PACIO Advance Directive Interoperability Implementation Guide
0.1.0 - STU 1 Ballot

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## Example Consent: Example-Smith-Johnson-HealthcareAgentConsent

status: active

scope: Powers granted to healthcare agent [Reported]

category: Advance Directive

patient: Betsy Smith-Johnson ; BetsySJ@example.com; gender: female; birthDate: 1950-11-15

dateTime: 2020-08-03

### Policies

- | Authority | Uri
* | https://www.michigan.gov/ | http://www.legislature.mi.gov/(S(tpnclc1ofteerx2x2dppcmdz))/mileg.aspx?page=GetObject&objectname=mcl-386-1998-V-5

> provision

> type: permit

> > actor

> > role: Primary healthcare agent [Reported]

> > reference: natural son; Charles Johnson ; CharlesSJ@example.com

> > actor

> > role: First alternate healthcare agent [Reported]

> > reference: First alternate healthcare agent [Reported], natural daughter; Debra Johnson ; DebraSJ@example.com

> action: Advance directive - request for intubation, Advance directive - request for tube feeding, Advance directive - request for life support, Advance directive - request for IV fluid and support, Advance directive - request for antibiotics, Advance directive - request for resuscitation that differs from cardiopulmonary resuscitation

> purpose: power of attorney