<?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"/>

  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>

<status value="executed"/>

<contentDerivative>
  <coding>
    <system value="http://terminology.hl7.org/CodeSystem/contract-content-derivative"/>
    <code value="registration"/>
  </coding>
</contentDerivative>

<issued value="2013-11-01T21:18:27-04:00"/>

<applies>
  <start value="2013-11-01T21:18:27-04:00"/>
</applies>

<subject>
  <reference value="Patient/f201"/>
</subject>

<type>
  <coding>
    <system value="http://mdhhs.org/fhir/consentdirective-type"/>
    <code value="OPTIN"/>
  </coding>
  <text value="Opt-in consent directive"/>
</type>
<subType>
  <coding>
    <system value="http://terminology.hl7.org/CodeSystem/consentcategorycodes"/>
    <code value="hcd"/>

<!– <code value=“MDHHS-5515”/>

    <display
      value="Michigan MDHHS-5515 Consent to Share Behavioral Health Information for Care Coordination Purposes"
    />   -->
  </coding>
</subType>

<term>
  <offer>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/contracttermtypecodes"/>
        <code value="statutory"/>
      </coding>
    </type>
    <decision>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="OPTIN"/>
      </coding>
    </decision>
    <text value="Can't refuse"/>
  </offer>

  <asset>
    <period>
      <start value="2013-11-01T21:18:27-04:00"/>
      <end value="2019-11-01T21:18:27-04:00"/>
    </period>
    <!--  
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-Confidentiality"/>
      <code value="R"/>
      <display value="Restricted"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="ETH"/>
      <display value="substance abuse information sensitivity"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="42CFRPart2"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="TREAT"/>
      <display value="treatment"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HPAYMT"/>
      <display value="healthcare payment"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HOPERAT"/>
      <display value="healthcare operations"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="PERSISTLABEL"/>
      <display value="persist security label"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="PRIVMARK"/>
      <display value="privacy mark"/>
    </securityLabel>
    <securityLabel>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <code value="NORDSCLCD"/>
      <display value="no redisclosure without consent directive"/>
    </securityLabel>
    -->
  </asset>

  <action>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/contractaction"/>
        <code value="action-a"/>
      </coding>
    </type>
    <subject>
      <reference>
        <reference value="Organization/f001"/>
        <display value="VA Ann Arbor Healthcare System"/>
      </reference>
      <role>
        <coding>
          <system value="http://mdhhs.org/fhir/consent-actor-type"/>
          <code value="IR"/>
          <display value="Recipient"/>
        </coding>
        <text value="Recipient of restricted health information"/>
      </role>
    </subject>
    <subject>
      <reference>
        <reference value="Organization/2"/>
        <display value="Community Mental Health Clinic"/>
      </reference>
      <role>
        <coding>
          <system value="http://mdhhs.org/fhir/consent-actor-type"/>
          <code value="IS"/>
          <display value="Sender"/>
        </coding>
        <text value="Sender of restricted health information"/>
      </role>
    </subject>
    <intent>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
        <code value="HPRGRP"/>
      </coding>
    </intent>
    <status>
      <text value="Sample"/>
    </status>
  </action>

</term>

<signer>
  <type>
    <system value="http://mdhhs.org/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"/>
        <who>
      <reference value="Patient/f201"/>
        </who>
  </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>