

**Example Usage Scenarios:**

The following are example usage scenarios for this profile:

- Query for the existence and location of any advance directive documents the patient may have.
- [Record or update] observations to indicate whether a patient has an advance directive document.

### Mandatory and Must Support Data Elements

The following data elements must always be present ([Mandatory] definition) or must be supported if the data is present in the sending system ([Must Support] definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The [Formal Views] below provides the formal summary, definitions, and terminology requirements.

**Each Observation Must Have:**

1. a status
2. a fixed code for the presence of advance directives
3. a patient

**Each Observation Must Support:**

1. references to ADI documents if they exist<sup>1</sup>
2. a category code of "observation-adi-documentation"
3. when this verified observation was made available
4. one or more performers of the observation<sup>2</sup>
5. a value<sup>3</sup>

<sup>1,2,3</sup> see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

- <sup>3</sup>The `Observation.value` element uses codes for "yes", "no", and "unknown" to answer the question posed by the fixed `Observation.code` - whether one or more advance directives are present.
- <sup>1</sup>If the system asserts the patient has ADI documents and the references to the (electronic) documents are known, it **SHOULD** reference them in the [Supporting Info Extension] using the [US Core ADI DocumentReference Profile] to exchange the ADI documents and their properties.
  - If the system asserts the patient has ADI documents, but the location of the  documents is unknown, there would be no reference.
- <sup>2</sup>An `Observation.performer` of type Practitioner or Organization typically makes the observation, and an `Observation.performer` of Patient or RelatedPerson usually supplies the information (for example, a next of kin who answers questions about the patient's advance directives). Systems may use the standard [Performer function Extension] to distinguish the type of involvement of the performer in the Observation resource.
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