---
type: "example"
title: "Provenance Example: provenance-example-advanced"
resource: "Provenance"
example: "provenance-example-advanced"
---
# Provenance Example: provenance-example-advanced

## Example XML



```xml
<?xml version="1.0" encoding="UTF-8"?>
<Provenance xmlns="http://hl7.org/fhir"
            xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
            xsi:schemaLocation="http://hl7.org/fhir ../../schema/provenance.xsd">
	<id value="example-advanced"/>
	<!-- 
    an example Provenance fully populated
  -->
	<target>
		<reference value="List/example"/>
	</target>
	<occurredDateTime value="2020-04-29T09:49:00.000Z"/>
	<recorded value="2020-04-29T09:49:00.000Z"/>
	<policy value="http://example.org/policy/1234"/>
	<location>
		<reference value="Location/1/_history/1"/>
	</location>
	<authorization>
		<concept>
			<coding>
				<system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
				<code value="TREAT"/>
			</coding>
		</concept>
	</authorization>
	<activity>
		<coding>
			<system value="http://terminology.hl7.org/CodeSystem/iso-21089-lifecycle"/>
			<code value="originate"/>
		</coding>
	</activity>
	<basedOn>
		<reference value="CarePlan/example"/>
	</basedOn>
	<patient>
		<reference value="Patient/example"/>
	</patient>
	<encounter>
		<reference value="Encounter/home"/>
	</encounter>
	<agent>
		<type>
			<coding>
				<system value="http://dicom.nema.org/resources/ontology/DCM"/>
				<code value="110153"/>
				<display value="Source Role ID"/>
			</coding>
		</type>
		<who>
			<display value="myMachine.example.org"/>
		</who>
	</agent>
	<agent>
		<type>
			<coding>
				<system value="http://dicom.nema.org/resources/ontology/DCM"/>
				<code value="110152"/>
				<display value="Destination Role ID"/>
			</coding>
		</type>
		<who>
			<reference value="Device/example"/>
		</who>
	</agent>
	<agent>
		<type>
			<coding>
				<system value="http://terminology.hl7.org/CodeSystem/v3-ParticipationType"/>
				<code value="INF"/>
				<display value="Informant"/>
			</coding>
		</type>
		<who>
			<display value="Betty Jones"/>
		</who>
	</agent>
	<signature>
		<!-- verification signature -->
		<type>
			<system value="urn:iso-astm:E1762-95:2013"/>
			<code value="1.2.840.10065.1.12.1.5"/>
			<display value="Verification Signature"/>
		</type>
		<when value="2020-04-29T09:49:00.000Z"/>
		<who>
			<display value="Betty Jones"/>
		</who>
		<sigFormat value="image/jpeg"/>
		<data value="/9j/4AAQSkZJRgABAQEAYABgAAD/4QAiRXhpZgAATU0AKgAAAAgAAQESAAMAAAABAAEAAAAAAAD/2wBDAAIBAQIBAQICAgICAgICAwUDAwMDAwYEBAMFBwYHBwcGBwcICQsJCAgKCAcHCg0KCgsMDAwMBwkODw0MDgsMDAz/2wBDAQICAgMDAwYDAwYMCAcIDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAz/wAARCAAXACQDASIAAhEBAxEB/8QAHwAAAQUBAQEBAQEAAAAAAAAAAAECAwQFBgcICQoL/8QAtRAAAgEDAwIEAwUFBAQAAAF9AQIDAAQRBRIhMUEGE1FhByJxFDKBkaEII0KxwRVS0fAkM2JyggkKFhcYGRolJicoKSo0NTY3ODk6Q0RFRkdISUpTVFVWV1hZWmNkZWZnaGlqc3R1dnd4eXqDhIWGh4iJipKTlJWWl5iZmqKjpKWmp6ipqrKztLW2t7i5usLDxMXGx8jJytLT1NXW19jZ2uHi4+Tl5ufo6erx8vP09fb3+Pn6/8QAHwEAAwEBAQEBAQEBAQAAAAAAAAECAwQFBgcICQoL/8QAtREAAgECBAQDBAcFBAQAAQJ3AAECAxEEBSExBhJBUQdhcRMiMoEIFEKRobHBCSMzUvAVYnLRChYkNOEl8RcYGRomJygpKjU2Nzg5OkNERUZHSElKU1RVVldYWVpjZGVmZ2hpanN0dXZ3eHl6goOEhYaHiImKkpOUlZaXmJmaoqOkpaanqKmqsrO0tba3uLm6wsPExcbHyMnK0tPU1dbX2Nna4uPk5ebn6Onq8vP09fb3+Pn6/9oADAMBAAIRAxEAPwD92rfxVJqU6vDIq/6SIUtNgaSSPeAZiQT8pQh1IxgEbuTtFq51y6t7u6k225s7OdIZQQQ6qVRjJuzjCh+QR0UnPasfwUxspoJF/wCXx4bWQH0WyWRSPcEMPfd7CneNtUms7u7tLG0k1GTUoljniiIVbfBAd3PJ5jkUfKrOAqfK2QKAOuorDfxRqFraxSz6HdjcmXSGRZX3bGYKoH+6FJbYAzDkjJEmi+JptTvLaCaxktXltTNIWLAJICgZFDKrMBv+/gA8cc8AGxRRRQBzvhvQrq2WzjmhMP2KVpZJXK5nIjMSBVUngIRknB+QcHcSNLQ9C/sfzXaXzp5j8z7dowGZgMZPOWYk9yx6DCgooA0Kr2mnJaXE026SSa4PzO55CjO1R2CjJwPck5JJJRQBYooooA//2Q=="/>
	</signature>
</Provenance>
```