Bundle - Provider Live Birth - Baby G Quinn - Birth And Fetal Death (BFDR) FHIR Implementation Guide v2.0.0

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

Example Bundle: Bundle - Provider Live Birth - Baby G Quinn

Document Details

Generated Narrative: Bundle Provider supplied live birth report Document

Document Subject

Unable to resolve subject ''

Document Content

Generated Narrative: Composition composition-provider-live-birth-babyg-quinn

status: Final

type: U.S. standard certificate of live birth - 2003 revision

encounter: Encounter: extension = child; identifier = http://hospital.smarthealthit.org#9937012; 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 = 2019-02-12 13:00:00-0700 --> 2019-02-15 10:00:00-0700

date: 2019-02-12

author: Practitioner Avery Jones

title: Provider supplied live birth report Document

Prenatal records

Clinical information

Newborn delivery information

Mother's administrative information

Father's administrative information

Questionnaire response Document

Additional Resources Included in Document

Entry 1 - fullUrl = http://www.example.org/fhir/Composition/composition-provider-live-birth-babyg-quinn

Resource Composition:

Generated Narrative: Composition composition-provider-live-birth-babyg-quinn

status: Final
type: U.S. standard certificate of live birth - 2003 revision
encounter: Encounter: extension = child; identifier = http://hospital.smarthealthit.org#9937012; 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 = 2019-02-12 13:00:00-0700 --> 2019-02-15 10:00:00-0700
date: 2019-02-12
author: Practitioner Avery Jones
title: Provider supplied live birth report Document

Entry 2 - fullUrl = http://www.example.org/fhir/Patient/patient-child-babyg-quinn

Resource Patient:

Generated Narrative: Patient patient-child-babyg-quinn

Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
Deceased: false Multiple Birth: 1
US Core Ethnicity Extension:
ombCategory: CDC Race and Ethnicity 2186-5: Not Hispanic or Latino
text: Not Hispanic or Latino
Reported Parent Age At Delivery Vital Records:
reportedAge: 34 a (Details: UCUM codea = 'a')
motherOrFather: mother
Reported Parent Age At Delivery Vital Records:
reportedAge: 35 a (Details: UCUM codea = 'a')
motherOrFather: father
Patient Birth Place Salt Lake City UT
US Core Birth Sex Extension F
US Core Race Extension:
ombCategory: CDC Race and Ethnicity 2106-3: White
text: White

Entry 3 - fullUrl = http://www.example.org/fhir/Encounter/encounter-birth-babyg-quinn

Resource Encounter:

Generated Narrative: Encounter encounter-birth-babyg-quinn

Extension Parental Role: child
identifier: http://hospital.smarthealthit.org/9937012
status: Finished
class: ActCode IMP: inpatient encounter
type: Under Observation or Inpatient Care Services (Including Admission and Discharge Services)
subject: BabyG Quinn
participant
type: Birth certifier [Extended Identifier]
period: 2019-02-12 13:30:00-0700 --> (ongoing)
individual: Practitioner - Vital Records (Avery Jones, MD)
participant
type: Birth attendant [Extended Identifier]
individual: Practitioner - Vital Records (Avery Jones, MD)
period: 2019-02-12 13:00:00-0700 --> 2019-02-15 10:00:00-0700
Hospitalizations
- Destination DischargeDisposition
* East Hospital Location The patient was transferred to another healthcare facility.
Locations
- Location PhysicalType
* Location - US Core Location (South Hospital) Hospital
partOf: Maternity Encounter - Jada Ann Quinn

Entry 4 - fullUrl = http://www.example.org/fhir/Encounter/encounter-maternity-jada-ann-quinn

Resource Encounter:

Generated Narrative: Encounter encounter-maternity-jada-ann-quinn

Extension Parental Role: mother
identifier: http://hospital.smarthealthit.org/9937012
status: Finished
class: ActCode IMP: inpatient encounter
type: Under Observation or Inpatient Care Services (Including Admission and Discharge Services)
subject: Patient - Mother (Jada Ann Quinn)
Participants
- Type Individual
* Birth attendant [Extended Identifier] Practitioner - Vital Records (Avery Jones, MD)
period: 2019-02-11 10:00:00-0700 --> 2019-02-15 10:00:00-0700
Hospitalizations
- Origin AdmitSource
* Location - US Core Location (North Hospital) The Patient has been transferred from another hospital for this encounter.
Locations
- Location PhysicalType
* Location - US Core Location (South Hospital) Hospital
serviceProvider: Organization - US Core Organization (South Hospital Organization)

Entry 5 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-avery-jones

Resource Practitioner:

Generated Narrative: Practitioner practitioner-vital-records-avery-jones

Practitioner Role - Birth Attendant: attendant
Practitioner Role - Certifier: certifier
identifier: NPI/76231001
name: Avery Jones
Qualifications
- Code
* Osteopath (occupation)

Entry 6 - fullUrl = http://www.example.org/fhir/Practitioner/practitioner-vital-records-janet-seito

Resource Practitioner:

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

Practitioner Role - Birth Attendant: attendant
Practitioner Role - Certifier: certifier
identifier: NPI/223347044
name: Janet Seito
Qualifications
- Code
* Osteopath (occupation)

Entry 7 - fullUrl = http://www.example.org/fhir/Patient/patient-mother-jada-ann-quinn

Resource Patient:

Generated Narrative: Patient patient-mother-jada-ann-quinn

Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
Other Id: Social Security number/132225986 (use: usual, )
Alt. Name: Jada Ann King (Name changed for Marriage)
Contact Detail
ph: 1-(404)555-1212(Home)
jadaann.quinn@example.com
1875 West Morton Avenue Salt Lake City UT 84116 US (home)
1848 South 1300 East Salt Lake City UT 84401 US (billing)
US Core Ethnicity Extension:
ombCategory: CDC Race and Ethnicity 2186-5: Not Hispanic or Latino
text: Not Hispanic or Latino
Patient Birth Place UT
US Core Birth Sex Extension F
US Core Race Extension:
ombCategory: CDC Race and Ethnicity 1002-5: American Indian or Alaska Native
text: White, American Indian or Alaska Native

Entry 8 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-first-prenatal-care-visit-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-first-prenatal-care-visit-jada-ann-quinn

status: Final
code: Date first prenatal visit
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2018-07-20

Entry 9 - fullUrl = http://www.example.org/fhir/Observation/observation-number-prenatal-visits-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-prenatal-visits-jada-ann-quinn

status: Final
code: Prenatal visits for this pregnancy #
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 8

Entry 10 - fullUrl = http://www.example.org/fhir/Observation/observation-last-menstrual-period-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-last-menstrual-period-jada-ann-quinn

status: Final
code: Last menstrual period start date
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2018-06-05

Entry 11 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-living-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-births-now-living-jada-ann-quinn

status: Final
code: [#] Births.still living
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 1

Entry 12 - fullUrl = http://www.example.org/fhir/Observation/observation-number-births-now-dead-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-births-now-dead-jada-ann-quinn

status: Final
code: Previous live births now dead #
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 0

Entry 13 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-live-birth-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-last-live-birth-jada-ann-quinn

status: Final
code: Date of last live birth
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2014-11-20

Entry 14 - fullUrl = http://www.example.org/fhir/Observation/observation-number-other-pregnancy-outcomes-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-other-pregnancy-outcomes-jada-ann-quinn

status: Final
code: Other pregnancy outcomes #
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 0

Entry 15 - fullUrl = http://www.example.org/fhir/Observation/observation-date-of-last-other-pregnancy-outcome-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-date-of-last-other-pregnancy-outcome-jada-ann-quinn

status: Final
code: Date of last other pregnancy outcome
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2015-05

Entry 16 - fullUrl = http://www.example.org/fhir/Coverage/coverage-principal-payer-for-delivery-jada-ann-quinn

Resource Coverage:

Generated Narrative: Coverage coverage-principal-payer-for-delivery-jada-ann-quinn

status: Active
type: Private Health Insurance
beneficiary: Patient - Mother (Jada Ann Quinn)
payor: Not asked

Entry 17 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-delivery-weight-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-delivery-weight-jada-ann-quinn

status: Final
category: Vital Signs
code: Mother's body weight --at delivery
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-02-12
performer: Practitioner Janet Seito
value: 175 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

Entry 18 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-height-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-height-jada-ann-quinn

status: Final
category: Vital Signs
code: Body height
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-02-10
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: 67 in (Details: UCUM code[in_i] = '[in_i]')

Entry 19 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-prepregnancy-weight-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-prepregnancy-weight-jada-ann-quinn

status: Final
category: Vital Signs
code: Body weight --pre current pregnancy
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 145 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

Entry 20 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-received-wic-food-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-received-wic-food-jada-ann-quinn

status: Final
code: Mother WIC food recipient
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Yes

Entry 21 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-1-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-1-jada-ann-quinn

status: Final
code: In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day [PhenX]
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: 20

Entry 22 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-2-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-2-jada-ann-quinn

status: Final
code: Cigarettes smoked per day by Mother--1st trimester
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: 3

Entry 23 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-3-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-3-jada-ann-quinn

status: Final
code: Cigarettes smoked per day by Mother--2nd trimester
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: 1

Entry 24 - fullUrl = http://www.example.org/fhir/Observation/observation-cig-smoking-pregnancy-4-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-cig-smoking-pregnancy-4-jada-ann-quinn

status: Final
code: In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day [PhenX]
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: 0

Entry 25 - fullUrl = http://www.example.org/fhir/Condition/condition-prepregnancy-diabetes-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-prepregnancy-diabetes-jada-ann-quinn

clinicalStatus: Active
category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]
code: Diabetes mellitus (disorder)
subject: Patient - Mother (Jada Ann Quinn)
onset: 2015-02-12

Entry 26 - fullUrl = http://www.example.org/fhir/Condition/condition-gestational-hypertension-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-gestational-hypertension-jada-ann-quinn

clinicalStatus: Active
category: Problem List Item, Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]
code: Pregnancy-induced hypertension (disorder)
subject: Patient - Mother (Jada Ann Quinn)

Entry 27 - fullUrl = http://www.example.org/fhir/Observation/observation-number-previous-cesareans-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-previous-cesareans-jada-ann-quinn

status: Final
code: Previous cesarean deliveries #
subject: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 1

Entry 28 - fullUrl = http://www.example.org/fhir/Condition/condition-infection-present-during-pregnancy-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-infection-present-during-pregnancy-jada-ann-quinn

clinicalStatus: Active
category: Problem List Item, Infections present AndOr treated during this pregnancy for live birth [US Standard Certificate of Live Birth]
code: Chlamydial infection (disorder)
subject: Patient - Mother (Jada Ann Quinn)

Entry 29 - fullUrl = http://www.example.org/fhir/Procedure/procedure-obstetric-procedure-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-obstetric-procedure-jada-ann-quinn

status: Completed
category: Obstetric procedures performed [US Standard Certificate of Live Birth]
code: External cephalic version: Failed
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700
outcome: External cephalic version: Unsuccessful

Entry 30 - fullUrl = http://www.example.org/fhir/Condition/condition-chorioamnionitis-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-chorioamnionitis-jada-ann-quinn

clinicalStatus: Active
category: Problem List Item, Characteristics of labor and delivery [US Standard Certificate of Live Birth]
code: Chorioamnionitis (disorder)
subject: Patient - Mother (Jada Ann Quinn)

Entry 31 - fullUrl = http://www.example.org/fhir/Procedure/procedure-induction-of-labor-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-induction-of-labor-jada-ann-quinn

status: Completed
category: Characteristics of labor and delivery [US Standard Certificate of Live Birth]
code: Induction of labor (procedure)
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700

Entry 32 - fullUrl = http://www.example.org/fhir/Observation/observation-fetal-presentation-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-fetal-presentation-babyg-quinn

status: Final
code: Fetal presentation--at birth [US Standard Certificate of Live Birth]
subject: Patient - Child (Baby G Quinn)
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Breech presentation (finding)

Entry 33 - fullUrl = http://www.example.org/fhir/Procedure/procedure-final-route-method-delivery-babyg-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-final-route-method-delivery-babyg-quinn

status: Completed
category: Final route and method of delivery [US Standard Certificate of Live Birth]
code: Cesarean section
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-12 12:45:00-0700 --> 2019-02-12 13:15:00-0700
reasonReference: Labor trial attempted - true

Entry 34 - fullUrl = http://www.example.org/fhir/Condition/condition-ruptured-uterus-jada-ann-quinn

Resource Condition:

Generated Narrative: Condition condition-ruptured-uterus-jada-ann-quinn

clinicalStatus: Active
category: Problem List Item, Maternal morbidity [US Standard Certificate of Live Birth]
code: Rupture of uterus (disorder)
subject: Patient - Mother (Jada Ann Quinn)

Entry 35 - fullUrl = http://www.example.org/fhir/Observation/observation-birth-weight-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-birth-weight-babyg-quinn

status: Final
category: Vital Signs
code: Birth weight Measured
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2500 g (Details: UCUM codeg = 'g')

Entry 36 - fullUrl = http://www.example.org/fhir/Observation/observation-gestational-age-at-delivery-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-gestational-age-at-delivery-babyg-quinn

status: Final
code: Gestational age Estimated
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 36 wk (Details: UCUM codewk = 'wk')

Entry 37 - fullUrl = http://www.example.org/fhir/Observation/observation-apgar-score-babyg-quinn-5-min

Resource Observation:

Generated Narrative: Observation observation-apgar-score-babyg-quinn-5-min

status: Final
category: Survey
code: 5 minute Apgar Score
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 5

Entry 38 - fullUrl = http://www.example.org/fhir/Observation/observation-apgar-score-babyg-quinn-10-min

Resource Observation:

Generated Narrative: Observation observation-apgar-score-babyg-quinn-10-min

status: Final
category: Survey
code: 10 minute Apgar Score
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 7

Entry 39 - fullUrl = http://www.example.org/fhir/Observation/observation-number-live-births-this-delivery-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-number-live-births-this-delivery-jada-ann-quinn

status: Final
code: Number of infants in this delivery delivered alive
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: 2

Entry 40 - fullUrl = http://www.example.org/fhir/Condition/condition-congenital-anomaly-of-newborn-babyg-quinn

Resource Condition:

Generated Narrative: Condition condition-congenital-anomaly-of-newborn-babyg-quinn

clinicalStatus: Active
category: Problem List Item, Congenital anomalies of the newborn [US Standard Certificate of Live Birth]
code: Cyanotic congenital heart disease (disorder)
subject: BabyG Quinn

Entry 41 - fullUrl = http://www.example.org/fhir/Condition/condition-congenital-anomaly-of-newborn-babyg-quinn-2

Resource Condition:

Generated Narrative: Condition condition-congenital-anomaly-of-newborn-babyg-quinn-2

clinicalStatus: Active
category: Problem List Item, Congenital anomalies of the newborn [US Standard Certificate of Live Birth]
code: Anomaly of chromosome pair 21 (disorder)
subject: Patient - Child (Baby G Quinn)
Evidences
- Code
* Karyotype determination pending

Entry 42 - fullUrl = http://www.example.org/fhir/Observation/observation-infant-living-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-infant-living-babyg-quinn

status: Final
code: Infant living at time of report [US Standard Certificate of Live Birth]
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: true

Entry 43 - fullUrl = http://www.example.org/fhir/Observation/observation-infant-breastfed-at-discharge-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-infant-breastfed-at-discharge-babyg-quinn

status: Final
code: Infant is being breastfed at discharge [US Standard Certificate of Live Birth]
subject: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: true

Entry 44 - fullUrl = http://www.example.org/fhir/Observation/observation-mother-married-during-pregnancy-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-mother-married-during-pregnancy-jada-ann-quinn

status: Final
code: Mother was married at any time during pregnancy
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
value: Yes

Entry 45 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-jada-ann-quinn

status: Final
code: Highest level of education Mother
subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
focus: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: Doctoral or post graduate education

Entry 46 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-present-job-jada-ann-quinn

Extension Parental Role: mother
status: Final
code: History of Occupation
subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
focus: Jada Ann Quinn - Mother
effective: 2019-01-09 --> (ongoing)
value: Carpenter
Components
- Code Value[x]
* History of Occupation industry Construction

Entry 47 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-jada-ann-quinn

status: Final
code: Mother Input Race and Ethnicity
subject: Patient - Mother (Jada Ann Quinn)
component
code: White
value: true
component
code: Black Or African American
value: false
component
code: American Indian Or Alaska Native
value: true
component
code: Asian Indian
value: false
component
code: Chinese
value: false
component
code: Filipino
value: false
component
code: Japanese
value: false
component
code: Korean
value: false
component
code: Vietnamese
value: false
component
code: Other Asian
value: true
component
code: Native Hawaiian
value: false
component
code: Guamanian Or Chamorro
value: false
component
code: Samoan
value: false
component
code: Other Pacific Islander
value: false
component
code: Other Race
value: false
component
code: Hispanic Mexican
value: No
component
code: Hispanic Cuban
value: No
component
code: Hispanic Puerto Rican
value: No
component
code: Hispanic Other
value: No

Entry 48 - fullUrl = http://www.example.org/fhir/Observation/observation-ssn-requested-for-child-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-ssn-requested-for-child-babyg-quinn

status: Final
code: Social Security Number was requested
subject: BabyG Quinn
focus: Patient - Mother (Jada Ann Quinn)
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: true

Entry 49 - fullUrl = http://www.example.org/fhir/RelatedPerson/relatedperson-father-natural-james-brandon-quinn

Resource RelatedPerson:

Generated Narrative: RelatedPerson relatedperson-father-natural-james-brandon-quinn

RelatedPerson Birth Place Vital Records: NY
identifier: Social Security number/132225987
active: true
patient: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
relationship: Natural Father
name: James Brandon Quinn (Official)
gender: Male
birthDate: 1972-11-24

Entry 50 - fullUrl = http://www.example.org/fhir/Observation/observation-paternity-acknowledgement-signed-james-quinn

Resource Observation:

Generated Narrative: Observation observation-paternity-acknowledgement-signed-james-quinn

status: Final
code: Paternity acknowledgment form signed Father
subject: Patient - Child (Baby G Quinn)
focus: RelatedPerson - Father (James Brandon Quinn)
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: Yes

Entry 51 - fullUrl = http://www.example.org/fhir/Observation/observation-parent-education-level-james-quinn

Resource Observation:

Generated Narrative: Observation observation-parent-education-level-james-quinn

status: Final
code: Highest level of education Father
subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
focus: RelatedPerson James Brandon Quinn (official)
effective: 2019-12-02
performer: Jada Ann Quinn (official) Female, DoB: 1985-01-15 ( Medical Record Number: 1032702 (use: usual, ))
value: Doctoral or post graduate education

Entry 52 - fullUrl = http://www.example.org/fhir/Observation/observation-present-job-james-brandon-quinn

Resource Observation:

Generated Narrative: Observation observation-present-job-james-brandon-quinn

Extension Parental Role: father
status: Final
code: History of Occupation
subject: Baby G Quinn (official) Female, DoB: 2019-02-12 ( Medical Record Number: 9932702 (use: usual, ))
focus: James Brandon Quinn - Father
effective: 2019-01-09 --> (ongoing)
value: Lawyer
Components
- Code Value[x]
* History of Occupation industry Legal Services

Entry 53 - fullUrl = http://www.example.org/fhir/Observation/observation-input-race-and-ethnicity-james-quinn

Resource Observation:

Generated Narrative: Observation observation-input-race-and-ethnicity-james-quinn

status: Final
code: Father Input Race and Ethnicity
subject: BabyG Quinn
focus: RelatedPerson James Brandon Quinn (official)
component
code: White
value: true
component
code: Black Or African American
value: false
component
code: American Indian Or Alaska Native
value: false
component
code: Asian Indian
value: false
component
code: Chinese
value: false
component
code: Filipino
value: false
component
code: Japanese
value: false
component
code: Korean
value: false
component
code: Vietnamese
value: false
component
code: Other Asian
value: false
component
code: Native Hawaiian
value: false
component
code: Guamanian Or Chamorro
value: false
component
code: Samoan
value: false
component
code: Other Pacific Islander
value: false
component
code: Other Race
value: false
component
code: First Other Asian Literal
value: Malaysian
component
code: First American Indian Or Alaska Native Literal
value: Arikara
component
code: Hispanic Mexican
value: No
component
code: Hispanic Cuban
value: No
component
code: Hispanic Puerto Rican
value: No
component
code: Hispanic Other
value: No

Entry 54 - fullUrl = http://www.example.org/fhir/QuestionnaireResponse/QuestionnaireResponse-mothers-live-birth-jada-quinn

Resource QuestionnaireResponse:

Generated Narrative: QuestionnaireResponse QuestionnaireResponse-mothers-live-birth-jada-quinn

LinkID Text Definition Answer
QuestionnaireResponse-mothers-live-birth-jada-quinn Questionnaire:Questionnaire - Mother's Worksheet for Child's Birth Certificate

mother-current-legal-name What is your current legal name?

mother-first-name First Jada

mother-middle-name Middle Ann

mother-last-name Last Quinn

child-name What will be your baby's legal name (as it should appear on the birth certificate)?

child-first-name First Baby

child-middle-name Middle G

child-last-name Last Quinn

mother-address Where do you usually live - that is - where is your household/residence located?

mother-nbr-street Complete number and street (do not enter rural route numbers) 1875 West Morton Avenue

mother-city City, Town, or Location Salt Lake City

mother-county County Salt Lake

mother-state State (or U.S. Territory, Canadian Province) UT

mother-zip Zip Code 84116

inside-city-limits Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)? v2 Y/N Indicator Y: Yes

mother-mail What is your mailing address

mother-mail-same Same as residence [Go to next question] false

mother-mail-nbr-street Complete number and street 1848 South 1300 East

mother-mail-city City, Town, or Location Salt Lake City

mother-mail-state State (or U.S. Territory, Canadian Province) UT

mother-mail-zip Zip Code 84401

mother-dob What is your date of birth? 1985-01-15

mother-birthplace In what State, U.S. territory, or foreign country were you born? Please specify one of the following:

mother-birthplace-state State UT

mother-education What is the highest level of schooling that you have completed at the time of delivery? (Check the box that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received). Education Level POSTG: Doctoral or post graduate education

mother-ethnicity false

mother-race

mother-race-white White true

mother-race-aian American Indian or Alaskan Native true

receive-wic Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy? v2 Y/N Indicator Y: Yes

infertility-treatment Did this pregnancy result from infertility treatment? (If yes, please answer 12a and 12b) true

drugs-ai-ii If yes, did this pregnancy result from fertility-enhancing drugs, artificial insemination, or intrauterine insemination? false

art-ivf-gift If yes, did this pregnancy result from assisted reproductive technology (e.g., in-vitro fertilization (IVF), gamete intrafallopian transfer (GIFT))? true

mothers-height What is your height?

mothers-height-feet Feet 5 ft (Details: UCUM codeft = 'ft')

mothers-height-inches Inches 7 [in_i] (Details: UCUM code[in_i] = '[in_i]')

mothers-prepregnancy-weight 145 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')

mothers-smoking How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? If you NEVER smoked, enter zero for each time period.

mothers-smoking-3-months-prior Three months before pregnancy

mothers-smoking-3-months-prior-cig # of cigarettes* 0

mothers-smoking-3-months-prior-pck # of packs 1

mothers-smoking-trimester-1 First three months of pregnancy

mothers-smoking-trimester-1-cig # of cigarettes* 3

mothers-smoking-trimester-1-pck # of packs 0

mothers-smoking-trimester-2 Second three months of pregnancy

mothers-smoking-trimester-2-cig # of cigarettes* 1

mothers-smoking-trimester-2-pck # of packs 0

mothers-smoking-trimester-3 Third trimester of pregnancy

mothers-smoking-trimester-3-cig # of cigarettes* 0

mothers-smoking-trimester-3-pck # of packs 0

mother-prior-name What name did you use prior to your first marriage?

mother-prior-first-name First Jada

mother-prior-middle-name Middle Ann

mother-prior-last-name Last King

married-conception Were you married at the time you conceived this child, at the time of birth, or at any time between conception and giving birth? [If yes, please go to question 19; If no, please see below] true

father-current-legal-name What is the current legal name of your baby's father?

father-first-name First James

father-middle-name Middle Brandon

father-last-name Last Quinn

father-dob What the father's date of birth? 1983-09-27

father-birthplace In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:

father-birthplace-state State NY

father-education What is the highest level of schooling that the father will have completed at the time of delivery? (Check the box that best describes his education. If he is currently enrolled, check the box that indicates the previous grade or highest degree received). Education Level POSTG: Doctoral or post graduate education

father-ethnicity false

father-race

father-race-white White true

parents-ssn Furnishing parent(s) Social Security Number(s) (SSNs) is required by Federal Law, 42 USC 405(c) (section 205(c) of the Social Security Act). The number(s) will be made available to the (State Social Services Agency) to assist with child support enforcement activities and to the Internal Revenue Service for the purpose of determining Earned Income Tax Credit compliance.

mother-ssn What is your Social Security Number? 132-22-5986

father-ssn What is the father’s Social Security Number? If you are not married, and if a paternity acknowledgment has not been completed, leave this item blank. 132-22-5987

baby-ssn Do you want a Social Security Number issued for your baby? [If yes, please sign request below false

informant-name If other than the mother, what is the name of the person providing information for this worksheet?

informant-first-name First Jane

informant-last-name Last King

informant-relationship What is your relationship to the baby's mother? Local BFDR Codes rel_otherrelative: Other relative

Documentation for this format

LinkID	Text	Answer
QuestionnaireResponse-mothers-live-birth-jada-quinn		Questionnaire:Questionnaire - Mother's Worksheet for Child's Birth Certificate
mother-current-legal-name	What is your current legal name?
mother-first-name	First	Jada
mother-middle-name	Middle	Ann
mother-last-name	Last	Quinn
child-name	What will be your baby's legal name (as it should appear on the birth certificate)?
child-first-name	First	Baby
child-middle-name	Middle	G
child-last-name	Last	Quinn
mother-address	Where do you usually live - that is - where is your household/residence located?
mother-nbr-street	Complete number and street (do not enter rural route numbers)	1875 West Morton Avenue
mother-city	City, Town, or Location	Salt Lake City
mother-county	County	Salt Lake
mother-state	State (or U.S. Territory, Canadian Province)	UT
mother-zip	Zip Code	84116
inside-city-limits	Is this household inside city limits (inside the incorporated limits of the city, town, or location where you live)?	v2 Y/N Indicator Y: Yes
mother-mail	What is your mailing address
mother-mail-same	Same as residence [Go to next question]	false
mother-mail-nbr-street	Complete number and street	1848 South 1300 East
mother-mail-city	City, Town, or Location	Salt Lake City
mother-mail-state	State (or U.S. Territory, Canadian Province)	UT
mother-mail-zip	Zip Code	84401
mother-dob	What is your date of birth?	1985-01-15
mother-birthplace	In what State, U.S. territory, or foreign country were you born? Please specify one of the following:
mother-birthplace-state	State	UT
mother-education	What is the highest level of schooling that you have completed at the time of delivery? (Check the box that best describes your education. If you are currently enrolled, check the box that indicates the previous grade or highest degree received).	Education Level POSTG: Doctoral or post graduate education
mother-ethnicity		false
mother-race
mother-race-white	White	true
mother-race-aian	American Indian or Alaskan Native	true
receive-wic	Did you receive WIC (Women, Infants and Children) food for yourself during this pregnancy?	v2 Y/N Indicator Y: Yes
infertility-treatment	Did this pregnancy result from infertility treatment? (If yes, please answer 12a and 12b)	true
drugs-ai-ii	If yes, did this pregnancy result from fertility-enhancing drugs, artificial insemination, or intrauterine insemination?	false
art-ivf-gift	If yes, did this pregnancy result from assisted reproductive technology (e.g., in-vitro fertilization (IVF), gamete intrafallopian transfer (GIFT))?	true
mothers-height	What is your height?
mothers-height-feet	Feet	5 ft (Details: UCUM codeft = 'ft')
mothers-height-inches	Inches	7 [in_i] (Details: UCUM code[in_i] = '[in_i]')
mothers-prepregnancy-weight		145 [lb_av] (Details: UCUM code[lb_av] = '[lb_av]')
mothers-smoking	How many cigarettes OR packs of cigarettes did you smoke on an average day during each of the following time periods? If you NEVER smoked, enter zero for each time period.
mothers-smoking-3-months-prior	Three months before pregnancy
mothers-smoking-3-months-prior-cig	# of cigarettes*	0
mothers-smoking-3-months-prior-pck	# of packs	1
mothers-smoking-trimester-1	First three months of pregnancy
mothers-smoking-trimester-1-cig	# of cigarettes*	3
mothers-smoking-trimester-1-pck	# of packs	0
mothers-smoking-trimester-2	Second three months of pregnancy
mothers-smoking-trimester-2-cig	# of cigarettes*	1
mothers-smoking-trimester-2-pck	# of packs	0
mothers-smoking-trimester-3	Third trimester of pregnancy
mothers-smoking-trimester-3-cig	# of cigarettes*	0
mothers-smoking-trimester-3-pck	# of packs	0
mother-prior-name	What name did you use prior to your first marriage?
mother-prior-first-name	First	Jada
mother-prior-middle-name	Middle	Ann
mother-prior-last-name	Last	King
married-conception	Were you married at the time you conceived this child, at the time of birth, or at any time between conception and giving birth? [If yes, please go to question 19; If no, please see below]	true
father-current-legal-name	What is the current legal name of your baby's father?
father-first-name	First	James
father-middle-name	Middle	Brandon
father-last-name	Last	Quinn
father-dob	What the father's date of birth?	1983-09-27
father-birthplace	In what State, U.S. territory, or foreign country was the father born? Please specify one of the following:
father-birthplace-state	State	NY
father-education	What is the highest level of schooling that the father will have completed at the time of delivery? (Check the box that best describes his education. If he is currently enrolled, check the box that indicates the previous grade or highest degree received).	Education Level POSTG: Doctoral or post graduate education
father-ethnicity		false
father-race
father-race-white	White	true
parents-ssn	Furnishing parent(s) Social Security Number(s) (SSNs) is required by Federal Law, 42 USC 405(c) (section 205(c) of the Social Security Act). The number(s) will be made available to the (State Social Services Agency) to assist with child support enforcement activities and to the Internal Revenue Service for the purpose of determining Earned Income Tax Credit compliance.
mother-ssn	What is your Social Security Number?	132-22-5986
father-ssn	What is the father’s Social Security Number? If you are not married, and if a paternity acknowledgment has not been completed, leave this item blank.	132-22-5987
baby-ssn	Do you want a Social Security Number issued for your baby? [If yes, please sign request below	false
informant-name	If other than the mother, what is the name of the person providing information for this worksheet?
informant-first-name	First	Jane
informant-last-name	Last	King
informant-relationship	What is your relationship to the baby's mother?	Local BFDR Codes rel_otherrelative: Other relative
Documentation for this format

Entry 55 - fullUrl = http://www.example.org/fhir/Location/location-east-hospital

Resource Location:

Generated Narrative: Location location-east-hospital

status: Active
name: East Hospital
type: Hospital, Transfer-to Location

Entry 56 - fullUrl = http://www.example.org/fhir/Location/location-south-hospital

Resource Location:

Generated Narrative: Location location-south-hospital

identifier: NPI/116441967701
status: Active
name: South Hospital
type: Hospital, Birth Location
address: 2100 North Ave Salt Lake City UT 84116 US
Positions
- Longitude Latitude
* 40.8 111.9
managingOrganization: Organization - South Hospital

Entry 57 - fullUrl = http://www.example.org/fhir/Location/location-north-hospital

Resource Location:

Generated Narrative: Location location-north-hospital

status: Active
name: North Hospital
type: Hospital, Transfer-from Location

Entry 58 - fullUrl = http://www.example.org/fhir/Organization/organization-south-hospital

Resource Organization:

Generated Narrative: Organization organization-south-hospital

identifier: NPI/5555512
active: true
type: Hospital
name: South Hospital
telecom: +1-555-555-1111, mail@southhospital.com
address: 2100 North Ave Salt Lake City UT 84116 US

Entry 59 - fullUrl = http://www.example.org/fhir/Observation/observation-labor-trial-attempted-babyg-quinn

Resource Observation:

Generated Narrative: Observation observation-labor-trial-attempted-babyg-quinn

status: Final
code: If cesarean, a trial of labor was attempted [US Standard Certificate of Live Birth]
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: true

Entry 60 - fullUrl = http://www.example.org/fhir/Procedure/procedure-infertility-treatment-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-infertility-treatment-jada-ann-quinn

status: Completed
category: Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]
code: Procedure related to reproduction (procedure)
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700

Entry 61 - fullUrl = http://www.example.org/fhir/Procedure/procedure-artificial-insemination-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-artificial-insemination-jada-ann-quinn

version: 1; Last updated: 2023-06-21 01:45:22+0000
Profile: Procedure - Fertility Enhancing Drug Therapy, Artificial or Intrauterine Insemination
status: Completed
category: Mothers Risk factors in this pregnancy [US Standard Certificate of Live Birth]
code: Artificial insemination (procedure)
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700

Entry 62 - fullUrl = http://www.example.org/fhir/Observation/observation-antibiotics-during-labor-jada-ann-quinn

Resource Observation:

Generated Narrative: Observation observation-antibiotics-during-labor-jada-ann-quinn

status: Final
code: Characteristics of labor and delivery
subject: Patient - Mother (Jada Ann Quinn)
focus: BabyG Quinn
effective: 2019-12-02
performer: Practitioner Janet Seito
value: Antibiotics received during labor

Entry 63 - fullUrl = http://www.example.org/fhir/Procedure/procedure-antibiotic-sepsis-babyg-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-antibiotic-sepsis-babyg-quinn

status: Completed
category: Abnormal conditions of the newborn [US Standard Certificate of Live Birth]
code: Antibiotic given for suspected neonatal sepsis (situation)
subject: BabyG Quinn
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700

Entry 64 - fullUrl = http://www.example.org/fhir/Procedure/procedure-epidural-or-spinal-anesthesia-jada-ann-quinn

Resource Procedure:

Generated Narrative: Procedure procedure-epidural-or-spinal-anesthesia-jada-ann-quinn

status: Completed
category: Characteristics of labor and delivery [US Standard Certificate of Live Birth]
code: Epidural anesthesia (procedure)
subject: Patient - Mother (Jada Ann Quinn)
performed: 2019-02-07 08:30:00-0700 --> 2019-02-07 08:45:00-0700