Polaris FHIR Implementation Guide
1.9.6 - ci-build

Polaris FHIR Implementation Guide - Local Development build (v1.9.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Polaris App Consent - DENIED Example - XML Representation

Raw xml | Download


<Consent xmlns="http://hl7.org/fhir">
  <id value="avery-wellness-consent-denied"/>
  <meta>
    <profile
             value="https://fhir.apps.health/StructureDefinition/polaris-core-app-consent"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>App Consent - DENIED</b></p><p>Patient: <strong>Avery Linwood</strong> has <strong>DECLINED</strong> to share clinical data with <strong>WellnessTracker Pro</strong> application.</p><p>Date: April 8, 2025 at 3:45 PM</p><p>Status: Active consent using FHIR R4 deny pattern (nested provision with type='deny').</p></div>
  </text>
  <identifier>
    <system
            value="https://fhir.apps.health/NamingSystem/cedarbrook-clinic-app-consent-identifier"/>
    <value value="app-consent-wellness-avery-denied-20250408"/>
  </identifier>
  <status value="active"/>
  <scope>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/consentscope"/>
      <code value="patient-privacy"/>
      <display value="Privacy Consent"/>
    </coding>
  </scope>
  <category>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/>
      <code value="infa"/>
      <display value="Information Access"/>
    </coding>
  </category>
  <patient>
    <identifier>
      <system
              value="https://fhir.apps.health/NamingSystem/cedarbrook-clinic-patient-identifier"/>
      <value value="1234567890"/>
    </identifier>
    <display value="Avery Linwood"/>
  </patient>
  <dateTime value="2025-04-08T15:45:00-06:00"/>
  <sourceAttachment>
    <contentType value="application/pdf"/>
    <data
          value="JVBERi0xLjQKJeLjz9MKMSAwIG9iago8PAovVHlwZSAvQ2F0YWxvZwovUGFnZXMgMiAwIFIKPj4KZW5kb2JqCjIgMCBvYmoKPDwKL1R5cGUgL1BhZ2VzCi9LaWRzIFszIDAgUl0KL0NvdW50IDEKPD4KZW5kb2JqCjMgMCBvYmoKPDwKL1R5cGUgL1BhZ2UKL1BhcmVudCAyIDAgUgovTWVkaWFCb3ggWzAgMCA2MTIgNzkyXQovUmVzb3VyY2VzIDw8L0ZvbnQgPDwvRjEgNCAwIFI+Pj4+Ci9Db250ZW50cyA1IDAgUgo+PgplbmRvYmoK"/>
    <size value="8456"/>
    <hash value="YTQwNTQwYTM5YTMwMGM5ZjYzZGI4YzJjYTI2ZWFmYzE="/>
    <title value="WellnessTracker Pro Consent Refusal Form - Signed"/>
    <creation value="2025-04-08T15:45:00-06:00"/>
  </sourceAttachment>
  <policyRule>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/consentpolicycodes"/>
      <code value="cric"/>
      <display value="Common Rule Informed Consent"/>
    </coding>
  </policyRule>
  <provision>
    <actor>
      <role>
        <coding>
          <system
                  value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
          <code value="IRCP"/>
          <display value="information recipient"/>
        </coding>
      </role>
      <reference>
        <identifier>
          <system
                  value="https://fhir.apps.health/NamingSystem/polaris-appdevice-identifier"/>
          <value value="wellness-tracker-pro"/>
        </identifier>
        <display value="WellnessTracker Pro"/>
      </reference>
    </actor>
    <provision>
      <type value="deny"/>
      <actor>
        <role>
          <coding>
            <system
                    value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
            <code value="IRCP"/>
            <display value="information recipient"/>
          </coding>
        </role>
        <reference>
          <identifier>
            <system
                    value="https://fhir.apps.health/NamingSystem/polaris-appdevice-identifier"/>
            <value value="wellness-tracker-pro"/>
          </identifier>
          <display value="WellnessTracker Pro"/>
        </reference>
      </actor>
    </provision>
  </provision>
</Consent>