{
  "resourceType": "DeviceUseStatement",
  "id": "example",
  "identifier": [
    {
      "system": "http:goodhealth.org/identifiers",
      "value": "51ebb7a9-4e3a-4360-9a05-0cc2d869086f"
    }
  ],
  "status": "active",
  "subject": {
    "reference": "Patient/example"
  },
  "device": {
    "reference": "Device/example"
  },
  "reasonReference": [
    {
      "reference": "Condition/example",
      "display": "Appendectomy (surgery)"
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}