Birth And Fetal Death (BFDR) FHIR Implementation Guide
2.0.0 - STU2
Birth And Fetal Death (BFDR) FHIR Implementation Guide
2.0.0 - STU2
This page is part of the Vital Records Birth and Fetal Death Reporting (v2.0.0: STU2) based on FHIR (HL7® FHIR® Standard) 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
<Bundle xmlns="http://hl7.org/fhir">
<id value="bundle-provider-fetal-death-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Bundle-document-fetal-death-report"/>
</meta>
<identifier>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/CertificateNumber">
<valueString value="9876"/>
</extension>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/AuxiliaryStateIdentifier1">
<valueString value="11111-11111"/>
</extension>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-ije-vr"/>
<value value="2019NJ009876"/>
</identifier>
<type value="document"/>
<timestamp value="2019-02-11T02:05:44.434Z"/>
<entry>
<fullUrl
value="http://www.example.org/fhir/Composition/composition-provider-fetal-death-not-named"/>
<resource>
<Composition>
<id value="composition-provider-fetal-death-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Composition-provider-fetal-death-report"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Composition_composition-provider-fetal-death-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Composition composition-provider-fetal-death-not-named</b></p><a name="composition-provider-fetal-death-not-named"> </a><a name="hccomposition-provider-fetal-death-not-named"> </a><a name="composition-provider-fetal-death-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>type</b>: <span title="Codes:{http://loinc.org 69045-3}">U.S. standard report of fetal death - 2003 revision</span></p><p><b>encounter</b>: <a href="Encounter-encounter-maternity-carmen-teresa-lee.html">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</a></p><p><b>date</b>: 2019-01-09</p><p><b>author</b>: <a href="Practitioner-practitioner-vital-records-jessica-leung.html">Practitioner Leung Jessica </a></p><p><b>title</b>: Provider fetal death report Document</p></div>
</text>
<status value="final"/>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="69045-3"/>
<display
value="U.S. standard report of fetal death - 2003 revision"/>
</coding>
</type>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
</subject>
<encounter>🔗
<reference value="Encounter/encounter-maternity-carmen-teresa-lee"/>
</encounter>
<date value="2019-01-09"/>
<author>🔗
<reference
value="Practitioner/practitioner-vital-records-jessica-leung"/>
</author>
<title value="Provider fetal death report Document"/>
<section>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="57073-9"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-last-menstrual-period-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-number-births-now-living-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-number-births-now-dead-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-date-of-last-live-birth-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-height-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-mother-received-wic-food-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
</entry>
</section>
<section>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="55752-0"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-number-previous-cesareans-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-fetal-presentation-not-named"/>
</entry>
<entry>🔗
<reference
value="Procedure/procedure-final-route-method-delivery-not-named"/>
</entry>
<entry>🔗
<reference
value="Condition/condition-gestational-diabetes-carmen-teresa-lee"/>
</entry>
</section>
<section>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="76400-1"/>
</coding>
</code>
<entry>🔗
<reference
value="Observation/observation-birth-weight-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-gestational-age-at-delivery-not-named"/>
</entry>
<entry>🔗
<reference
value="Condition/condition-fetal-death-cause-or-condition-not-named"/>
</entry>
<entry>🔗
<reference
value="Condition/condition-fetal-death-other-significant-cause-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-fetal-death-time-point-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-autopsy-performed-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-histological-placental-exam-performed-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-autopsy-histological-exam-results-used-not-named"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-number-deaths-this-delivery-carmen-teresa-lee"/>
</entry>
</section>
<section>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="92014-0"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-parent-education-level-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-present-job-carmen-teresa-lee"/>
</entry>
<entry>🔗
<reference
value="Observation/observation-input-race-and-ethnicity-carmen-teresa-lee"/>
</entry>
</section>
<section>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="92013-2"/>
</coding>
</code>
<focus>🔗
<reference
value="RelatedPerson/relatedperson-father-natural-tom-yan-lee"/>
</focus>
<entry>🔗
<reference
value="Observation/observation-present-job-tom-yan-lee"/>
</entry>
</section>
<section>
<title value="Patient's QuestionnaireResponse Section"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="74465-6"/>
</coding>
</code>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</focus>
<entry>🔗
<reference
value="QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
</entry>
</section>
</Composition>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Patient/patient-decedent-fetus-not-named"/>
<resource>
<Patient>
<id value="patient-decedent-fetus-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Patient-decedent-fetus"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_patient-decedent-fetus-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Patient patient-decedent-fetus-not-named</b></p><a name="patient-decedent-fetus-not-named"> </a><a name="hcpatient-decedent-fetus-not-named"> </a><a name="patient-decedent-fetus-not-named-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Known status of Patient">Deceased:</td><td>true</td><td style="background-color: #f3f5da" title="Known multipleBirth status of Patient">Multiple Birth:</td><td colspan="3">3</td></tr><tr><td style="background-color: #f3f5da" title="This Extension profile represents the reported age of the parent (either the gestational mother or the natural father - as defined by NCHS) at the delivery time of the newborn or fetus.
A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (**US Core Patient Profile** or **US Core RelatedPerson Profile**).">Reported Parent Age At Delivery Vital Records:</td><td colspan="3"><ul><li>reportedAge: 34 a<span style="background: LightGoldenRodYellow"> (Details: UCUM codea = 'a')</span></li><li>motherOrFather: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode MTH}">mother</span></li></ul></td></tr><tr><td style="background-color: #f3f5da" title="This Extension profile represents the reported age of the parent (either the gestational mother or the natural father - as defined by NCHS) at the delivery time of the newborn or fetus.
A required code indicates whether the mother or father's age is provided. It can optionally contain a reference to the reporter (**US Core Patient Profile** or **US Core RelatedPerson Profile**).">Reported Parent Age At Delivery Vital Records:</td><td colspan="3"><ul><li>reportedAge: 35 a<span style="background: LightGoldenRodYellow"> (Details: UCUM codea = 'a')</span></li><li>motherOrFather: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode FTH}">father</span></li></ul></td></tr><tr><td style="background-color: #f3f5da" title="The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements."><a href="http://hl7.org/fhir/extensions/5.1.0/StructureDefinition-patient-birthPlace.html">Patient Birth Place</a></td><td colspan="3">Ann Arbor MI 48103 </td></tr><tr><td style="background-color: #f3f5da" title="A code classifying the person's sex assigned at birth as specified by the [Office of the National Coordinator for Health IT (ONC)](https://www.healthit.gov/newsroom/about-onc). This extension aligns with the C-CDA Birth Sex Observation (LOINC 76689-9)."><a href="http://hl7.org/fhir/us/core/STU5.0.1/StructureDefinition-us-core-birthsex.html">US Core Birth Sex Extension</a></td><td colspan="3">F</td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthPlace">
<valueAddress>
<city value="Ann Arbor"/>
<state value="MI"/>
<postalCode value="48103"/>
</valueAddress>
</extension>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-reported-parent-age-at-delivery-vr">
<extension url="reportedAge">
<valueQuantity>
<value value="34"/>
<system value="http://unitsofmeasure.org"/>
<code value="a"/>
</valueQuantity>
</extension>
<extension url="motherOrFather">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="MTH"/>
<display value="mother"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-reported-parent-age-at-delivery-vr">
<extension url="reportedAge">
<valueQuantity>
<value value="35"/>
<system value="http://unitsofmeasure.org"/>
<code value="a"/>
</valueQuantity>
</extension>
<extension url="motherOrFather">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="FTH"/>
<display value="father"/>
</coding>
</valueCodeableConcept>
</extension>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
</type>
<system value="http://hospital.smarthealthit.org"/>
<value value="9932702"/>
</identifier>
<name>
<use value="official"/>
<family>
<extension
url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
<valueCode value="not-applicable"/>
</extension>
</family>
</name>
<gender value="female"/>
<birthDate value="2019-01-09">
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthTime">
<valueDateTime value="2019-01-09T18:23:00-07:00"/>
</extension>
</birthDate>
<deceasedBoolean value="true">
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-patient-fetal-death-vr">
<valueBoolean value="true"/>
</extension>
</deceasedBoolean>
<multipleBirthInteger value="3"/>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Encounter/encounter-maternity-carmen-teresa-lee"/>
<resource>
<Encounter>
<id value="encounter-maternity-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Encounter-maternity"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Encounter_encounter-maternity-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Encounter encounter-maternity-carmen-teresa-lee</b></p><a name="encounter-maternity-carmen-teresa-lee"> </a><a name="hcencounter-maternity-carmen-teresa-lee"> </a><a name="encounter-maternity-carmen-teresa-lee-en-US"> </a><p><b>Extension Parental Role</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode MTH}">mother</span></p><p><b>identifier</b>: <code>http://hospital.smarthealthit.org</code>/8937015</p><p><b>status</b>: Finished</p><p><b>class</b>: <a href="http://terminology.hl7.org/6.0.2/CodeSystem-v3-ActCode.html#v3-ActCode-IMP">ActCode</a> IMP: inpatient encounter</p><p><b>type</b>: <span title="Codes:{http://www.ama-assn.org/go/cpt 99234}">Under Observation or Inpatient Care Services (Including Admission and Discharge Services)</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><h3>Participants</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Type</b></td><td><b>Individual</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://loinc.org 87286-1}">Birth attendant [Extended Identifier]</span></td><td><a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner - Vital Records (Janet Seito, DO)</a></td></tr></table><p><b>period</b>: 2019-01-08 10:00:00-0700 --> 2019-01-09 17:00:00-0700</p><h3>Locations</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Location</b></td><td><b>PhysicalType</b></td></tr><tr><td style="display: none">*</td><td><a href="Location-location-south-hospital.html">Location - US Core Location (South Hospital)</a></td><td><span title="Codes:{http://snomed.info/sct 22232009}">Hospital</span></td></tr></table><p><b>serviceProvider</b>: <a href="Organization-organization-south-hospital.html">Organization - US Core Organization (South Hospital Organization)</a></p></div>
</text>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/Extension-role">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="MTH"/>
</coding>
</valueCodeableConcept>
</extension>
<identifier>
<system value="http://hospital.smarthealthit.org"/>
<value value="8937015"/>
</identifier>
<status value="finished"/>
<class>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="IMP"/>
<display value="inpatient encounter"/>
</class>
<type>
<coding>
<system value="http://www.ama-assn.org/go/cpt"/>
<code value="99234"/>
</coding>
<text
value="Under Observation or Inpatient Care Services (Including Admission and Discharge Services)"/>
</type>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<participant>
<type>
<coding>
<system value="http://loinc.org"/>
<code value="87286-1"/>
<display value="Birth attendant [Extended Identifier]"/>
</coding>
</type>
<individual>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
<display value="Practitioner - Vital Records (Janet Seito, DO)"/>
</individual>
</participant>
<period>
<start value="2019-01-08T10:00:00-07:00"/>
<end value="2019-01-09T17:00:00-07:00"/>
</period>
<location>
<location>🔗
<reference value="Location/location-south-hospital"/>
<display value="Location - US Core Location (South Hospital)"/>
</location>
<physicalType>
<coding>
<system value="http://snomed.info/sct"/>
<code value="22232009"/>
<display value="Hospital"/>
</coding>
</physicalType>
</location>
<serviceProvider>🔗
<reference value="Organization/organization-south-hospital"/>
<display
value="Organization - US Core Organization (South Hospital Organization)"/>
</serviceProvider>
</Encounter>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Patient/patient-mother-carmen-teresa-lee"/>
<resource>
<Patient>
<id value="patient-mother-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Patient-mother-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Patient_patient-mother-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Patient patient-mother-carmen-teresa-lee</b></p><a name="patient-mother-carmen-teresa-lee"> </a><a name="hcpatient-mother-carmen-teresa-lee"> </a><a name="patient-mother-carmen-teresa-lee-en-US"> </a><p style="border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</p><hr/><table class="grid"><tr><td style="background-color: #f3f5da" title="Alternate names (see the one above)">Alt. Name:</td><td colspan="3">Carmen Teresa Santos (Name changed for Marriage)</td></tr><tr><td style="background-color: #f3f5da" title="Ways to contact the Patient">Contact Detail</td><td colspan="3">3670 Miller Road Ann Arbor MI 48103 US (home)</td></tr><tr><td style="background-color: #f3f5da" title="Patient Links">Links:</td><td colspan="3"><ul><li>Also see: <a href="RelatedPerson-relatedperson-mother-carmen-teresa-lee.html">RelatedPerson Carmen Teresa Lee (official)</a></li></ul></td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the [CDC ethnicity and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.">US Core Ethnicity Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238#CDCREC-2135-2">CDC Race and Ethnicity</a> 2135-2: Hispanic or Latino</li><li>text: Hispanic or Latino</li></ul></td></tr><tr><td style="background-color: #f3f5da" title="The registered place of birth of the patient. A sytem may use the address.text if they don't store the birthPlace address in discrete elements."><a href="http://hl7.org/fhir/extensions/5.1.0/StructureDefinition-patient-birthPlace.html">Patient Birth Place</a></td><td colspan="3">PR </td></tr><tr><td style="background-color: #f3f5da" title="A code classifying the person's sex assigned at birth as specified by the [Office of the National Coordinator for Health IT (ONC)](https://www.healthit.gov/newsroom/about-onc). This extension aligns with the C-CDA Birth Sex Observation (LOINC 76689-9)."><a href="http://hl7.org/fhir/us/core/STU5.0.1/StructureDefinition-us-core-birthsex.html">US Core Birth Sex Extension</a></td><td colspan="3">F</td></tr><tr><td style="background-color: #f3f5da" title="Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White.">US Core Race Extension:</td><td colspan="3"><ul><li>ombCategory: <a href="https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.6.238#CDCREC-2054-5">CDC Race and Ethnicity</a> 2054-5: Black or African American</li><li>text: Black or African America</li></ul></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-race">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2054-5"/>
<display value="Black or African American"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Black or African America"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity">
<extension url="ombCategory">
<valueCoding>
<system value="urn:oid:2.16.840.1.113883.6.238"/>
<code value="2135-2"/>
<display value="Hispanic or Latino"/>
</valueCoding>
</extension>
<extension url="text">
<valueString value="Hispanic or Latino"/>
</extension>
</extension>
<extension
url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/patient-birthPlace">
<valueAddress>
<state value="PR"/>
</valueAddress>
</extension>
<identifier>
<use value="usual"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
<code value="MR"/>
<display value="Medical Record Number"/>
</coding>
</type>
<system value="http://hospital.smarthealthit.org"/>
<value value="9992702"/>
</identifier>
<name>
<use value="official"/>
<family value="Lee"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<name>
<use value="maiden"/>
<family value="Santos"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<gender value="female"/>
<birthDate value="1986-02-15"/>
<address>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-within-city-limits-indicator-vr">
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</extension>
<use value="home"/>
<line value="3670 Miller Road"/>
<city value="Ann Arbor"/>
<state value="MI"/>
<postalCode value="48103"/>
<country value="US"/>
</address>
<link>
<other>🔗
<reference
value="RelatedPerson/relatedperson-mother-carmen-teresa-lee"/>
</other>
<type value="seealso"/>
</link>
</Patient>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
<resource>
<Observation>
<id
value="observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-date-of-first-prenatal-care-visit"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-carmen-teresa-lee</b></p><a name="observation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><a name="hcobservation-date-of-first-prenatal-care-visit-carmen-teresa-lee"> </a><a name="observation-date-of-first-prenatal-care-visit-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 69044-6}">Date first prenatal visit</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 2018-05-18</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="69044-6"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2018-05-18"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-last-menstrual-period-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-last-menstrual-period-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-last-menstrual-period"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-last-menstrual-period-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-last-menstrual-period-carmen-teresa-lee</b></p><a name="observation-last-menstrual-period-carmen-teresa-lee"> </a><a name="hcobservation-last-menstrual-period-carmen-teresa-lee"> </a><a name="observation-last-menstrual-period-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 8665-2}">Last menstrual period start date</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2018-05-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 2018-04-18</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="8665-2"/>
<display value="Last menstrual period start date"/>
</coding>
<text value="Last menstrual period start date"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2018-05-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2018-04-18"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-number-births-now-living-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-births-now-living-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-number-births-now-living"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-births-now-living-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-births-now-living-carmen-teresa-lee</b></p><a name="observation-number-births-now-living-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-living-carmen-teresa-lee"> </a><a name="observation-number-births-now-living-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11638-4}">[#] Births.still living</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11638-4"/>
<display value="[#] Births.still living"/>
</coding>
<text value="[#] Births.still living"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-number-births-now-dead-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-births-now-dead-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-number-births-now-dead"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-births-now-dead-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-births-now-dead-carmen-teresa-lee</b></p><a name="observation-number-births-now-dead-carmen-teresa-lee"> </a><a name="hcobservation-number-births-now-dead-carmen-teresa-lee"> </a><a name="observation-number-births-now-dead-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68496-9}">Previous live births now dead #</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68496-9"/>
<display value="Previous live births now dead #"/>
</coding>
<text value="Previous live births now dead #"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-date-of-last-live-birth-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-date-of-last-live-birth-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-date-of-last-live-birth"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-date-of-last-live-birth-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-date-of-last-live-birth-carmen-teresa-lee</b></p><a name="observation-date-of-last-live-birth-carmen-teresa-lee"> </a><a name="hcobservation-date-of-last-live-birth-carmen-teresa-lee"> </a><a name="observation-date-of-last-live-birth-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68499-3}">Date of last live birth</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 2016-01-28</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68499-3"/>
<display value="Date last live birth"/>
</coding>
<text value="Date of last live birth"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueDateTime value="2016-01-28"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-mother-height-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-height-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-mother-height"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-height-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-height-carmen-teresa-lee</b></p><a name="observation-mother-height-carmen-teresa-lee"> </a><a name="hcobservation-mother-height-carmen-teresa-lee"> </a><a name="observation-mother-height-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8302-2}">Body height</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-01-10</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 65 in<span style="background: LightGoldenRodYellow"> (Details: UCUM code[in_i] = '[in_i]')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
</coding>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="8302-2"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-01-10"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueQuantity>
<value value="65"/>
<unit value="in"/>
<system value="http://unitsofmeasure.org"/>
<code value="[in_i]"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-prepregnancy-weight-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-mother-prepregnancy-weight"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-prepregnancy-weight-carmen-teresa-lee</b></p><a name="observation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><a name="hcobservation-mother-prepregnancy-weight-carmen-teresa-lee"> </a><a name="observation-mother-prepregnancy-weight-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 56077-1}">Body weight --pre current pregnancy</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 180 [lb_av]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[lb_av] = '[lb_av]')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
<display value="Vital Signs"/>
</coding>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="56077-1"/>
<display value="Body weight --pre current pregnancy"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="180"/>
<system value="http://unitsofmeasure.org"/>
<code value="[lb_av]"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-mother-received-wic-food-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-mother-received-wic-food-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-mother-received-wic-food"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-mother-received-wic-food-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-mother-received-wic-food-carmen-teresa-lee</b></p><a name="observation-mother-received-wic-food-carmen-teresa-lee"> </a><a name="hcobservation-mother-received-wic-food-carmen-teresa-lee"> </a><a name="observation-mother-received-wic-food-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87303-4}">Mother WIC food recipient</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 N}">No</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87303-4"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="N"/>
<display value="No"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-1-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-1-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-1-carmen-teresa-lee"> </a><a name="observation-cig-smoking-pregnancy-1-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 64794-1}">In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="64794-1"/>
<display
value="In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]"/>
</coding>
<text
value="In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-2-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-2-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-2-carmen-teresa-lee"> </a><a name="observation-cig-smoking-pregnancy-2-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87298-6}">Cigarettes smoked per day by Mother--1st trimester</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87298-6"/>
<display
value="Cigarettes smoked per day by Mother--1st trimester"/>
</coding>
<text value="Cigarettes smoked per day by Mother--1st trimester"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-3-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-3-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-3-carmen-teresa-lee"> </a><a name="observation-cig-smoking-pregnancy-3-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 87299-4}">Cigarettes smoked per day by Mother--2nd trimester</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="87299-4"/>
<display
value="Cigarettes smoked per day by Mother--2nd trimester"/>
</coding>
<text value="Cigarettes smoked per day by Mother--2nd trimester"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-cig-smoking-pregnancy-4-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-cigarette-smoking-before-during-pregnancy"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-cig-smoking-pregnancy-4-carmen-teresa-lee</b></p><a name="observation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><a name="hcobservation-cig-smoking-pregnancy-4-carmen-teresa-lee"> </a><a name="observation-cig-smoking-pregnancy-4-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 64795-8}">In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: 0</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="64795-8"/>
<display
value="In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]"/>
</coding>
<text
value="In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueInteger value="0"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-number-previous-cesareans-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-number-previous-cesareans-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-number-previous-cesareans"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-previous-cesareans-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-previous-cesareans-carmen-teresa-lee</b></p><a name="observation-number-previous-cesareans-carmen-teresa-lee"> </a><a name="hcobservation-number-previous-cesareans-carmen-teresa-lee"> </a><a name="observation-number-previous-cesareans-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 68497-7}">Previous cesarean deliveries #</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="68497-7"/>
<display value="Previous cesarean deliveries #"/>
</coding>
<text value="Previous cesarean deliveries #"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Condition/condition-gestational-diabetes-carmen-teresa-lee"/>
<resource>
<Condition>
<id value="condition-gestational-diabetes-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Condition-gestational-diabetes"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_condition-gestational-diabetes-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Condition condition-gestational-diabetes-carmen-teresa-lee</b></p><a name="condition-gestational-diabetes-carmen-teresa-lee"> </a><a name="hccondition-gestational-diabetes-carmen-teresa-lee"> </a><a name="condition-gestational-diabetes-carmen-teresa-lee-en-US"> </a><p><b>clinicalStatus</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-clinical active}">Active</span></p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-category problem-list-item}">Problem List Item</span>, <span title="Codes:{http://loinc.org 73775-9}">Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 11687002}">Gestational diabetes mellitus (disorder)</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>onset</b>: 2018-12-12</p></div>
</text>
<clinicalStatus>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-clinical"/>
<code value="active"/>
<display value="Active"/>
</coding>
<text value="Active"/>
</clinicalStatus>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-category"/>
<code value="problem-list-item"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="73775-9"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="11687002"/>
<display value="Gestational diabetes mellitus (disorder)"/>
</coding>
<text value="Gestational diabetes mellitus (disorder)"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<onsetDateTime value="2018-12-12"/>
</Condition>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-fetal-presentation-not-named"/>
<resource>
<Observation>
<id value="observation-fetal-presentation-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-fetal-presentation"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-fetal-presentation-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-fetal-presentation-not-named</b></p><a name="observation-fetal-presentation-not-named"> </a><a name="hcobservation-fetal-presentation-not-named"> </a><a name="observation-fetal-presentation-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73761-9}">Fetal presentation--at birth [US Standard Certificate of Live Birth]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 6096002}">Breech presentation (finding)</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73761-9"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="6096002"/>
<display value="Breech presentation (finding)"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Procedure/procedure-final-route-method-delivery-not-named"/>
<resource>
<Procedure>
<id value="procedure-final-route-method-delivery-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Procedure-final-route-method-delivery"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Procedure_procedure-final-route-method-delivery-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Procedure procedure-final-route-method-delivery-not-named</b></p><a name="procedure-final-route-method-delivery-not-named"> </a><a name="hcprocedure-final-route-method-delivery-not-named"> </a><a name="procedure-final-route-method-delivery-not-named-en-US"> </a><p><b>status</b>: Completed</p><p><b>category</b>: <span title="Codes:{http://loinc.org 73762-7}">Final route and method of delivery [US Standard Certificate of Live Birth]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 700000006}">Spontaneous vaginal delivery</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>performed</b>: 2019-01-19 18:00:00-0700 --> 2019-01-19 18:23:00-0700</p></div>
</text>
<status value="completed"/>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="73762-7"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="700000006"/>
<display value="Vaginal delivery of fetus (procedure)"/>
</coding>
<text value="Spontaneous vaginal delivery"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<performedPeriod>
<start value="2019-01-19T18:00:00-07:00"/>
<end value="2019-01-19T18:23:00-07:00"/>
</performedPeriod>
</Procedure>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-birth-weight-not-named"/>
<resource>
<Observation>
<id value="observation-birth-weight-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-birth-weight"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-birth-weight-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-birth-weight-not-named</b></p><a name="observation-birth-weight-not-named"> </a><a name="hcobservation-birth-weight-not-named"> </a><a name="observation-birth-weight-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/observation-category vital-signs}">Vital Signs</span></p><p><b>code</b>: <span title="Codes:{http://loinc.org 8339-4}">Birth weight Measured</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-01-10</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 1530 g<span style="background: LightGoldenRodYellow"> (Details: UCUM codeg = 'g')</span></p></div>
</text>
<status value="final"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/observation-category"/>
<code value="vital-signs"/>
</coding>
</category>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="8339-4"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-01-10"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="1530"/>
<system value="http://unitsofmeasure.org"/>
<code value="g"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-gestational-age-at-delivery-not-named"/>
<resource>
<Observation>
<id value="observation-gestational-age-at-delivery-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-gestational-age-at-delivery"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-gestational-age-at-delivery-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-gestational-age-at-delivery-not-named</b></p><a name="observation-gestational-age-at-delivery-not-named"> </a><a name="hcobservation-gestational-age-at-delivery-not-named"> </a><a name="observation-gestational-age-at-delivery-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11884-4}">Gestational age Estimated</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 20 wk<span style="background: LightGoldenRodYellow"> (Details: UCUM codewk = 'wk')</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11884-4"/>
<display value="Gestational age Estimated"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueQuantity>
<value value="20"/>
<system value="http://unitsofmeasure.org"/>
<code value="wk"/>
</valueQuantity>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Condition/condition-fetal-death-cause-or-condition-not-named"/>
<resource>
<Condition>
<id value="condition-fetal-death-cause-or-condition-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Condition-fetal-death-initiating-cause-or-condition"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_condition-fetal-death-cause-or-condition-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Condition condition-fetal-death-cause-or-condition-not-named</b></p><a name="condition-fetal-death-cause-or-condition-not-named"> </a><a name="hccondition-fetal-death-cause-or-condition-not-named"> </a><a name="condition-fetal-death-cause-or-condition-not-named-en-US"> </a><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-category encounter-diagnosis}">Encounter Diagnosis</span>, <span title="Codes:{http://loinc.org 76060-3}">Initiating cause or condition of fetal death [US Standard Report of Fetal Death]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 44223004}">Premature rupture of membranes (disorder)</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p></div>
</text>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-category"/>
<code value="encounter-diagnosis"/>
<display value="Encounter Diagnosis"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="76060-3"/>
<display
value="Initiating cause or condition of fetal death [US Standard Report of Fetal Death]"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="44223004"/>
<display value="Premature rupture of membranes (disorder)"/>
</coding>
<text value="Premature rupture of membranes (disorder)"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
</Condition>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Condition/condition-fetal-death-other-significant-cause-not-named"/>
<resource>
<Condition>
<id value="condition-fetal-death-other-significant-cause-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Condition-fetal-death-other-cause-or-condition"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Condition_condition-fetal-death-other-significant-cause-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Condition condition-fetal-death-other-significant-cause-not-named</b></p><a name="condition-fetal-death-other-significant-cause-not-named"> </a><a name="hccondition-fetal-death-other-significant-cause-not-named"> </a><a name="condition-fetal-death-other-significant-cause-not-named-en-US"> </a><p><b>category</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/condition-category encounter-diagnosis}">Encounter Diagnosis</span>, <span title="Codes:{http://loinc.org 76061-1}">Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]</span></p><p><b>code</b>: <span title="Codes:{http://snomed.info/sct 237292005}">Placental insufficiency (disorder)</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p></div>
</text>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/condition-category"/>
<code value="encounter-diagnosis"/>
<display value="Encounter Diagnosis"/>
</coding>
</category>
<category>
<coding>
<system value="http://loinc.org"/>
<code value="76061-1"/>
<display
value="Other significant causes or conditions of fetal death [US Standard Report of Fetal Death]"/>
</coding>
</category>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="237292005"/>
<display value="Placental insufficiency (disorder)"/>
</coding>
<text value="Placental insufficiency (disorder)"/>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
</Condition>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-fetal-death-time-point-not-named"/>
<resource>
<Observation>
<id value="observation-fetal-death-time-point-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-fetal-death-time-point"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-fetal-death-time-point-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-fetal-death-time-point-not-named</b></p><a name="observation-fetal-death-time-point-not-named"> </a><a name="hcobservation-fetal-death-time-point-not-named"> </a><a name="observation-fetal-death-time-point-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73811-2}">Estimated timing of fetal death [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 434631000124100}">Fetal intrapartum death after first assessment (event)</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73811-2"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="434631000124100"/>
<display
value="Fetal intrapartum death after first assessment (event)"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-autopsy-performed-not-named"/>
<resource>
<Observation>
<id value="observation-autopsy-performed-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-autopsy-performed-indicator"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-autopsy-performed-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-autopsy-performed-not-named</b></p><a name="observation-autopsy-performed-not-named"> </a><a name="hcobservation-autopsy-performed-not-named"> </a><a name="observation-autopsy-performed-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 85699-7}">Autopsy was performed</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 398166005}">Performed</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="85699-7"/>
<display value="Autopsy was performed"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="398166005"/>
<display value="Performed"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-histological-placental-exam-performed-not-named"/>
<resource>
<Observation>
<id
value="observation-histological-placental-exam-performed-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-histological-placental-exam-performed"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-histological-placental-exam-performed-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-histological-placental-exam-performed-not-named</b></p><a name="observation-histological-placental-exam-performed-not-named"> </a><a name="hcobservation-histological-placental-exam-performed-not-named"> </a><a name="observation-histological-placental-exam-performed-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73767-6}">Histological placental examination was performed [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: <span title="Codes:{http://snomed.info/sct 398166005}">Performed</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73767-6"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://snomed.info/sct"/>
<code value="398166005"/>
<display value="Performed"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-autopsy-histological-exam-results-used-not-named"/>
<resource>
<Observation>
<id
value="observation-autopsy-histological-exam-results-used-not-named"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-autopsy-histological-exam-results-used"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-autopsy-histological-exam-results-used-not-named"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-autopsy-histological-exam-results-used-not-named</b></p><a name="observation-autopsy-histological-exam-results-used-not-named"> </a><a name="hcobservation-autopsy-histological-exam-results-used-not-named"> </a><a name="observation-autopsy-histological-exam-results-used-not-named-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 74498-7}">Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 Y}">Yes</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="74498-7"/>
<display
value="Autopsy or histological placental examination results were used [US Standard Report of Fetal Death]"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="Y"/>
<display value="Yes"/>
</coding>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-number-deaths-this-delivery-carmen-teresa-lee"/>
<resource>
<Observation>
<id
value="observation-number-deaths-this-delivery-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-number-fetal-deaths-this-delivery"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-number-deaths-this-delivery-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-number-deaths-this-delivery-carmen-teresa-lee</b></p><a name="observation-number-deaths-this-delivery-carmen-teresa-lee"> </a><a name="hcobservation-number-deaths-this-delivery-carmen-teresa-lee"> </a><a name="observation-number-deaths-this-delivery-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 73772-6}">Number of fetal deaths delivered</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>focus</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Practitioner-practitioner-vital-records-janet-seito.html">Practitioner Janet Seito</a></p><p><b>value</b>: 1</p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="73772-6"/>
<display value="Number of fetal deaths delivered"/>
</coding>
<text value="Number of fetal deaths delivered"/>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference
value="Practitioner/practitioner-vital-records-janet-seito"/>
</performer>
<valueInteger value="1"/>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-parent-education-level-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-parent-education-level-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Observation-education-level-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-parent-education-level-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-parent-education-level-carmen-teresa-lee</b></p><a name="observation-parent-education-level-carmen-teresa-lee"> </a><a name="hcobservation-parent-education-level-carmen-teresa-lee"> </a><a name="observation-parent-education-level-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 57712-2}">Highest level of education Mother</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>focus</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><p><b>effective</b>: 2019-12-02</p><p><b>performer</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Carmen Teresa Lee (official) Female, DoB: 1986-02-15 ( Medical Record Number: 9992702 (use: usual, ))</a></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-EducationLevel SEC}">9th through 12th grade; no diploma</span></p></div>
</text>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="57712-2"/>
<display value="Highest level of education Mother"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<focus>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</focus>
<effectiveDateTime value="2019-12-02"/>
<performer>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
</performer>
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-EducationLevel"/>
<code value="SEC"/>
<display value="Some secondary or high school education"/>
</coding>
<text value="9th through 12th grade; no diploma"/>
</valueCodeableConcept>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-present-job-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-present-job-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-present-job"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-present-job-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-present-job-carmen-teresa-lee</b></p><a name="observation-present-job-carmen-teresa-lee"> </a><a name="hcobservation-present-job-carmen-teresa-lee"> </a><a name="observation-present-job-carmen-teresa-lee-en-US"> </a><p><b>Extension Parental Role</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode MTH}">mother</span></p><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11341-5}">History of Occupation</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))</a></p><p><b>focus</b>: <a href="RelatedPerson-relatedperson-mother-carmen-teresa-lee.html">RelatedPerson Carmen Teresa Lee (official)</a></p><p><b>effective</b>: 2019-01-09 --> (ongoing)</p><p><b>value</b>: <span title="Codes:">Secretary</span></p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://loinc.org 86188-0}">History of Occupation industry</span></td><td><span title="Codes:">State Agency</span></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/Extension-role">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="MTH"/>
<display value="mother"/>
</coding>
</valueCodeableConcept>
</extension>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11341-5"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
</subject>
<focus>🔗
<reference
value="RelatedPerson/relatedperson-mother-carmen-teresa-lee"/>
</focus>
<effectivePeriod>
<start value="2019-01-09"/>
</effectivePeriod>
<valueCodeableConcept>
<text value="Secretary"/>
</valueCodeableConcept>
<component>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="86188-0"/>
</coding>
</code>
<valueCodeableConcept>
<text value="State Agency"/>
</valueCodeableConcept>
</component>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-present-job-tom-yan-lee"/>
<resource>
<Observation>
<id value="observation-present-job-tom-yan-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Observation-present-job"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-present-job-tom-yan-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-present-job-tom-yan-lee</b></p><a name="observation-present-job-tom-yan-lee"> </a><a name="hcobservation-present-job-tom-yan-lee"> </a><a name="observation-present-job-tom-yan-lee-en-US"> </a><p><b>Extension Parental Role</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode FTH}">father</span></p><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://loinc.org 11341-5}">History of Occupation</span></p><p><b>subject</b>: <a href="Patient-patient-decedent-fetus-not-named.html">null (official) Female, DoB: 2019-01-09 ( Medical Record Number: 9932702 (use: usual, ))</a></p><p><b>focus</b>: <a href="RelatedPerson-relatedperson-father-natural-tom-yan-lee.html">RelatedPerson Tom Yan Lee (official)</a></p><p><b>effective</b>: 2019-01-09 --> (ongoing)</p><p><b>value</b>: <span title="Codes:">Teaching Assistant</span></p><h3>Components</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://loinc.org 86188-0}">History of Occupation industry</span></td><td><span title="Codes:">Elementary and Secondary Schools</span></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/Extension-role">
<valueCodeableConcept>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="FTH"/>
<display value="father"/>
</coding>
</valueCodeableConcept>
</extension>
<status value="final"/>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="11341-5"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
</subject>
<focus>🔗
<reference
value="RelatedPerson/relatedperson-father-natural-tom-yan-lee"/>
</focus>
<effectivePeriod>
<start value="2019-01-09"/>
</effectivePeriod>
<valueCodeableConcept>
<text value="Teaching Assistant"/>
</valueCodeableConcept>
<component>
<code>
<coding>
<system value="http://loinc.org"/>
<code value="86188-0"/>
</coding>
</code>
<valueCodeableConcept>
<text value="Elementary and Secondary Schools"/>
</valueCodeableConcept>
</component>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-carmen-teresa-lee"/>
<resource>
<Observation>
<id value="observation-input-race-and-ethnicity-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/input-race-and-ethnicity-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Observation_observation-input-race-and-ethnicity-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: Observation observation-input-race-and-ethnicity-carmen-teresa-lee</b></p><a name="observation-input-race-and-ethnicity-carmen-teresa-lee"> </a><a name="hcobservation-input-race-and-ethnicity-carmen-teresa-lee"> </a><a name="observation-input-race-and-ethnicity-carmen-teresa-lee-en-US"> </a><p><b>status</b>: Final</p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/CodeSystem-local-observation-codes-vr inputraceandethnicityMother}">Mother Input Race and Ethnicity</span></p><p><b>subject</b>: <a href="Patient-patient-mother-carmen-teresa-lee.html">Patient - Mother (Carmen Teresa Lee)</a></p><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component White}">White</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component BlackOrAfricanAmerican}">Black Or African American</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component AmericanIndianOrAlaskanNative}">American Indian Or Alaska Native</span></p><p><b>value</b>: true</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component AsianIndian}">Asian Indian</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Chinese}">Chinese</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Filipino}">Filipino</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Japanese}">Japanese</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Korean}">Korean</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Vietnamese}">Vietnamese</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component OtherAsian}">Other Asian</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component NativeHawaiian}">Native Hawaiian</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component GuamanianOrChamorro}">Guamanian Or Chamorro</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component Samoan}">Samoan</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component OtherPacificIslander}">Other Pacific Islander</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component OtherRace}">Other Race</span></p><p><b>value</b>: false</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component FirstOtherAsianLiteral}">First Other Asian Literal</span></p><p><b>value</b>: Malaysian</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component FirstAmericanIndianOrAlaskanNativeLiteral}">First American Indian Or Alaska Native Literal</span></p><p><b>value</b>: Arikara</p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component HispanicMexican}">Hispanic Mexican</span></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 Y}">Yes</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component HispanicCuban}">Hispanic Cuban</span></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 Y}">Yes</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component HispanicPuertoRican}">Hispanic Puerto Rican</span></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 Y}">Yes</span></p></blockquote><blockquote><p><b>component</b></p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component HispanicOther}">Hispanic Other</span></p><p><b>value</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v2-0136 N}">No</span></p></blockquote></div>
</text>
<status value="final"/>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/CodeSystem-local-observation-codes-vr"/>
<code value="inputraceandethnicityMother"/>
</coding>
</code>
<subject>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</subject>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="White"/>
</coding>
</code>
<valueBoolean value="true"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="BlackOrAfricanAmerican"/>
</coding>
</code>
<valueBoolean value="true"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="AmericanIndianOrAlaskanNative"/>
</coding>
</code>
<valueBoolean value="true"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="AsianIndian"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Chinese"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Filipino"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Japanese"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Korean"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Vietnamese"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="OtherAsian"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="NativeHawaiian"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="GuamanianOrChamorro"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="Samoan"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="OtherPacificIslander"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="OtherRace"/>
</coding>
</code>
<valueBoolean value="false"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="FirstOtherAsianLiteral"/>
</coding>
</code>
<valueString value="Malaysian"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="FirstAmericanIndianOrAlaskanNativeLiteral"/>
</coding>
</code>
<valueString value="Arikara"/>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="HispanicMexican"/>
</coding>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="Y"/>
<display value="Yes"/>
</coding>
</valueCodeableConcept>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="HispanicCuban"/>
</coding>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="Y"/>
<display value="Yes"/>
</coding>
</valueCodeableConcept>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="HispanicPuertoRican"/>
</coding>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="Y"/>
<display value="Yes"/>
</coding>
</valueCodeableConcept>
</component>
<component>
<code>
<coding>
<system
value="http://hl7.org/fhir/us/vr-common-library/CodeSystem/codesystem-vr-component"/>
<code value="HispanicOther"/>
</coding>
</code>
<valueCodeableConcept>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="N"/>
<display value="No"/>
</coding>
</valueCodeableConcept>
</component>
</Observation>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
<resource>
<QuestionnaireResponse>
<id value="QuestionnaireResponse-patients-fetal-death-carmen-lee"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="QuestionnaireResponse_QuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><p class="res-header-id"><b>Generated Narrative: QuestionnaireResponse QuestionnaireResponse-patients-fetal-death-carmen-lee</b></p><a name="QuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><a name="hcQuestionnaireResponse-patients-fetal-death-carmen-lee"> </a><a name="QuestionnaireResponse-patients-fetal-death-carmen-lee-en-US"> </a><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireResponseRoot" class="hierarchy"/> QuestionnaireResponse-patients-fetal-death-carmen-lee</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire:<a href="Questionnaire-Questionnaire-patients-fetal-death.html">Questionnaire - Patient's Worksheet for the Report of Fetal Death</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-current-legal-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your current legal name?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-first-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Carmen</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-middle-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Middle</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Teresa</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-last-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Last</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Lee</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-address</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Where do you usually live - that is - where is your household/residence located?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-nbr-street</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Complete number and street (do not enter rural route numbers)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">3670 Miller Road</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-city</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">City, Town, or Location</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-state</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">State (or U.S. Territory, Canadian Province)</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">MI</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-zip</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Zip Code</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">48103</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> inside-city-limits</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://hl7.org/fhir/R4/v2/0136/index.html#v2-0136-N">v2 Y/N Indicator</a> N: No</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mother-mail</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your mailing address</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-mail-same</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Same as residence [Go to next question]</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-dob</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your date of birth?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1986-02-15</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mother-birthplace</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">In what State, U.S. territory, or foreign country were you born? Please specify one of the following:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-birthplace-territory</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">PR</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-education</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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).</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://terminology.hl7.org/6.0.2/CodeSystem-v3-EducationLevel.html#v3-EducationLevel-SEC">Education Level</a> SEC: Some secondary or high school education</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-ethnicity</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-ethnicity-mexican</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-ethnicity-puerto-rican</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mother-ethnicity-cuban</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-ethnicity-other</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">false</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mother-race</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mother-race-black-or-aa</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">true</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> father-current-legal-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is the current legal name of your baby's father?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> father-first-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Tom</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> father-middle-name</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Middle</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Yan</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> father-last-name</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Last</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Lee</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> father-dob</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is the father's date of birth?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1984-02-27</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> father-birthplace</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> father-birthplace-state</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">State</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">NY</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> receive-wic</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="http://hl7.org/fhir/R4/v2/0136/index.html#v2-0136-N">v2 Y/N Indicator</a> N: No</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-height</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What is your height?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-height-inches</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Inches</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>65 [in_i]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[in_i] = '[in_i]')</span></span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-prepregnancy-weight</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">lbs</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span>180 [lb_av]<span style="background: LightGoldenRodYellow"> (Details: UCUM code[lb_av] = '[lb_av]')</span></span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-3-months-prior</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Three months before pregnancy</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-3-months-prior-cig</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-3-months-prior-pck</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">First three months of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-1-cig</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-1-pck</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Second three months of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-2-cig</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-2-pck</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> mothers-smoking-trimester-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Third trimester of pregnancy</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-3-cig</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of cigarettes*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> mothers-smoking-trimester-3-pck</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"># of packs</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0</td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
</text>
<questionnaire
value="http://hl7.org/fhir/us/bfdr/Questionnaire/Questionnaire-patients-fetal-death"/>
<status value="completed"/>
<subject>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</subject>
<source>🔗
<reference value="Patient/patient-mother-carmen-teresa-lee"/>
<display value="Patient - Mother (Carmen Teresa Lee)"/>
</source>
<item>
<linkId value="mother-current-legal-name"/>
<text value="What is your current legal name?"/>
<item>
<linkId value="mother-first-name"/>
<text value="First"/>
<answer>
<valueString value="Carmen"/>
</answer>
</item>
<item>
<linkId value="mother-middle-name"/>
<text value="Middle"/>
<answer>
<valueString value="Teresa"/>
</answer>
</item>
<item>
<linkId value="mother-last-name"/>
<text value="Last"/>
<answer>
<valueString value="Lee"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-address"/>
<text
value="Where do you usually live - that is - where is your household/residence located?"/>
<item>
<linkId value="mother-nbr-street"/>
<text
value="Complete number and street (do not enter rural route numbers)"/>
<answer>
<valueString value="3670 Miller Road"/>
</answer>
</item>
<item>
<linkId value="mother-city"/>
<text value="City, Town, or Location"/>
</item>
<item>
<linkId value="mother-state"/>
<text value="State (or U.S. Territory, Canadian Province)"/>
<answer>
<valueString value="MI"/>
</answer>
</item>
<item>
<linkId value="mother-zip"/>
<text value="Zip Code"/>
<answer>
<valueString value="48103"/>
</answer>
</item>
</item>
<item>
<linkId value="inside-city-limits"/>
<text
value="Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mother-mail"/>
<text value="What is your mailing address"/>
<item>
<linkId value="mother-mail-same"/>
<text value="Same as residence [Go to next question]"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-dob"/>
<text value="What is your date of birth?"/>
<answer>
<valueDate value="1986-02-15"/>
</answer>
</item>
<item>
<linkId value="mother-birthplace"/>
<text
value="In what State, U.S. territory, or foreign country were you born? Please specify one of the following:"/>
<item>
<linkId value="mother-birthplace-territory"/>
<text
value="or U.S. territory, i.e., Puerto Rico, U.S. Virgin Islands, Guam, American Samoa or Norther Marianas"/>
<answer>
<valueString value="PR"/>
</answer>
</item>
</item>
<item>
<linkId value="mother-education"/>
<text
value="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)."/>
<answer>
<valueCoding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-EducationLevel"/>
<code value="SEC"/>
<display value="Some secondary or high school education"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mother-ethnicity"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
<item>
<linkId value="mother-ethnicity-mexican"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
<item>
<linkId value="mother-ethnicity-puerto-rican"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
<item>
<linkId value="mother-ethnicity-cuban"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
<item>
<linkId value="mother-ethnicity-other"/>
<answer>
<valueBoolean value="false"/>
</answer>
</item>
<item>
<linkId value="mother-race"/>
<item>
<linkId value="mother-race-black-or-aa"/>
<answer>
<valueBoolean value="true"/>
</answer>
</item>
</item>
<item>
<linkId value="father-current-legal-name"/>
<text
value="What is the current legal name of your baby's father?"/>
<item>
<linkId value="father-first-name"/>
<text value="First"/>
<answer>
<valueString value="Tom"/>
</answer>
</item>
<item>
<linkId value="father-middle-name"/>
<text value="Middle"/>
<answer>
<valueString value="Yan"/>
</answer>
</item>
<item>
<linkId value="father-last-name"/>
<text value="Last"/>
<answer>
<valueString value="Lee"/>
</answer>
</item>
</item>
<item>
<linkId value="father-dob"/>
<text value="What is the father's date of birth?"/>
<answer>
<valueDate value="1984-02-27"/>
</answer>
</item>
<item>
<linkId value="father-birthplace"/>
<text
value="In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:"/>
<item>
<linkId value="father-birthplace-state"/>
<text value="State"/>
<answer>
<valueString value="NY"/>
</answer>
</item>
</item>
<item>
<linkId value="receive-wic"/>
<text
value="Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v2-0136"/>
<code value="N"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="mothers-height"/>
<text value="What is your height?"/>
<item>
<linkId value="mothers-height-inches"/>
<text value="Inches"/>
<answer>
<valueQuantity>
<value value="65"/>
<unit value="[in_i]"/>
<system value="http://unitsofmeasure.org"/>
<code value="[in_i]"/>
</valueQuantity>
</answer>
</item>
</item>
<item>
<linkId value="mothers-prepregnancy-weight"/>
<text value="lbs"/>
<answer>
<valueQuantity>
<value value="180"/>
<unit value="[lb_av]"/>
<system value="http://unitsofmeasure.org"/>
<code value="[lb_av]"/>
</valueQuantity>
</answer>
</item>
<item>
<linkId value="mothers-smoking"/>
<text
value="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."/>
<item>
<linkId value="mothers-smoking-3-months-prior"/>
<text value="Three months before pregnancy"/>
<item>
<linkId value="mothers-smoking-3-months-prior-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-3-months-prior-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-1"/>
<text value="First three months of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-1-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-1-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-2"/>
<text value="Second three months of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-2-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-2-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
<item>
<linkId value="mothers-smoking-trimester-3"/>
<text value="Third trimester of pregnancy"/>
<item>
<linkId value="mothers-smoking-trimester-3-cig"/>
<text value="# of cigarettes*"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
<item>
<linkId value="mothers-smoking-trimester-3-pck"/>
<text value="# of packs"/>
<answer>
<valueInteger value="0"/>
</answer>
</item>
</item>
</item>
</QuestionnaireResponse>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Practitioner/practitioner-vital-records-janet-seito"/>
<resource>
<Practitioner>
<id value="practitioner-vital-records-janet-seito"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Practitioner-vr"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_practitioner-vital-records-janet-seito"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner practitioner-vital-records-janet-seito</b></p><a name="practitioner-vital-records-janet-seito"> </a><a name="hcpractitioner-vital-records-janet-seito"> </a><a name="practitioner-vital-records-janet-seito-en-US"> </a><p><b>Practitioner Role - Birth Attendant</b>: attendant</p><p><b>Practitioner Role - Certifier</b>: certifier</p><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/223347044</p><p><b>name</b>: Janet Seito</p><h3>Qualifications</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://snomed.info/sct 76231001}">Osteopath (occupation)</span></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/practitioner-role-birth-attendant">
<valueCode value="attendant"/>
</extension>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/practitioner-role-birth-certifier">
<valueCode value="certifier"/>
</extension>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="223347044"/>
</identifier>
<name>
<text value="Janet Seito"/>
<family value="Janet"/>
<given value="Seito"/>
<suffix value="D.O."/>
</name>
<qualification>
<code>
<coding>
<system value="http://snomed.info/sct"/>
<code value="76231001"/>
<display value="Osteopath (occupation)"/>
</coding>
</code>
</qualification>
</Practitioner>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Location/location-south-hospital"/>
<resource>
<Location>
<id value="location-south-hospital"/>
<meta>
<profile
value="http://hl7.org/fhir/us/bfdr/StructureDefinition/Location-bfdr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Location_location-south-hospital"> </a><p class="res-header-id"><b>Generated Narrative: Location location-south-hospital</b></p><a name="location-south-hospital"> </a><a name="hclocation-south-hospital"> </a><a name="location-south-hospital-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/116441967701</p><p><b>status</b>: Active</p><p><b>name</b>: South Hospital</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode HOSP}">Hospital</span>, <span title="Codes:{http://hl7.org/fhir/us/bfdr/CodeSystem/CodeSystem-local-bfdr-codes loc_birth}">Birth Location</span></p><p><b>address</b>: 2100 North Ave Salt Lake City UT 84116 US </p><h3>Positions</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Longitude</b></td><td><b>Latitude</b></td></tr><tr><td style="display: none">*</td><td>40.8</td><td>111.9</td></tr></table><p><b>managingOrganization</b>: <a href="Organization-organization-south-hospital.html">Organization - South Hospital</a></p></div>
</text>
<identifier>
<extension
url="http://hl7.org/fhir/us/bfdr/StructureDefinition/Extension-jurisdictional-facility-identifier">
<valueString value="UT12"/>
</extension>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="116441967701"/>
</identifier>
<status value="active"/>
<name value="South Hospital"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="HOSP"/>
<display value="Hospital"/>
</coding>
</type>
<type>
<coding>
<system
value="http://hl7.org/fhir/us/bfdr/CodeSystem/CodeSystem-local-bfdr-codes"/>
<code value="loc_birth"/>
<display value="Birth Location"/>
</coding>
</type>
<address>
<line value="2100 North Ave"/>
<city value="Salt Lake City"/>
<district value="Made Up"/>
<state value="UT"/>
<postalCode value="84116"/>
<country value="US"/>
</address>
<position>
<longitude value="40.8"/>
<latitude value="111.9"/>
</position>
<managingOrganization>🔗
<reference value="Organization/organization-south-hospital"/>
<display value="Organization - South Hospital"/>
</managingOrganization>
</Location>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Organization/organization-south-hospital"/>
<resource>
<Organization>
<id value="organization-south-hospital"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Organization_organization-south-hospital"> </a><p class="res-header-id"><b>Generated Narrative: Organization organization-south-hospital</b></p><a name="organization-south-hospital"> </a><a name="hcorganization-south-hospital"> </a><a name="organization-south-hospital-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/5555512</p><p><b>active</b>: true</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode HOSP}">Hospital</span></p><p><b>name</b>: South Hospital</p><p><b>telecom</b>: <a href="tel:+1-555-555-1111">+1-555-555-1111</a>, <a href="mailto:mail@southhospital.com">mail@southhospital.com</a></p><p><b>address</b>: 2100 North Ave Salt Lake City UT 84116 US </p></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="5555512"/>
</identifier>
<active value="true"/>
<type>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="HOSP"/>
<display value="Hospital"/>
</coding>
</type>
<name value="South Hospital"/>
<telecom>
<system value="phone"/>
<value value="+1-555-555-1111"/>
</telecom>
<telecom>
<system value="email"/>
<value value="mail@southhospital.com"/>
</telecom>
<address>
<line value="2100 North Ave"/>
<city value="Salt Lake City"/>
<state value="UT"/>
<postalCode value="84116"/>
<country value="US"/>
</address>
</Organization>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/RelatedPerson/relatedperson-mother-carmen-teresa-lee"/>
<resource>
<RelatedPerson>
<id value="relatedperson-mother-carmen-teresa-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/RelatedPerson-mother-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_relatedperson-mother-carmen-teresa-lee"> </a><p class="res-header-id"><b>Generated Narrative: RelatedPerson relatedperson-mother-carmen-teresa-lee</b></p><a name="relatedperson-mother-carmen-teresa-lee"> </a><a name="hcrelatedperson-mother-carmen-teresa-lee"> </a><a name="relatedperson-mother-carmen-teresa-lee-en-US"> </a><p><b>active</b>: true</p><p><b>patient</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode GESTM}">Gestational Mother</span></p><p><b>name</b>: Carmen Teresa Lee (Official)</p><p><b>gender</b>: Female</p><p><b>birthDate</b>: 1986-02-15</p></div>
</text>
<active value="true"/>
<patient>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="GESTM"/>
<display value="gestational mother"/>
</coding>
<text value="Gestational Mother"/>
</relationship>
<name>
<use value="official"/>
<family value="Lee"/>
<given value="Carmen"/>
<given value="Teresa"/>
</name>
<gender value="female"/>
<birthDate value="1986-02-15"/>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/RelatedPerson/relatedperson-father-natural-tom-yan-lee"/>
<resource>
<RelatedPerson>
<id value="relatedperson-father-natural-tom-yan-lee"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/RelatedPerson-father-natural-vr"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="RelatedPerson_relatedperson-father-natural-tom-yan-lee"> </a><p class="res-header-id"><b>Generated Narrative: RelatedPerson relatedperson-father-natural-tom-yan-lee</b></p><a name="relatedperson-father-natural-tom-yan-lee"> </a><a name="hcrelatedperson-father-natural-tom-yan-lee"> </a><a name="relatedperson-father-natural-tom-yan-lee-en-US"> </a><p><b>RelatedPerson Birth Place Vital Records</b>: NY </p><p><b>active</b>: true</p><p><b>patient</b>: <a href="Patient-patient-decedent-fetus-not-named.html">Patient - Decedent Fetus (Fetus Not Named)</a></p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-RoleCode NFTH}">Natural Father</span></p><p><b>name</b>: Tom Yan Lee (Official)</p><p><b>gender</b>: Male</p><p><b>birthDate</b>: 1984-02-27</p></div>
</text>
<extension
url="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Extension-relatedperson-birthplace-vr">
<valueAddress>
<state value="NY"/>
</valueAddress>
</extension>
<active value="true"/>
<patient>🔗
<reference value="Patient/patient-decedent-fetus-not-named"/>
<display value="Patient - Decedent Fetus (Fetus Not Named)"/>
</patient>
<relationship>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-RoleCode"/>
<code value="NFTH"/>
<display value="natural father"/>
</coding>
<text value="Natural Father"/>
</relationship>
<name>
<use value="official"/>
<family value="Lee"/>
<given value="Tom"/>
<given value="Yan"/>
</name>
<gender value="male"/>
<birthDate value="1984-02-27"/>
</RelatedPerson>
</resource>
</entry>
<entry>
<fullUrl
value="http://www.example.org/fhir/Practitioner/practitioner-vital-records-jessica-leung"/>
<resource>
<Practitioner>
<id value="practitioner-vital-records-jessica-leung"/>
<meta>
<profile
value="http://hl7.org/fhir/us/vr-common-library/StructureDefinition/Practitioner-vr"/>
</meta>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><a name="Practitioner_practitioner-vital-records-jessica-leung"> </a><p class="res-header-id"><b>Generated Narrative: Practitioner practitioner-vital-records-jessica-leung</b></p><a name="practitioner-vital-records-jessica-leung"> </a><a name="hcpractitioner-vital-records-jessica-leung"> </a><a name="practitioner-vital-records-jessica-leung-en-US"> </a><p><b>identifier</b>: <a href="http://terminology.hl7.org/5.0.0/NamingSystem-npi.html" title="National Provider Identifier">NPI</a>/223347055</p><p><b>name</b>: Leung Jessica </p><h3>Qualifications</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Code</b></td></tr><tr><td style="display: none">*</td><td><span title="Codes:{http://terminology.hl7.org/CodeSystem/v3-NullFlavor OTH}">Birth Clerk</span></td></tr></table></div>
</text>
<identifier>
<system value="http://hl7.org/fhir/sid/us-npi"/>
<value value="223347055"/>
</identifier>
<name>
<family value="Jessica"/>
<given value="Leung"/>
</name>
<qualification>
<code>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/v3-NullFlavor"/>
<code value="OTH"/>
<display value="other"/>
</coding>
<text value="Birth Clerk"/>
</code>
</qualification>
</Practitioner>
</resource>
</entry>
</Bundle>
IG © 2023+ HL7 International / Public Health. Package hl7.fhir.us.bfdr#2.0.0 based on FHIR 4.0.1. Generated 2024-10-15
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