The ADI Document Reference profile DocumentReference contentType and format needs further guidance on specifying the various formats of advance directive attachments. This involves further specification of:

• content types that are aligned with the appropriate format.
  • contentType is "text/xml" with format code "urn:hl7-org:sdwg:pacp-structuredBody:1.2.0.1" for a PACP CDA xml document.
• a means of specifying content by profile (a feature in the R5 DocumentReference)
• examples of code snippets that demonstrate examples of how to represent different AD metadata (see attached image).
• addition of a note that it is up to the implementer to use which is the appropriate content type in an attachment.