intended to be a legal document or a digitization of a legal document. However, a PACP can reference a legal document, and it can represent information contained in a legal document such as the appointment of healthcare agents and the identity of witnesses or a notary.



HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2 may also go by the following names or acronyms:

"CDA R2 IG: Personal Advance Care Plan, R1", Personal Advance Care Plan, Personal Advance Care Plan Document, PACP, PACP Document


  • Payors
  • Patients or Consumers
  • EHR, PHR Vendors
  • Health Care IT Vendors
  • Clinical Decision Support Systems Vendors
  • Health Information Exchange
  • Patient Portal Vendors
  • Emergency Services Providers
  • Local and State Departments of Health
  • Healthcare Institutions (hospitals, long term care, home care, mental health)
  • Architects and developers of healthcare information technology (HIT) systems in the US Realm that exchange patient generated health data


  • Improves the guidance available on how to include advance care plan and advance care planning information in a C-CDA document.
  • Creates additional supplemental templates for representing decisions made by the patient or the patient’s surrogate decision-maker (e.g., a healthcare agent) at the time of service (obligation instructions or prohibition instructions).
  • Creates a supplemental template for representing advance care planning services delivered to provide advance care planning education and assistance, and to review advance care plans with the patient.
  • Creates a standard for expressing personal medical treatment and care goals, preferences, and priorities which can be referenced by or included in the medical record
  • Enables a person to make their wishes known to their care team, even when he or she cannot speak for his or her self
  • Supports patient-centered care coordination and care delivery
  • Informs clinical decision-making by providing critical information on the individual’s values, goals, preferences and priorities related to his or her health care and medical treatments
  • Can be referenced by Clinical Summary documents and Care Plan documents


  • ADVault, Inc. (MyDirectives.com)


Advance directives and advance care plans are documents that people have traditionally used to express their medical treatment wishes. Advance directives typically consist of two documents – the “living will,” and the “medical power of attorney.” A living will documents whether a person wants “life-sustaining treatments” (e.g., artificial nutrition or hydration, dialysis or the use of a ventilator to help with breathing) should that person suffer a medical emergency and be unable to communicate with the care team. A person uses a medical power of attorney to appoint one or more people to serve as advocates or “healthcare agents” empowered to make medical treatment decisions on behalf of the person if he or she is incapacitated and cannot communicate with medical personnel. The living will provides information that helps the healthcare agent make treatment decisions on the person’s behalf. Advance care plans cover the same subjects as living wills and medical powers of attorney; however, they are broader in scope and often include an individual’s thoughts on religion, hospice and palliative care options, and the person’s desired care experience more generally.

A new CDA R2 schema extension has be released by SDWG to support the extensions used in this implementation guides.

The July 2016 CDA_SDTC schema extension release package is available at: http://gforge.hl7.org/gf/project/strucdoc/frs/


HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2


HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan Document, Release 1 - US Realm STU R2 Expiration Aug 2022

(Download) (7.54 MB)

HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan Document, Release 1 - US Realm Expiration Aug 2020

(Download) (4.10 MB)


  • Care Provision
  • Clinical Quality
  • Decision Support
  • Medical Records
  • Patient Care


  • STU




Structured Documents


  • EHR, PHR Vendors
  • Emergency Services Providers
  • Health Care IT Vendors
  • Healthcare Institutions


  • CDA


  • Active


  • US Realm