Basic Example. Describes the fathers death at age 74 from a heart attack

{
  "resourceType" : "FamilyMemberHistory",
  "id" : "father",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Father died of a heart attack aged 74</div>"
  },
  "identifier" : [{
    "value" : "12345"
  }],
  "instantiatesUri" : ["http://example.org/family-member-history-questionnaire"],
  "status" : "completed",
  "patient" : {
    "reference" : "Patient/example",
    "display" : "Peter Patient"
  },
  "date" : "2011-03-18",
  "participant" : [{
    "function" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
        "code" : "verifier",
        "display" : "Verifier"
      }]
    },
    "actor" : {
      "reference" : "Practitioner/f201"
    }
  }],
  "relationship" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
      "code" : "FTH",
      "display" : "father"
    }]
  },
  "sex" : {
    "coding" : [{
      "system" : "http://hl7.org/fhir/administrative-gender",
      "code" : "male",
      "display" : "Male"
    }]
  },
  "condition" : [{
    "code" : {
      "coding" : [{
        "system" : "http://snomed.info/sct",
        "code" : "315619001",
        "display" : "Myocardial Infarction"
      }],
      "text" : "Heart Attack"
    },
    "contributedToDeath" : true,
    "onsetAge" : {
      "value" : 74,
      "unit" : "yr",
      "system" : "http://unitsofmeasure.org",
      "code" : "a"
    },
    "note" : [{
      "text" : "Was fishing at the time. At least he went doing someting he loved."
    }]
  }]
}