Recorded provenance
Originating system, author/source, creation time, revision/addendum, derivation and final state.
Trust states remain separate
Provenance should travel with the medical record.
Document integrity
Whether the checked bytes match the sealed state.
Identity assurance
Whether the signing key is trusted and connected to a verified real-world identity.
Clinical truth
Whether the medical statement is correct. A valid signature or seal does not prove this.
A later amendment begins new lineage; it does not silently rewrite the sealed clinical record.