This page is part of the Vital Records Birth and Fetal Death Reporting (v1.0.0: STU 1 on FHIR R4) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Patient Worksheet Questionnaires

For both Live Birth and Fetal Death, information is collected from the mother as defined by the Mother’s Worksheet for the Birth Certificate and the Patient’s Worksheet for the Fetal Death Report. The information gathered (per NCHS) using these worksheets must come from the patient and not from the medical record.

For ease of implementation, optional Questionnaire instances have been defined based on the worksheets.

• Questionnaire for Mother’s Worksheet for the Birth Certificate
• Questionnaire for Patient’s Worksheet for the Fetal Death Report

QuestionnaireResponse

Example QuestionnaireResponse instances have also been created:

• Example QuestionnaireResponse to the Questionnaire for Mother’s Worksheet for the Birth Certificate
• Example QuestionnaireResponse to the Questionnaire for Patient’s Worksheet for the Fetal Death Report

Implementation Notes

• The Questionnaire instances include all the questions in the standard worksheets.
• To address state/jurisdiction specific requirements, it is possible to make a copy of the Questionnaire and add questions (Questionnaire.item) to gather data over and above that defined in the standard worksheets. (See FHIR Questionnaire for futher information).
• All Questionnaire items are optional in the provided Questionnaire instances, however, it is possible to make a copy of the Questionnaire and set Questionnaire.item.required to “true” to make selected items required.
• Information gathered using the Questionnaire should be reviewed by the birth clerk or clinician before it is sent.
• It is possible to send the resulting QuestionnaireResponse contained in the relevant Composition (Composition - Provider Live Birth Report or Composition - Provider Fetal Death Report).
  • The containment of the QuestionnaireResponse is optional and is not “must support”
  • If sending the QuestionnaireResponse in the Composition is a consideration, it is important to work with the receiving jurisdication to ensure they can support receipt of the instance