<Patient xmlns="http://hl7.org/fhir">
  <id value="example-decedent" />
  <extension url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
    <extension url="text">
      <valueString value="Hispanic or Latino" />
    </extension>
    <extension url="ombCategory">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238" />
        <code value="2135-2" />
        <display value="Hispanic or Latino" />
      </valueCoding>
    </extension>
    <extension url="text">
      <valueString value="Puerto Rican" />
    </extension>
    <extension url="detailed">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238" />
        <code value="2180-8" />
        <display value="Puerto Rican" />
      </valueCoding>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
    <extension url="text">
      <valueString value="Native Hawaiian or Other Pacific Islander" />
    </extension>
    <extension url="ombCategory">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238" />
        <code value="2076-8" />
        <display value="Native Hawaiian or Other Pacific Islander" />
      </valueCoding>
    </extension>
    <extension url="text">
      <valueString value="Tahitian" />
    </extension>
    <extension url="detailed">
      <valueCoding>
        <system value="urn:oid:2.16.840.1.113883.6.238" />
        <code value="2081-8" />
        <display value="Tahitian" />
      </valueCoding>
    </extension>
  </extension>
  <extension url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
    <valueCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/us/core/ValueSet/us-core-birthsex" />
        <code value="M" />
        <display value="Male" />
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <type>
      <coding>
        <code value="BR" />
        <display value="Social Beneficiary Identifier" />
      </coding>
    </type>
    <system value="urn:oid:2.16.840.1.113883.4.1" />
    <value value="123-45-6789" />
  </identifier>
  <name>
    <use value="official" />
    <family value="Smith" />
    <given value="Robert" />
    <given value="John" />
    <suffix value="Jr." />
  </name>
  <name>
    <use value="nickname" />
    <text value="Bobby" />
  </name>
  <gender value="male" />
  <birthDate value="1974-12-31" />
  <deceasedDateTime value="2017-12-31" />
  <maritalStatus>
    <coding>
      <system value="http://hl7.org/fhir/ValueSet/marital-status" />
      <code value="S" />
      <display value="Never Married" />
    </coding>
  </maritalStatus>
</Patient>