Basic Example. Describes the fathers death at age 74 from a heart attack (id = "father")

<?xml version="1.0" encoding="UTF-8"?>

<FamilyMemberHistory xmlns="http://hl7.org/fhir">
  <id value="father"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">Father died of a heart attack aged 74</div> 
  </text> 
  <identifier> 
  <value value="12345"/> 
  </identifier> 
  <instantiatesUri value="http://example.org/family-member-history-questionnaire"/> 
  <status value="completed"/> 
  <patient> 
    <reference value="Patient/example"/> 
    <display value="Peter Patient"/> 
  </patient> 

  <date value="2011-03-18"/> 
  <participant>  
    <function>  
      <coding>  
        <system value="http://terminology.hl7.org/CodeSystem/provenance-participant-type"/>  
        <code value="verifier"/>  
        <display value="Verifier"/>  
      </coding>  
    </function>  
    <actor>  
      <reference value="Practitioner/f201"/>  
    </actor>  
  </participant> 
  <relationship> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/> 
      <code value="FTH"/> 
      <display value="father"/> 
    </coding> 
  </relationship> 
  <sex> 
  <coding> 
      <system value="http://hl7.org/fhir/administrative-gender"/> 
      <code value="male"/> 
      <display value="Male"/> 
    </coding> 
  </sex> 
  <condition> 
    <code> 
    <coding> 
      <system value="http://snomed.info/sct"/> 
      <code value="315619001"/> 
      <display value="Myocardial Infarction"/> 
    </coding> 
    <text value="Heart Attack"/> 
    </code> 
 
  <contributedToDeath value="true"/> 
    <onsetAge> 
      <value value="74"/> 
      <unit value="yr"/> 
      <system value="http://unitsofmeasure.org"/> 
      <code value="a"/> 
    </onsetAge> 
    <note> 
      <text value="Was fishing at the time. At least he went doing someting he loved."/> 
    </note> 
  </condition> 
</FamilyMemberHistory>