<?xml version=“1.0” encoding=“UTF-8”?><Contract xmlns=“hl7.org/fhir”>

<id value="C-2121"/>
<meta>
  <versionId value="1"/>
  <lastUpdated value="2016-07-19T18:18:42.108-04:00"/>
</meta>
<text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: C-2121</p><p><b>meta</b>: </p><p><b>issued</b>: Nov 1, 2031 9:18:27 PM</p><p><b>subject</b>: <a>Patient/f201</a></p><p><b>type</b>: Opt-in consent directive <span>(Details : {http://org.mdhhs.fhir.consentdirective-type code &#39;OPTIN&#39; = &#39;OPTIN)</span></p><p><b>subType</b>: Michigan MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes <span>(Details : {http://hl7.org/fhir/consentcategorycodes code &#39;MDHHS-5515&#39; = &#39;Michigan MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes&#39;, given as &#39;Michigan MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes&#39;})</span></p><p><b>securityLabel</b>: Restricted (Details: http://hl7.org/fhir/v3/Confidentiality code R = &#39;restricted&#39;, stated as &#39;Restricted&#39;), substance abuse information sensitivity (Details: http://hl7.org/fhir/v3/ActCode code ETH = &#39;substance abuse information sensitivity&#39;, stated as &#39;substance abuse information sensitivity&#39;), 42 CFR Part2 (Details: http://hl7.org/fhir/v3/ActCode code 42CFRPart2 = &#39;42 CFR Part2&#39;, stated as &#39;null&#39;), treatment (Details: http://hl7.org/fhir/v3/ActReason code TREAT = &#39;treatment&#39;, stated as &#39;treatment&#39;), healthcare payment (Details: http://hl7.org/fhir/v3/ActReason code HPAYMT = &#39;healthcare payment&#39;, stated as &#39;healthcare payment&#39;), healthcare operations (Details: http://hl7.org/fhir/v3/ActReason code HOPERAT = &#39;healthcare operations&#39;, stated as &#39;healthcare operations&#39;), persist security label (Details: http://hl7.org/fhir/v3/ActCode code PERSISTLABEL = &#39;persist security label&#39;, stated as &#39;persist security label&#39;), privacy mark (Details: http://hl7.org/fhir/v3/ActCode code PRIVMARK = &#39;privacy mark&#39;, stated as &#39;privacy mark&#39;), no redisclosure without consent directive (Details: http://hl7.org/fhir/v3/ActCode code NORDSCLCD = &#39;no redisclosure without consent directive&#39;, stated as &#39;no redisclosure without consent directive&#39;)</p><blockquote><p><b>agent</b></p><p><b>actor</b>: <a>VA Ann Arbor Healthcare System</a></p><p><b>role</b>: Recipient of restricted health information <span>(Details : {http://org.mdhhs.fhir.consent-actor-type code &#39;IR&#39; = &#39;IR&#39;, given as &#39;Recipient&#39;})</span></p></blockquote><blockquote><p><b>agent</b></p><p><b>actor</b>: <a>Community Mental Health Clinic</a></p><p><b>role</b>: Sender of restricted health information <span>(Details : {http://org.mdhhs.fhir.consent-actor-type code &#39;IS&#39; = &#39;IS&#39;, given as &#39;Sender&#39;})</span></p></blockquote><h3>Signers</h3><table><tr><td>-</td><td><b>Type</b></td><td><b>Party</b></td><td><b>Signature</b></td></tr><tr><td>*</td><td>SELF (Details: http://org.mdhhs.fhir.consent-signer-type code SELF = &#39;SELF&#39;, stated as &#39;null&#39;)</td><td><a>Alice Recruit</a></td><td/></tr></table><h3>Legals</h3><table><tr><td>-</td><td><b>Content[x]</b></td></tr><tr><td>*</td><td/></tr></table></div></text><issued value="2031-11-01T21:18:27-04:00"/>
<subject>
  <reference value="Patient/f201"/>
</subject>
<type>
  <coding>
    <system value="http://org.mdhhs.fhir.consentdirective-type"/>
    <code value="OPTIN"/>
  </coding>
  <text value="Opt-in consent directive"/>
</type>
<subType>
  <coding>
    <system value="http://hl7.org/fhir/consentcategorycodes"/>
    <code value="MDHHS-5515"/>
    <display value="Michigan MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes"/>
  </coding>
</subType>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/Confidentiality"/>
  <code value="R"/>
  <display value="Restricted"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActCode"/>
  <code value="ETH"/>
  <display value="substance abuse information sensitivity"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActCode"/>
  <code value="42CFRPart2"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActReason"/>
  <code value="TREAT"/>
  <display value="treatment"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActReason"/>
  <code value="HPAYMT"/>
  <display value="healthcare payment"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActReason"/>
  <code value="HOPERAT"/>
  <display value="healthcare operations"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActCode"/>
  <code value="PERSISTLABEL"/>
  <display value="persist security label"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActCode"/>
  <code value="PRIVMARK"/>
  <display value="privacy mark"/>
</securityLabel>
<securityLabel>
  <system value="http://hl7.org/fhir/v3/ActCode"/>
  <code value="NORDSCLCD"/>
  <display value="no redisclosure without consent directive"/>
</securityLabel>
<agent>
  <actor>
    <reference value="Organization/f001"/>
    <display value="VA Ann Arbor Healthcare System"/>
  </actor>
  <role>
    <coding>
      <system value="http://org.mdhhs.fhir.consent-actor-type"/>
      <code value="IR"/>
      <display value="Recipient"/>
    </coding>
    <text value="Recipient of restricted health information"/>
  </role>
</agent>
<agent>
  <actor>
    <reference value="Organization/2"/>
    <display value="Community Mental Health Clinic"/>
  </actor>
  <role>
    <coding>
      <system value="http://org.mdhhs.fhir.consent-actor-type"/>
      <code value="IS"/>
      <display value="Sender"/>
    </coding>
    <text value="Sender of restricted health information"/>
  </role>
</agent>
<signer>
  <type>
    <system value="http://org.mdhhs.fhir.consent-signer-type"/>
    <code value="SELF"/>
  </type>
  <party>
    <reference value="Patient/f201"/>
    <display value="Alice Recruit"/>
  </party>
  <signature>
    <type>
      <system value="urn:iso-astm:E1762-95:2013"/>
      <code value="1.2.840.10065.1.12.1.1"/>
    </type>
    <when value="2017-02-08T10:57:34+01:00"/>
    <whoReference>
      <reference value="Patient/f201"/>
    </whoReference>
  </signature>
</signer>
<legal>
  <contentAttachment>
    <contentType value="application/pdf"/>
    <language value="en-US"/>
    <url value="http://org.mihin.ecms/ConsentDirective-2121"/>
    <title value="MDHHS-5515 Consent To Share Your Health Information"/>
  </contentAttachment>
</legal>

</Contract>