This project is intended to write a FHIR IG for Advance Directives (AD). It is a complex area that involves many stakeholders. The Post-Acute Care Interoperability (PACIO) Community has a strong interest in the topic of Advance Directives and will support the community engagement need to successfully develop a FHIR IG for Advance Directives. PACIO is supported by MITRE, CMS, ONC and many other stakeholders (both clinical and technical). The PACIO Community formally discussed adding AD as a new area of focus on September 9th 2020 and voted 31-0 to approve. The PACIO group noted that sharing important information about a patient’s AD are often not communicated in the post-acute care community and that establishing standards to share this information will help ensure that the patient’s voice is heard. The importance of the patient’s voice being heard is the primary reason the Patient Empowerment Work Group is a natural fit to sponsor this project. The Patient Empowerment Work Group mission is to promote and amplify the viewpoints of patients and their care givers. For this AD FHIR IG to be successful, the patient's voice must be included to inform treatment, care planning, and orders. Although the patient is the centering point for this project, it is understood that this work is complex. With the multiple FHIR resources that will be involve and previous standards work that has occurred, this project has identified the following Work Groups to be Co-sponsors. • Community Based Care & Privacy • FHIR Management Group • Patient Care • Financial Management • Structured Documents • Orders & Observations. The following attachments are being included to support this proposal. 1. Sample of patient treatment decision making form (Form_for_Patient_Care_Decision-making.pdf) 2. HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2 August 2020 Volume 1 — Introductory Material (CDAR2_IG_PERSADVCAREPLAN_R1_STU2_2020AUG_Vol1.pdf) 3. HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan (PACP) Document, Release 1 - US Realm STU Release 2 August 2020 Volume 2 — Templates (CDAR2_IG_PERSADVCAREPLAN_R1_STU2_2020AUG_Vol2.pdf) 4. HL7 CDA® R2 Implementation Guide: C-CDA R2.1; Advance Directives Templates, Release 1 - US Realm (CDAR2_IG_CCDA_SUPP_ADR_R1_STU_2018MAR.pdf) 5. Rendered CDA Personal Advance Care plan (McBee_L3_20200610.html) 6. Sample Personal Advance Care plan (Roger_McBee_2014-08-20.pdf) 7. Example DNR Form from Texas (Texas Out-of-Hospital DNR.pdf) 8. Example DNR Form from Florida (Florida Do-Not-Resuscitate Order.pdf) 9. Sample Medical Orders for Life Sustaining Treatment (New York MOLST example) 10. Sample Portable Medical Orders (National POLST Form; state-specific differences exist; master source https://polst.org/wp-content/uploads/2020/08/2020.08.15-National-POLST-Form-Adoption.pdf)