<?xml version=“1.0” encoding=“UTF-8”?> <Procedure xmlns=“hl7.org/fhir”>
<id value="HCBS"/> <meta> <security> <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/> <code value="HTEST"/> <display value="test health data"/> </security> </meta> <basedOn> <!-- <reference value="CarePlan/example-HCBS"/> --> <display value="Peter's Long Term Service and Supports (LTSS) Care Plan"/> </basedOn> <status value="completed"/> <code> <coding> <system value="https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/Alpha-Numeric-HCPCS.html"/> <code value="T1019"/> <display value="Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment."/> </coding> <text value="Personal care services"/> </code> <subject> <reference value="Patient/example"/> <display value="Peter James"/> </subject> <performedDateTime value="2018-04-05"/> <performer> <actor> <reference value="Practitioner/example"/> <display value="Adam Careful"/> </actor> </performer> <location> <reference value="Location/ph"/> <display value="Peter's Home"/> </location> <note> <text value="Assisted with bathing and dressing, doing laundry, and meal preparation"/> </note>
</Procedure>