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Advanced Directives

Witness requirements and notary public functions have been part of US jurisprudence since it’s founding, being largely based on English, French, and Spanish contract law respectively. Yet, these legal traditions each presented slightly different requirements, which eventually resulted in the situation where some US states require no signatures for advanced directives, others require a witness, some require two witnesses, and yet others require a notary public. To further complicate matters, COVID19 has created yet more variations in the law, in that people are now allowed to enter contracts remotely using online software services as a witness/notary intermediary.

./Map-USStates-AdvancedDirectives.jpeg

Example Encoding

Florida requires an advanced directive to be verified (although it may be done online)

Which translates into:

The state denies care management, except for the permitted relatives who have a power of attorney, as witnessed by Nancy Notary.

{ 
    "resourceType": "Consent",
    "policy": {
        "authority": "https://www.myflorida.com/"
    },
    "verification": [{
        "verified": true,
        "verifiedWith: {
            "display": "Nancy Notary",
            "reference": "RelatedPerson/nancy-notary",
            "verificationDate": ""
        },
        "verificationDate": "2021-10-01"
    }],
    "provision": {
        "type": "deny",
        "purpose": [{
            "code": "CAREMGT",
            "display": "care management",
            "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason"
        }]
        "provision": [{
            "type": "permit",
            "class": [{
                "code": "RelatedPerson",
                "display": "RelatedPerson",
                "system": "http://hl7.org/fhir/resource-types"
            }],
            "code": [{
                "text": "Power of Attorney",
                "coding": [{
                    "code": "POWATT",
                    "display": "power of attorney",
                    "system": " http://hl7.org/fhir/ValueSet/relatedperson-relationshiptype"
                }]
            }]
        }]
    }
}

References

Cross-sectional analysis of US scope of practice laws and employed physician assistants
Answers To Urgent Questions Notaries Are Asking About Remote Online Notarization How to Become an Online Notary Guide
Advance Care Planning in an Online World: State Law Activity and Challenges Since COVID-19
Find Advance Directives Forms By State

Datasets

Locations.US.States.AdvancedDirectives.20240128.ndjson