{

"resourceType": "Provenance",
"id": "example",
"target": [
  {
    "reference": "Procedure/example/_history/1"
  }
],
"occurredPeriod": {
  "start": "2015-06-27",
  "end": "2015-06-28"
},
"recorded": "2015-06-27T08:39:24+10:00",
"policy": [
  "http://acme.com/fhir/Consent/25"
],
"location": {
  "reference": "Location/1"
},
"reason": [
  {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "3457005",
        "display": "Referral"
      }
    ]
  }
],
"agent": [
  {
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
          "code": "AUT"
        }
      ]
    },
    "who": {
      "reference": "Practitioner/xcda-author"
    }
  },
  {
    "id": "a1",
    "type": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
          "code": "DEV"
        }
      ]
    },
    "who": {
      "reference": "Device/software"
    }
  }
],
"entity": [
  {
    "role": "source",
    "what": {
      "reference": "DocumentReference/example",
      "display": "CDA Document in XDS repository"
    }
  }
],
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}