<?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>