Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/composition-provider-fetal-death-not-named

Resource Composition:

Generated Narrative: Composition composition-provider-fetal-death-not-named

status: Final

type: U.S. standard report of fetal death - 2003 revision

encounter: Encounter: extension = mother; identifier = http://hospital.smarthealthit.org#8937015; status = finished; class = inpatient encounter (ActCode#IMP); type = Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.; period = 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700

date: 2019-01-09

author: Practitioner Leung Jessica

title: Provider fetal death report Document

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/patient-decedent-fetus-not-named

Resource Patient:

Generated Narrative: Patient patient-decedent-fetus-not-named

null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))

---

Deceased:	true	Multiple Birth:	3
Reported Parent Age At Delivery Vital Records:	reportedAge: 34 a (Details: UCUM codea = 'a') motherOrFather: mother
Reported Parent Age At Delivery Vital Records:	reportedAge: 35 a (Details: UCUM codea = 'a') motherOrFather: father
Patient Birth Place	Ann Arbor MI 48103
US Core Birth Sex Extension	F

Entry 3 - fullUrl = http://www.example.org/fhir/Encounter/encounter-maternity-carmen-teresa-lee

Resource Encounter:

Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee

Extension Parental Role: mother

identifier: http://hospital.smarthealthit.org/8937015

status: Finished

class: ActCode IMP: inpatient encounter

type: Under Observation or Inpatient Care Services (Including Admission and Discharge Services)

subject: Patient - Mother (Carmen Teresa Lee)

Participants

-	Type	Individual
*	Birth attendant [Extended Identifier]	Practitioner - Vital Records (Janet Seito, DO)

period: 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700

Locations

-	Location	PhysicalType
*	Location - US Core Location (South Hospital)	Hospital

serviceProvider: Organization - US Core Organization (South Hospital Organization)

Entry 4 - fullUrl = http://www.example.org/fhir/Patient/patient-mother-carmen-teresa-lee

Resource Patient:

Generated Narrative: Patient patient-mother-carmen-teresa-lee

Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

---

Alt. Name:	Carmen Teresa Santos (Name changed for Marriage)
Contact Detail	3670 Miller Road Ann Arbor MI 48103 US (home)
Links:	Also see: RelatedPerson Carmen Teresa Lee (official)
US Core Ethnicity Extension:	ombCategory: CDC Race and Ethnicity 2135-2: Hispanic or Latino text: Hispanic or Latino
Patient Birth Place	PR
US Core Birth Sex Extension	F
US Core Race Extension:	ombCategory: CDC Race and Ethnicity 2054-5: Black or African American text: Black or African America

Entry 5 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee

status: Final

code: Date first prenatal visit

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2018-05-18

Entry 6 - fullUrl = http://www.example.org/fhir/Observation/observation-last-menstrual-period-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee

status: Final

code: Last menstrual period start date

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2018-05-02

performer: Practitioner Janet Seito

value: 2018-04-18

Entry 7 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-living-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee

status: Final

code: [#] Births.still living

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 1

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-dead-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee

status: Final

code: Previous live births now dead #

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 0

Entry 9 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-live-birth-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee

status: Final

code: Date of last live birth

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 2016-01-28

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-height-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-height-carmen-teresa-lee

status: Final

category: Vital Signs

code: Body height

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-01-10

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 65 in (Details: UCUM code[in_i] = '[in_i]')

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee

status: Final

category: Vital Signs

code: Body weight --pre current pregnancy

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

Entry 12 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-received-wic-food-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee

status: Final

code: Mother WIC food recipient

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: No

Entry 13 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee

status: Final

code: In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 0

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee

status: Final

code: Cigarettes smoked per day by Mother--1st trimester

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 0

Entry 15 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee

status: Final

code: Cigarettes smoked per day by Mother--2nd trimester

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 1

Entry 16 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee

status: Final

code: In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 0

Entry 17 - fullUrl = http://www.example.org/fhir/Observation/observation-number-previous-cesareans-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee

status: Final

code: Previous cesarean deliveries #

subject: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 1

Entry 18 - fullUrl = http://www.example.org/fhir/Condition/condition-gestational-diabetes-carmen-teresa-lee

Resource Condition:

Generated Narrative: Condition condition-gestational-diabetes-carmen-teresa-lee

clinicalStatus: Active

category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]

code: Gestational diabetes mellitus (disorder)

subject: Patient - Mother (Carmen Teresa Lee)

onset: 2018-12-12

Entry 19 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-presentation-not-named

Resource Observation:

Generated Narrative: Observation observation-fetal-presentation-not-named

status: Final

code: Fetal presentation--at birth [US Standard Certificate of Live Birth]

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Breech presentation (finding)

Entry 20 - fullUrl = http://www.example.org/fhir/Procedure/procedure-final-route-method-delivery-not-named

Resource Procedure:

Generated Narrative: Procedure procedure-final-route-method-delivery-not-named

status: Completed

category: Final route and method of delivery [US Standard Certificate of Live Birth]

code: Spontaneous vaginal delivery

subject: Patient - Mother (Carmen Teresa Lee)

performed: 2019-01-19 18:00:00-0700 --> 2019-01-19 18:23:00-0700

Entry 21 - fullUrl = http://www.example.org/fhir/Observation/observation-birth-weight-not-named

Resource Observation:

Generated Narrative: Observation observation-birth-weight-not-named

status: Final

category: Vital Signs

code: Birth weight Measured

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-01-10

performer: Practitioner Janet Seito

value: 1530 g (Details: UCUM codeg = 'g')

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/observation-gestational-age-at-delivery-not-named

Resource Observation:

Generated Narrative: Observation observation-gestational-age-at-delivery-not-named

status: Final

code: Gestational age Estimated

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 20 wk (Details: UCUM codewk = 'wk')

Entry 23 - fullUrl = http://www.example.org/fhir/Condition/condition-fetal-death-cause-or-condition-not-named

Resource Condition:

Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named

category: Encounter Diagnosis, Initiating cause or condition of fetal death [US Standard Report of Fetal Death]

code: Premature rupture of membranes (disorder)

subject: Patient - Decedent Fetus (Fetus Not Named)

Entry 24 - fullUrl = http://www.example.org/fhir/Condition/condition-fetal-death-other-significant-cause-not-named

Resource Condition:

Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named

category: Encounter Diagnosis, Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]

code: Placental insufficiency (disorder)

subject: Patient - Decedent Fetus (Fetus Not Named)

Entry 25 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-death-time-point-not-named

Resource Observation:

Generated Narrative: Observation observation-fetal-death-time-point-not-named

status: Final

code: Estimated timing of fetal death [US Standard Report of Fetal Death]

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Fetal intrapartum death after first assessment (event)

Entry 26 - fullUrl = http://www.example.org/fhir/Observation/observation-autopsy-performed-not-named

Resource Observation:

Generated Narrative: Observation observation-autopsy-performed-not-named

status: Final

code: Autopsy was performed

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Performed

Entry 27 - fullUrl = http://www.example.org/fhir/Observation/observation-histological-placental-exam-performed-not-named

Resource Observation:

Generated Narrative: Observation observation-histological-placental-exam-performed-not-named

status: Final

code: Histological placental examination was performed [US Standard Report of Fetal Death]

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Performed

Entry 28 - fullUrl = http://www.example.org/fhir/Observation/observation-autopsy-histological-exam-results-used-not-named

Resource Observation:

Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named

status: Final

code: Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]

subject: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: Yes

Entry 29 - fullUrl = http://www.example.org/fhir/Observation/observation-number-deaths-this-delivery-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-number-deaths-this-delivery-carmen-teresa-lee

status: Final

code: Number of fetal deaths delivered

subject: Patient - Mother (Carmen Teresa Lee)

focus: Patient - Decedent Fetus (Fetus Not Named)

effective: 2019-12-02

performer: Practitioner Janet Seito

value: 1

Entry 30 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee

status: Final

code: Highest level of education Mother

subject: Patient - Decedent Fetus (Fetus Not Named)

focus: Patient - Mother (Carmen Teresa Lee)

effective: 2019-12-02

performer: Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))

value: 9th through 12th grade; no diploma

Entry 31 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-present-job-carmen-teresa-lee

Extension Parental Role: mother

status: Final

code: History of Occupation

subject: null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))

focus: RelatedPerson Carmen Teresa Lee (official)

effective: 2019-01-09 --> (ongoing)

value: Secretary

Components

-	Code	Value[x]
*	History of Occupation industry	State Agency

Entry 32 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-tom-yan-lee

Resource Observation:

Generated Narrative: Observation observation-present-job-tom-yan-lee

Extension Parental Role: father

status: Final

code: History of Occupation

subject: null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))

focus: RelatedPerson Tom Yan Lee (official)

effective: 2019-01-09 --> (ongoing)

value: Teaching Assistant

Components

-	Code	Value[x]
*	History of Occupation industry	Elementary and Secondary Schools

Entry 33 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-carmen-teresa-lee

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-carmen-teresa-lee

status: Final

code: Mother Input Race and Ethnicity

subject: Patient - Mother (Carmen Teresa Lee)

component

code: White

value: true

component

code: Black Or African American

value: true

component

code: American Indian Or Alaska Native

value: true

component

code: Asian Indian

value: false

component

code: Chinese

value: false

component

code: Filipino

value: false

component

code: Japanese

value: false

component

code: Korean

value: false

component

code: Vietnamese

value: false

component

code: Other Asian

value: false

component

code: Native Hawaiian

value: false

component

code: Guamanian Or Chamorro

value: false

component

code: Samoan

value: false

component

code: Other Pacific Islander

value: false

component

code: Other Race

value: false

component

code: First Other Asian Literal

value: Malaysian

component

code: First American Indian Or Alaska Native Literal

value: Arikara

component

code: Hispanic Mexican

value: Yes

component

code: Hispanic Cuban

value: Yes

component

code: Hispanic Puerto Rican

value: Yes

component

code: Hispanic Other

value: No

Entry 34 - fullUrl = http://www.example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee

Resource QuestionnaireResponse:

Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee

LinkID	Text	Definition	Answer
QuestionnaireResponse-patients-fetal-death-carmen-lee			Questionnaire:Questionnaire - Patient's Worksheet for the Report of Fetal Death
mother-current-legal-name	What is your current legal name?
mother-first-name	First		Carmen
mother-middle-name	Middle		Teresa
mother-last-name	Last		Lee
mother-address	Where do you usually live - that is - where is your household/residence located?
mother-nbr-street	Complete number and street (do not enter rural route numbers)		3670 Miller Road
mother-city	City, Town, or Location
mother-state	State (or U.S. Territory, Canadian Province)		MI
mother-zip	Zip Code		48103
inside-city-limits	Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?		v2 Y/N Indicator N: No
mother-mail	What is your mailing address
mother-mail-same	Same as residence [Go to next question]		true
mother-dob	What is your date of birth?		1986-02-15
mother-birthplace	In what State, U.S. territory, or foreign country were you born? Please specify one of the following:
mother-birthplace-territory	or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas		PR
mother-education	What is the highest level of schooling that you have completed at the time of delivery? (Check the box that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received).		Education Level SEC: Some secondary or high school education
mother-ethnicity			true
mother-ethnicity-mexican			true
mother-ethnicity-puerto-rican			true
mother-ethnicity-cuban			true
mother-ethnicity-other			false
mother-race
mother-race-black-or-aa			true
father-current-legal-name	What is the current legal name of your baby's father?
father-first-name	First		Tom
father-middle-name	Middle		Yan
father-last-name	Last		Lee
father-dob	What is the father's date of birth?		1984-02-27
father-birthplace	In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
father-birthplace-state	State		NY
receive-wic	Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?		v2 Y/N Indicator N: No
mothers-height	What is your height?
mothers-height-inches	Inches		65 [in_i] (Details: UCUM code[in_i] = '[in_i]')
mothers-prepregnancy-weight	lbs		180 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')
mothers-smoking	How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? If you NEVER smoked, enter zero for each time period.
mothers-smoking-3-months-prior	Three months before pregnancy
mothers-smoking-3-months-prior-cig	# of cigarettes*		0
mothers-smoking-3-months-prior-pck	# of packs		0
mothers-smoking-trimester-1	First three months of pregnancy
mothers-smoking-trimester-1-cig	# of cigarettes*		0
mothers-smoking-trimester-1-pck	# of packs		0
mothers-smoking-trimester-2	Second three months of pregnancy
mothers-smoking-trimester-2-cig	# of cigarettes*		0
mothers-smoking-trimester-2-pck	# of packs		0
mothers-smoking-trimester-3	Third trimester of pregnancy
mothers-smoking-trimester-3-cig	# of cigarettes*		0
mothers-smoking-trimester-3-pck	# of packs		0
Documentation for this format

Entry 35 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-janet-seito

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-janet-seito

Practitioner Role - Birth Attendant: attendant

Practitioner Role - Certifier: certifier

identifier: NPI/223347044

name: Janet Seito

Qualifications

-	Code
*	Osteopath (occupation)

Entry 36 - fullUrl = http://www.example.org/fhir/Location/location-south-hospital

Resource Location:

Generated Narrative: Location location-south-hospital

identifier: NPI/116441967701

status: Active

name: South Hospital

type: Hospital, Birth Location

address: 2100 North Ave Salt Lake City UT 84116 US

Positions

-	Longitude	Latitude
*	40.8	111.9

managingOrganization: Organization - South Hospital

Entry 37 - fullUrl = http://www.example.org/fhir/Organization/organization-south-hospital

Resource Organization:

Generated Narrative: Organization organization-south-hospital

identifier: NPI/5555512

active: true

type: Hospital

name: South Hospital

telecom: +1-555-555-1111, mail@southhospital.com

address: 2100 North Ave Salt Lake City UT 84116 US

Entry 38 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-mother-carmen-teresa-lee

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee

active: true

patient: Patient - Decedent Fetus (Fetus Not Named)

relationship: Gestational Mother

name: Carmen Teresa Lee (Official)

gender: Female

birthDate: 1986-02-15

Entry 39 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-father-natural-tom-yan-lee

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-father-natural-tom-yan-lee

RelatedPerson Birth Place Vital Records: NY

active: true

patient: Patient - Decedent Fetus (Fetus Not Named)

relationship: Natural Father

name: Tom Yan Lee (Official)

gender: Male

birthDate: 1984-02-27

Entry 40 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-jessica-leung

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-jessica-leung

identifier: NPI/223347055

name: Leung Jessica

Qualifications

-	Code
*	Birth Clerk